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PubMed2005

The classification of chronic daily headache in adolescents--a comparison between the second edition of the international classification of headache disorders and alternative diagnostic criteria.

OBJECTIVES: To compare the second edition of the International Classification of Headache Disorders (ICHD-2) and the Silberstein-Lipton (S-L) criteria in the classification of adolescents with chronic daily headache (CDH). METHODS: We reviewed the clinical records and the headache diaries of 170 adolescents (13 to 17 years) seen between 1998 and 2003 at a headache center. Relevant information was transferred to a standardized form that included operational criteria for the ICHD-2. CDH subtypes were classified according the criteria proposed by S-L into transformed migraine (TM) with (TM+) and without medication overuse (TM-), chronic tension-type headache (CTTH), new daily persistent headache (NDPH), and hemicrania continua (HC). RESULTS: From the 69 patients with TM- according the S-L criteria, most (71%) could be classified as chronic migraine (CM), while a minority of patients required a combination of diagnosis, mainly migraine and CTTH (14.4%). Of the patients with TM+, just 39.6% met the criteria for probable CM (PCM) with probable medication overuse (PMO). If instead of 15 migraine days per month, we considered 15 or more days of migraine or probable migraine, 84% of the subjects with TM- and 68.7% of those with TM+ could be classified. Of the 27 subjects classified as NDPH without medication overuse according to the S-L system, the majority (51.2%) were also classified as NDPH according the ICHD-2. Interestingly, three (11.1% of the subjects with NDPH without medication overuse) were classified as CM in the ICHD-2 because these patients had an abrupt onset of 15 or more days of migraine per month. All patients with NDPH with medication overuse according to the S-L criteria required a combination of diagnoses in the ICHD-2. All subjects with CTTH received a single diagnosis in both classification systems. CONCLUSIONS: (i) Among adolescents with TM, the majority (58.1%) could be classified as CM, according to the ICHD-2. These results were driven by TM without medication overuse. (ii) If the ICHD-2 criteria for CM are revised to require 15 days of migraine or probable migraine, the proportion of patients with TM- who meet the criteria for CM increases from 71% to 84%; for TM+, the proportion with probable chronic migraine and PMO increases from 30% to 68%. (iii) About half of the patients with NDPH according to the S-L criteria have too many migraine features to meet ICHD-2 criteria for NDPH.

Adolescent↗
PubMed1997

Neck mobility in different headache disorders.

The main purpose of this study was to assess neck mobility (by Cybex equipment) in different headache disorders and, in particular, cervicogenic headache, and to compare these findings with those in controls. A total of 51 control subjects and 90 headache patients were investigated, where of 28 patients suffered from common migraine (migraine without aura), 34 from tension-type headache (9 episodic and 25 chronic), and 28 patients from cervicogenic headache. One-way ANOVA and post hoc Bonferroni analysis showed significant differences between those with cervicogenic headache and the other groups for rotation (P < 0.001) and flexion/extension (P < 0.001), but not for lateral neck movement (P = NS). There were no significant differences between migraine patients, tension-type headache patients, and controls. In all four groups, there was a significant positive correlation between active and passive neck movement for rotation (P < 0.001), flexion/extension (P < 0.001), and lateral neck movement (P < 0.001). Repeated measures analysis of variance (ANOVA) showed no significant day-to-day differences in 10 control subjects. In the control group (n = 51), there was a significant negative correlation between age and neck movement. For rotation, Pearson's correlation coefficient was; r = -0.71 (P < 0.001), for flexion/extension r = -0.71 (P < 0.001), and for lateral neck movement r = -0.67 (P < 0.001). No significant sex difference was found as for any of the neck movements. Pain at the time of investigation did not seem to influence neck mobility. Cervicogenic headache has been recognized as a pain syndrome by the International Association for the Study of Pain (IASP). Since reduced neck mobility is one of the major criteria for this diagnosis, it emphasizes the need for systematic, objective neck mobility measurements in the individual patient to substantiate the diagnosis. The technique is simple and proved reliable.

Adult↗
PubMedDate not supplied

Classification and diagnostic criteria for primary headache disorders (Ad Hoc Committee IHS, 1988).

Clinical features and pathophysiological mechanisms of primary (idiopathic) headaches are revisited in the light of the new classification of headache, recently proposed by the Ad Hoc Committee of the International Headache Society. This computer-based classification is hierarchically constructed and offers operational diagnostic criteria for all headache disorders. However, further investigations are required in some cases (e.g. in case of tension-type headache) to better define the clinical form.

Cluster Headache↗
PubMed2006

Investigating prophylactic botulinum toxin type A for chronic headache disorders.

There is an increasing number of studies on botulinum toxin A in the treatment of idiopathic and symptomatic headache; however, many studies can hardly be compared with each other because of different end points and different trial designs. For the prophylactic treatment of tension-type headache, migraine and cervicogenic headache, no sufficient positive evidence for a successful treatment can be obtained from the randomised, double-blind and placebo-controlled trials performed so far. For the treatment of chronic daily headache (including medication-overuse headache), there is inconsistent positive evidence for subgroups (e.g., patients without other prophylactic treatment). This means that most of the double-blind and placebo-controlled studies do not confirm the assumption that botulinum toxin A is efficacious in the treatment of idiopathic headache disorders; however, it is possible that some subgroups of patients with chronic migraine benefit from a long-term treatment for > or = 6 months.

Botulinum Toxins, Type A↗
PubMed1992

Long-term follow-up of relaxation training for pediatric headache disorders.

The long-term effects of relaxation training for pediatric headache disorders was determined for 17 of 20 original participants from a prospective control-group experimental design study with random assignment to autogenic relaxation, progressive relaxation, autogenic plus progressive relaxation, or waiting list control groups. Long-term follow-up data were obtained at an average of 51 months post-treatment. All participants reported some increases in headache activity. Participants in the three relaxation treatment groups, however, had significantly more headache-free days and less severe headaches compared to the control group. There were no significant effects of treatment for headache duration, medication intake and rest time due to headache. Twelve of the 13 treated participants indicated relaxation training was effective in relieving headaches, with 7 reporting they practiced relaxation exercises within the past month. The results generally support the long-term benefits of relaxation in reducing headaches originating in childhood.

Adolescent↗
PubMedDate not supplied

Cerebrospinal fluid biomarkers in primary headache disorders.

OBJECTIVE: The object of this review is to examine the published literature for cerebrospinal fluid laboratory measures of primary headache disorders to identify biomarkers and provide recommendations for future biomarker discovery. BACKGROUND: Biomarkers may distinguish deviation from a normal state, provide insight into mechanisms of pathophysiology, quantify the degree of change, discriminate what may be clinically overlapping disorders, and allow monitoring and/or selection of specific treatment. High-throughput, discovery technologies fuel the ability to reveal more biomarkers than past hypothesis-driven studies. DESIGN OR METHODS: Publications were identified in PubMed, ISI web of knowledge (both Web of Science and BIOSYS), and SciFinder, using the key words for cerebrospinal fluid (CSF) and migraine, headache, or biomarkers. Additional references were sought from the papers identified in these searches. Data were assessed relating to all primary headache types for clinical and scientific methods and results. RESULTS: Fifty-five out of 82 biomarkers were found from 55 publications, though none have been validated for clinical utility. Data for site (ventricular, cervical, lumbar) and timing of CSF collection, headache state, and diagnostic description were patchy, and controls were often poorly defined. Most routinely performed CSF measurements were within normal limits. Most levels of pain-related molecules were reduced, and concentrations of most neurotransmitters, neuropeptides, proteins, and small molecules were increased. Though few studies assessed the specificity of biomarkers for primary headaches, it is clear that there are differences in CSF biomarkers between migraine, cluster headache, tension-type headache, and trigeminal neuralgia. CONCLUSIONS: The high proportion (67%) of biomarkers identified from laboratory measures tested thus far predicts that many more biomarkers will be identified for primary headaches when more candidates are evaluated. In order to discover and evaluate more biomarkers, especially those that may have clinical application for headache management, 3 recommendations are encouraged: prospective design of care-independent studies; evaluation of more clinical variables; and evaluation of substantially more candidates by using discovery-based research methods. Outlines of approaches to pursue these aims are proposed.

Biomarkers↗
PubMedDate not supplied

The burden of illness associated with headache disorders among young adults in a representative cohort study.

This study investigated the functional impairment (work and social functioning and general health status) associated with migraine and tension-type headache (TTH) among young adult members of the Dunedin Multidisciplinary Health and Development Study. Using criteria based on the International Headache Society classificatory system, the 1-year prevalence for migraine headache was 7.4%, TTH was 11.1%, and combined headache (coexisting migraine and TTH) was 4.3%. All comparisons were against a health control group (headache free) and a diagnostic control group (individuals without headache currently using medication for asthma). Although those suffering from migraine and combined headache had the most severe impairment in work- and social-related activities, those with TTH reported significantly poorer social and mental health functioning and poorer emotional and physical functioning while performing everyday roles than did headache-free controls. Study members with combined headache had the poorest self-reported health, with significantly lower ratings on physical, vitality, and mental health measures than asthmatics currently using medication. The pervasive impairment reported across multiple life domains among young headache sufferers illustrates the significant burden of illness associated with headache disorders.

Adult↗
PubMed2002

The effectiveness of spinal manipulation for the treatment of headache disorders: a systematic review of randomized clinical trials.

To carry out a systematic review of the literature examining the effectiveness of spinal manipulation for the treatment of headache disorders, computerized literature searches were carried out in Medline, Embase, Amed and CISCOM. Studies were included only if they were randomized trials of (any type of) spinal manipulation for (any type of) headache in human patients in which spinal manipulation was compared either to no treatment, usual medical care, a 'sham' intervention, or to some other active treatment. Two investigators independently extracted data on study design, sample size and characteristics, type of intervention, type of control/comparison, direction and nature of the outcome(s). Methodological quality of the trials was also assessed using the Jadad scale. Eight trials were identified that met our inclusion criteria. Three examined tension-type headaches, three migraine, one 'cervicogenic' headache, and one 'spondylogenic' chronic headache. In two studies, patients receiving spinal manipulation showed comparable improvements in migraine and tension headaches compared to drug treatment. In the 4 studies employing some 'sham' interventions (e.g. laser light therapy), results were less conclusive with 2 studies showing a benefit for manipulation and 2 studies failing to find such an effect. Considerable methodological limitations were observed in most trials, the principal one being inadequate control for nonspecific (placebo) effects. Despite claims that spinal manipulation is an effective treatment for headache, the data available to date do not support such definitive conclusions. It is unclear to what extent the observed treatment effects can be explained by manipulation or by nonspecific factors (e.g. of personal attention, patient expectation). Whether manipulation produces any long-term changes in these conditions is also uncertain. Future studies should address these two crucial questions and overcome the methodological limitations of previous trials.

Headache Disorders↗
PubMed2006

Facial pain and the second edition of the International Classification of Headache Disorders.

BACKGROUND: Recurrent or chronic facial pain may be a diagnostic challenge. Applying the diagnostic criteria of the second edition of the International Classification of Headache Disorders (ICHD-II) leaves a considerable number of patients unclassifiable. OBJECTIVE: The aim of this study was to establish and evaluate revised criteria of trigeminal neuralgia and persistent idiopathic facial pain. METHODS: Based on the diagnostic value of 12 clinical features of trigeminal neuralgia and 15 features of persistent idiopathic facial in 97 patients referred for facial pain to a neurological tertiary care centre we established revised criteria for persistent idiopathic facial pain and additional criteria for probable trigeminal neuralgia and probable idiopathic facial pain. RESULTS: Applying the newly proposed criteria reduced the number of patients with facial pain not classifiable by more than 50%. The new criteria improved the sensitivity, particularly in idiopathic facial pain and did not cause a relevant decrease in specificity compared to ICHD-II. CONCLUSION: This study suggests that amendments to the ICHD-II criteria improve the diagnostic classification of facial pain.

Facial Pain↗
PubMed2002

Headache Disorders in the Elderly.

Headache prevalence declines in the elderly, but remains a common reason for patients to seek medical attention. Although primary headache types remain most frequent, secondary headaches become more likely in this age group. Accurate diagnosis is essential, and the clinician should maintain a lower threshold for ordering laboratory testing and neuroimaging. The elderly are more likely to have co-existent medical conditions, which present both therapeutic limitations and opportunities when selecting acute and preventative treatments for headache. Altered pharmacokinetics and pharmacodynamics in this age group may increase the likelihood of side effects and drug interactions. Downward dose adjustments and simplifying medication regimens are often appropriate, as is using nonpharmacologic therapies whenever possible. Due to frequent contraindications related to acute medications, preventative drug regimens and nonpharmacologic treatments assume greater prominence when treating the elderly suffering frequent/severe headaches. Medication-induced headache and analgesic rebound headache occur commonly in this age group and may initiate, aggravate, or perpetuate headache. Chronic daily headache is often due to these conditions, and recognition of these problems can allow effective intervention.

Journal Article↗
PubMed2003

Fibromyalgia, fatigue, and headache disorders.

Fibromyalgia, chronic fatigue, and primary headaches are common and debilitating disorders, and their related symptoms of widespread pain, fatigue, and headache have complex interactions and different implications for classification, diagnosis, mechanisms, and treatment. The "continuum" or "spectrum" idea and the modular headache theory are fundamental concepts in understanding these interactions. The overlap between symptom-based conditions leads the reasons to consider them as "functional somatic syndromes." Management of these patients includes a correct diagnosis, appropriate investigation for associated conditions, adequate treatment, and considering the therapeutic opportunities and limitations the comorbid disorders may impose.

Fatigue↗
PubMed2005

Facial pain in a neurological tertiary care centre--evaluation of the International Classification of Headache Disorders.

The aim of this study was to examine the diagnostic spectrum of facial pain and to evaluate the clinical features relevant to the differential diagnosis in a neurological tertiary care centre. This is the first investigation comparing the first with the second edition of the International Classification of Headache Disorders (ICHD-I, ICHD-II) in consecutively referred patients comprising a broad spectrum of disorders without restricting the inclusion to certain diagnoses. Studying 97 consecutive patients referred for facial pain, we found trigeminal neuralgia or other types of cranial neuralgia in 38% and 39% according to ICHD-I and ICHD-II, respectively; persistent idiopathic facial pain was diagnosed in 27% and 21%, respectively. The proportion of patients who could not be classified was 24% in ICHD-I and 29% in ICHD-II. Six per cent of the patients had cluster headache or chronic paroxysmal hemicrania, the remaining 5% had various other disorders. The agreement between ICHD-I and ICHD-II was very good to perfect. In ICHD-II, sensitivity and specificity were similar to ICHD-I, the specificity and negative predictive value were imrpoved in single features of trigeminal neuralgia, but were widely unchanged in persistent idiopathic facial pain. The number of patients who could not be classified was larger in ICHD-II than in ICHD-I. Modifying the diagnostic criteria for different types of facial pain, in particular changes in the criteria of persistent idiopathic facial pain, might be helpful in reducing the number of patients with unclassifiable facial pain.

Aged↗
PubMed2005

Ehlers-Danlos syndrome: correlation with headache disorders in a young woman.

Ehlers-Danlos syndrome is a rare inherited illness, which includes an autosomal dominant and also a recessive X-linked variant. Its main clinical characteristic is a generalised connective tissue involving collagen and elastin, causing fragile and hyperextensible skin, loose jointedness and bruising. Many clinical subtypes are described, each of a different severity degree pattern. The correlation of this syndrome and headache disorders is rare. In this paper we describe the case of a young woman with Type II (less severe) Ehlers-Danlos Syndrome and headache.

Adult↗