Muscle discrimination ability at three muscle sites in three headache groups

The present study examined the ability of three headache groups (migraine, mixed migraine/tension, and tension) to accurately discriminate subjective levels of muscle tension at the forearm flexor, frontalis, and trapezius muscle sites. Discrimination ability was assessed at pre- and posttreatment using a psychophysical method of magnitude production. Results show that the ability to discriminate muscle tension levels at pretreatment varied across the headache groups, with migraineurs being the most accurate (r=.854), followed by the mixed headache group (r=.785), and finally the tension headache group (r=.732). Discrimination ability significantly increased at the posttreatment assessment. A multiple regression analysis showed that pretreatment performance on the muscle discrimination task significantly predicted outcome (r=.75) from relaxation and biofeedback training for migraine patients but not for the mixed or tension headache groups.This research was supported by a grant from NINCDS, NS-15235.     

Hand temperature norms for headache, hypertension, and irritable bowel syndrome

Hand temperature norms are presented for 221 headache patients (migraine, mixed, and tension), 105 hypertensives, 45 irritable bowel syndrome patients, and 56 normal controls under conditions of resting baseline, self-relaxation, volitional handwarming, mental arithmetic, and cold pressor. The two vascular headache groups (migraine and mixed) had significantly lower hand temperatures across conditions.     

Self-regulatory treatment of headache in the elderly

We examined the utility of various combinations of relaxation, cognitive coping, and feedback in an uncontrolled series of 16 older headache patients (aged 60 to 77) diagnosed as having tension, mixed, or migraine headache. At 1-month follow-up, statistically and clinically significant reductions were observed in both overall headache activity and medication intake; 10 patients (63%) were more than 50% improved in both headache reduction and medication reduction. Female headache suffers were more improved than males. These results are inconsistent with our past findings with geriatric headache sufferers but consistent with other, more recent favorable findings. The efficacy of nondrug treatment for geriatric headache clearly warrants further attention.This research was supported in part by a grant from NINDS, NS-23440.     

The relationship between muscle discrimination ability and response to relaxation training in three kinds of headaches

Accurate discrimination of changes in physiological response has been noted as an important element in learning to control that response. Using a magnitude production procedure involving forearm isometric contractions, it was found that the ability to discriminate muscle tension varied across headache groups, with the no-headache control group (r=.76) being most accurate, followed by the tension group (r=.68), the mixed tension and migraine group (r=.60), and finally the migraine group (r=.51). The most important result, however, was that muscle discrimination ability significantly predicted clinical outcome from treatment by relaxation training for tension headache subjects (r=.50) but did not predict outcome for migraine or mixed headache subjects.This research was supported by a grant from NINCDS, NS-15235.     

Evaluation of home-based thermal biofeedback treatment of pediatric migraine headache

Sixteen children and adolescents with migraine headache were treated with thermal biofeedback. Seven were seen individually in the clinic while the other nine participated in a limited-contact, partly home-based regimen. Evaluation of headache diary data from 4-week monitoring periods before and after treatment showed significant (p<.01) reduction in headaches, with no significant difference in efficacy between the two conditions.This research was supported in part by grants from NIMH, MH-41341, and NINCDS, NS-23440.     

Muscle discrimination ability at three muscle sites in three headache groups

The present study examined the ability of three headache groups (migraine, mixed migraine/tension, and tension) to accurately discriminate subjective levels of muscle tension at the forearm flexor, frontalis, and trapezius muscle sites. Discrimination ability was assessed at pre- and posttreatment using a psychophysical method of magnitude production. Results show that the ability to discriminate muscle tension levels at pretreatment varied across the headache groups, with migraineurs being the most accurate (r = .854), followed by the mixed headache group (r = .785), and finally the tension headache group (r = .732). Discrimination ability significantly increased at the posttreatment assessment. A multiple regression analysis showed that pretreatment performance on the muscle discrimination task significantly predicted outcome (r = .75) from relaxation and biofeedback training for migraine patients but not for the mixed or tension headache groups.     

What is an adequate length of baseline in research and clinical practice with chronic headache?

We examined the representativeness of baseline headache diary recording periods of 1, 2, 3, and 4 weeks for three kinds of headache disorder — tension, migraine, and combined migraine and tension. For research purposes at pretreatment, 2 weeks of diary recording are preferable for tension headache, while at least 3 weeks are preferred for migraine and combined headache. At follow-up, 1 week of diary recording appears adequate for all three headache types. Recommendations are also made for clinical practice.This research was supported by grants from NINCDS, NS-23440, and NIMH, MH-41341.     

Continuous versus interrupted schedules of thermal biofeedback: An exploratory analysis with clinical subjects

Researchers administer thermal biofeedback in several different formats, although the most common are continuous administration and a series of brief trials separated by frequent rest breaks. The present study directly compared these two administration schedules with individuals suffering from migraine headache. Optimal training effects occurred for the continuous schedule of administration. Surprisingly, the interrupted schedule actually led to decreases in hand temperature over eight sessions. Possible reasons for this finding and its implications are discussed.This research was supported in part by grants from the National Institute of Neurological and Communicative Disorders and Stroke (NS-15235; NS-16891; NS-00818) and the Research Foundation of the State University of New York.     

心脏右向左分流对偏头痛患者临床症状的影响

目的:探讨心脏右向左分流(RLS)对偏头痛患者临床特征是否存在影响,并研究RLS分级与头痛强度之间的关系。方法:选择2016年6月-2018年12月青岛大学附属医院收治的偏头痛患者216例作为偏头痛组,选择于青岛大学附属医院体检的健康志愿者60例作为对照组。216例偏头痛患者根据有无RLS分为有RLS偏头痛组(127例)和无RLS偏头痛组(89例)。有RLS偏头痛患者根据RLS分级将其分为大分流组(n=51)、中分流组(n=11)和小分流组(n=65)。观察对照组与偏头痛组RLS情况,比较有RLS偏头痛组和无RLS偏头痛组患者的一般资料情况,比较大分流组、中分流组和小分流组患者的一般资料情况,采用多因素Logistic回归分析偏头痛患者产生RLS的危险因素。结果:对照组与偏头痛组小分流、中分流患病率比较差异无统计学意义(P0.05),而偏头痛组大分流患病率高于对照组(P0.05)。有RLS偏头痛组患者的视觉先兆、感觉先兆的比例均大于无RLS偏头痛组,头痛初始年龄均小于无RLS偏头痛组,头痛强度均高于无RLS偏头痛组(P0.05),两组患者年龄、性别、吸烟、饮酒、高血压、糖尿病、高血脂、运动先兆、遗传、头痛频率、头痛持续时间比较差异无统计学意义(P0.05)。不同RLS分级的偏头痛患者的视觉先兆、感觉先兆、头痛初始年龄、头痛强度整体比较差异有统计学意义(P0.05)。多因素Logistic回归分析显示,视觉先兆、感觉先兆、头痛初始年龄是偏头痛患者产生RLS的独立危险因素(P0.05)。结论:偏头痛发病年龄较小或有视觉先兆、感觉先兆可能提示偏头痛患者伴有RLS,RLS分级与头痛强度没有关系。     

Precipitating and relieving factors of migraine versus tension type headache

ABSTRACT: BACKGROUND: To determine the differences of precipitating and relieving factors between migraine and tension type headache METHODS: This is a cross sectional study. We retrospectively reviewed the records of 250 migraine patients and 250 patients diagnosed as tension type headache from the specialized headache clinic in Dept. of Neurology, Dhaka Medical College Hospital. Data were collected through a predesigned questionnaire containing information on age, sex, social status and a predetermined list of precipitating and relieving factors. RESULTS: In this study, the female patients predominated (67%). Most of the patients were within 21--30 years age group (58.6%). About 58% of them belonged to middle class families. The common precipitating factors like stress, anxiety, activity, journey, reading, cold and warm were well distributed among both the migraine and tension type headache (TTH) patients. But significant difference was demonstrated for fatigue (p < 0.05), sleep deprivation (p < 0.05), sunlight (p < 0.01) and food (p < 0.05), which were common among migraineurs. In consideration of relieving factors of pain, different maneuvers were commonly tried by migraineurs and significant difference were observed for both analgesic drug and massage (p < 0.05), which relieved migraine headache. But maneuvers like sleep, rest and posture were used by both groups. CONCLUSION: The most frequent precipitating factors for headache appear to be identical for both migraine and TTH patients. Even though some factors like fatigue, sleep deprivation, sunlight and food significantly precipitate migraine and drug, massage are effective maneuver for relieving pain among migrianeurs.     

Assessment of dietary risk factors in chronic headache

An investigation of the awareness level and potential impact of dietary risk factors on chronic headache patients revealed that (1) approximately 75% of the 130 patients in this study stated they were aware of possible food-intake/headache connections, (2) less than half reported being informed of this relationship by medical professionals, and (3) the awareness of this nutritional information did not prompt changes in subjects' dietary practices. The comparison of food-intake patterns of the headache patients and nonheadache control group revealed a significant difference only on red wine consumption.This research was supported in part by a grant from NINCDS, NS-23440.     

Neurological evaluation of chronic headache patients: Is laboratory testing always necessary?

A review of records was conducted to examine the utility of doing routine laboratory testing (EEG and skull X rays) versus testing at the discretion of the attending neurologist on patients presenting for the nonpharmacological treatment of chronic headache. A total of 278 patients underwent neurological evaluation as part of a routine assessment prior to beginning self-regulatory treatment for headache. The first 112 subjects received routine laboratory tests of EEG and skull X-ray films. The second set of 166 subjects received laboratory tests only when deemed necessary by the neurologist. The rate of abnormal EEG in chronic headache sufferers was no greater than that found in the normal population, and only one or two potentially serious abnormalities were found on any laboratory test. A higher rate of abnormality was found when the CT scan was used in conjunction with clinical judgment. The majority of clients with abnormal laboratory tests (most of which were mildly abnormal) still saw substantial headache reduction with self-regulatory treatment for chronic headache. The authors suggest that routine laboratory testing may not be necessary and should be left to the discretion of a qualified neurologist.This research was supported in part by grants from NINCDS, NS-15235 and NS-23440.     

Classification and Clinical Features of Headache Disorders in Pakistan: A Retrospective Review of Clinical Data

Background

Morbidity associated with primary headache disorders is a major public health problem with an overall prevalence of 46%. Tension-type headache and migraine are the two most prevalent causes. However, headache has not been sufficiently studied as a cause of morbidity in the developing world. Literature on prevalence and classification of these disorders in South Asia is scarce. The aim of this study is to describe the classification and clinical features of headache patients who seek medical advice in Pakistan.

Methods and Results

Medical records of 255 consecutive patients who presented to a headache clinic at a tertiary care hospital were reviewed. Demographic details, onset and lifetime duration of illness, pattern of headache, associated features and family history were recorded. International Classification of Headache Disorders version 2 was applied.66% of all patients were women and 81% of them were between 16 and 49 years of age. Migraine was the most common disorder (206 patients) followed by tension-type headache (58 patients), medication-overuse headache (6 patients) and cluster headache (4 patients). Chronic daily headache was seen in 99 patients. Patients with tension-type headache suffered from more frequent episodes of headache than patients with migraine (p<0.001). Duration of each headache episode was higher in women with menstrually related migraine (p = 0.015). Median age at presentation and at onset was lower in patients with migraine who reported a first-degree family history of the disease (p = 0.003 and p<0.001 respectively).

Conclusions/Significance

Patients who seek medical advice for headache in Pakistan are usually in their most productive ages. Migraine and tension-type headache are the most common clinical presentations of headache. Onset of migraine is earlier in patients with first-degree family history. Menstrually related migraine affects women with headache episodes of longer duration than other patients and it warrants special therapeutic consideration. Follow-up studies to describe epidemiology and burden of headache in Pakistan are needed.     

Self-regulatory treatment of headache in the elderly

We examined the utility of various combinations of relaxation, cognitive coping, and feedback in an uncontrolled series of 16 older headache patients (aged 60 to 77) diagnosed as having tension, mixed, or migraine headache. At 1-month follow-up, statistically and clinically significant reductions were observed in both overall headache activity and medication intake; 10 patients (63%) were more than 50% improved in both headache reduction and medication reduction. Female headache suffers were more improved than males. These results are inconsistent with our past findings with geriatric headache sufferers but consistent with other, more recent favorable findings. The efficacy of nondrug treatment for geriatric headache clearly warrants further attention.     

Surgical treatment of migraine headaches by corrugator muscle resection

The authors, a plastic surgeon (Dirnberger) and a neurologist (Becker), conducted this study after reading the article by of Bahman Guyuron et al. in the August 2000 issue of Plastic and Reconstructive Surgery (106: 429, 2000). Sixty patients were operated on between June of 2001 and June of 2002; postoperative follow-up ranged between 6 and 18 months. Patients' charts were reviewed to confirm the diagnosis of migraine headache according to the criteria of the International Headache Society. Sixty patients (13 men and 47 women) from Austria and four neighboring countries took part in the study. The patients were divided into three groups, based on the severity of their migraines: group A comprised patients with up to 4 days of migraine per month; group B included patients with 5 to 14 days of migraine per month; and group C was composed of patients with more than 15 days of headache per month ("permanent headache") or evidence of drug abuse and drug-related headaches. The effectiveness of the operation was evaluated using the following factors: percentage reduction of headache days; percentage reduction of drugs; percentage reduction of side effects, severity of headaches, and response to drugs; and patient grade of personal satisfaction, using a scale from 1 to 5 [1 = excellent (total elimination of migraine headache) to 5 = insufficient or no improvement]. From the entire group of 60 patients, 17 (28.3 percent) reported a total relief from migraine, 24 (40 percent) reported an essential improvement, and 19 (31.7 percent) reported minimal or no change. Patients with a rather mild form of migraine headache had a much better chance (almost 90 percent in group A and 75 percent in group B) to experience an improvement or total elimination of migraine than those patients (n = 27) from group C with severe migraine, "permanent headaches," and drug-induced headaches. Contrary to the reports by Guyuron, 11 patients who had a very favorable response immediately and in the first weeks after the operation experienced a gradual return of their headaches to preoperative intensity after about 4 postoperative weeks. After 3 months, the results in all patients could be declared permanent. All side effects, such as paraesthesia in the frontal region, disappeared in all patients within 3 to 9 months.     

Migraine: Intelligence,Social Class,and Familial Prevalence

Groups of individuals with headache, unilateral headache, and migraine, and a fourth group who had not had a headache in the previous year, were identified by questionnaire from a random sample of adults in the general population. Intelligence and social class were assessed in about 400 individuals. There was no evidence that individuals with migraine were more intelligent or of higher social class. There was, however, a suggestion that the more intelligent individuals with migraine, and those in social classes I and II, were more likely to consult a doctor for their headaches. This trend might explain the origin of the hypotheses associating migraine with intelligence and with social class.Random samples of individuals with migraine with headache and without headache in the previous year were the probands for a family study. There were 524 first-degree relatives over 21 years of age who lived in South Wales. Headache histories, obtained “blindly” from over 99% of these relatives with a standard questionnaire, were classified as migraine, possible migraine, headache, or without headache in the previous year. The prevalence of migraine in the families of the migrainous probands was nearly twice as high as the prevalence in the other families, but this difference was not statistically significant. It is suggested that family history should not be included in the definition of migraine and that heredity is much less important in migraine than is usually supposed.     

Biofeedback and relaxation treatments for headache in the elderly: A caution and a challenge

Results for 11 older (60 years or greater) headache patients treated with combinations of biofeedback and relaxation are presented. Overall, only 18.2% were clinically improved after treatment. None of the 5 tension headache patients were improved. Suggestions for future work with the older headache patient are offered.This research was supported in part by a grant from NINCDS, NS-15235.     

Preliminary results from the self-regulatory treatment of high-medication-consumption headache

Data are presented from a prospective clinical replication series of ten consecutive high-medication headache patients who presented for nondrug treatment of their headaches. For the first eight, an attempt was made to withdraw the patients from medication, with the assistance of relaxation training, prior to entering a comprehensive self-regulatory treatment program. For the last two, drug withdrawal accompanied the treatment. Six of the ten patients showed clinically significant reductions in headache activity, which held up over follow-ups of up to 12 months. Psychological tests provide some discrimination between success and failures.This research was supported in part by a grant from NINDS, No. NS-23340. Appreciation is expressed to Dr. Kenneth A. Appelbaum and Ms. Denise Michultka for their roles in this study.     

Acupuncture for chronic headache in primary care: large,pragmatic, randomised trial

Objective To determine the effects of a policy of “use acupuncture” on headache, health status, days off sick, and use of resources in patients with chronic headache compared with a policy of “avoid acupuncture.”Design Randomised, controlled trial.Setting General practices in England and Wales.Participants 401 patients with chronic headache, predominantly migraine.Interventions Patients were randomly allocated to receive up to 12 acupuncture treatments over three months or to a control intervention offering usual care.Main outcome measures Headache score, SF-36 health status, and use of medication were assessed at baseline, three, and 12 months. Use of resources was assessed every three months.Results Headache score at 12 months, the primary end point, was lower in the acupuncture group (16.2, SD 13.7, n = 161, 34% reduction from baseline) than in controls (22.3, SD 17.0, n = 140, 16% reduction from baseline). The adjusted difference between means is 4.6 (95% confidence interval 2.2 to 7.0; P = 0.0002). This result is robust to sensitivity analysis incorporating imputation for missing data. Patients in the acupuncture group experienced the equivalent of 22 fewer days of headache per year (8 to 38). SF-36 data favoured acupuncture, although differences reached significance only for physical role functioning, energy, and change in health. Compared with controls, patients randomised to acupuncture used 15% less medication (P = 0.02), made 25% fewer visits to general practitioners (P = 0.10), and took 15% fewer days off sick (P = 0.2).Conclusions Acupuncture leads to persisting, clinically relevant benefits for primary care patients with chronic headache, particularly migraine. Expansion of NHS acupuncture services should be considered.     

Oxidative Stress in Migraine with and Without Aura

Migraine is the most common neurological disorder, but the molecular basis is still not completely understood. An impairment of mitochondrial oxidative metabolism might play a role in the pathophysiology. The goal of this study was to investigate the differences in oxidative stress status with the measurement of erythrocyte superoxide dismutase (SOD), catalase activity, and malondialdehyde (MDA) levels in the migraine patients with or without aura and attack. There were 56 patients (46 female, 10 male) in the migraine group and 25 matched healthy subjects in the control group. The patients comprised 37 with migraine without aura (MWoA], 19 with migraine with aura (MWA), and 22 with headache attack. The MDA levels of patients in the migraine group were significantly higher than that in the control group. The SOD activity was significantly higher in the MWA as compared to MWoA. There was no significant correlation between these levels and headache attack period. Conclusively, in this preliminary study, we had found increased oxidative stress in the migraine patients especially the patients with MWA. Further knowledge about this issue may contribute the cause and complications of migraine and may be essential for development of treatment approaches.