Quality of life in migraine and chronic daily headache patients

Primary chronic headache can affect a patient's health-related quality of life (HQL). The Medical Outcomes Study Short Form (SF-36) questionnaire has been used to address this issue. We compare the impact of headache on the HQL of patients with migraine and chronic daily headache (CDH) using the SF-36 instrument. We analyzed a group of 115 consecutive patients; 62 migraine patients and 53 CDH patients completed the questionnaire. Patterns of disability were similar between the two groups, but CDH was marked by a lower level of health scales. Patients with CDH had a significantly worse pain score in physical functioning, role functioning (physical), bodily pain, general health perceptions, and mental health than patients with migraine headache. Our results in the migraine group were similar to findings in other publications, with the lowest scores in role functioning (physical) and bodily pain. There is no previous experience in CDH patients, but the present data suggest that the SF-36 questionnaire is valuable in determining the differences in functional status among headache types. These data suggest that the SF-36 is a reliable and valid measure of the HQL of patients with CDH, and may indeed prove to be valuable in studying the efficacy of therapeutic agents for this type of headache.     

Response to treatment of chronic daily headache with analgesic abuse

The incidence of right aneurysms of the innominate or subclavian arteries is not very high. The majority of these aneurysms is placed in the distal segment of subclavian arteries. These aneurysms are involved in the complex of the thoracic outlet compressive neurovascular syndrome, especially in occurrence of the cervical rib. All aneurysms in this region can rupture and embolize. This is the main purpose of surgical management of this clinical entity. The aim of this study is to refer an interesting case history of a relatively young patient with a right aneurysm of the middle portion of left subclavian artery. The patient had no known vascular risks and the aneurysm was asymptomatic, the only sign was the visible and palpable pulsating mass over the left clavicle. The aneurysms of the middle and central portion of the left subclavian artery are usually explored through the left high posterolateral thoracotomy. The authors refer their experience with the use of a modified technique of exposure--supraclavicular (or transclavicular) incision with the subperiostal resection of the medial portion of the clavicle. This approach affords excellent exposure and a safe surgical procedure. This approach has been described in 1988 by H. Machleder. The advantage of this approach is a diminished risk of surgery in comparison with the transthoracic approach. The authors suppose, however, that it can be useful in traumatic or occlusive lesions, as well.     

The clinical link between migraine and cluster headaches

We describe seven patients with vascular headaches. Five of them had cluster headaches, which were preceded by migrainous scotamata (two patients), weakness contralateral to the pain (one), accompanied by ipsilateral photopsias (one), or by contralateral paresthesias (one). The other two patients had "clusters" of daily common migraine headaches separated by long free intervals. The symptoms of these patients suggest a common root for cluster and migraine headaches.     

Side-locked unilaterality and pain localization in long-lasting headaches: migraine, tension-type headache, and cervicogenic headache

Side-locked unilaterality and specific localization of pain are not as well-defined clinical characteristics in long-lasting headaches (duration more than 4 hours) as they are in short-lasting forms. We examined side-locked unilaterality and pain distribution at onset and at peak headache in 74 patients with different forms of long-lasting headache: migraine and tension-type headache (IHS) and cervicogenic headache (according to Sjaastad et al). Side-locked unilaterality of pain was found in all forms, but to differing extents - 20.8% in migraine, 12.5% in tension-type headache, while it was a mandatory criterion for cervicogenic headache. The pain tended to localize anteriorly, particularly at onset, in migraine; was more diffuse in tension-type headache; and always began in the occipitonuchal region in cervicogenic headache. Our results may contribute to a better clinical definition of long-lasting headaches.     

Psychophysiological treatment of migraine and tension headaches: A 12-month follow-up.

Conducted a 12-mo follow-up of the present authors' (1983) study population of chronic headache sufferers by telephone interviewing 31 chronic migraine and 25 chronic tension headache patients (aged 18–61 yrs) who had been treated with EMG, muscle relaxation, and fingertip temperature training to test a hypothesis of biofeedback placebo effects. A previous 3-mo follow-up had revealed that all treatments had produced significant improvement, and relaxation was not as good as the biofeedback devices for obtaining a reduction in monthly headache hours. At 12-mo follow-up, the 3-mo improvement was sustained overall, but migraineurs as a group appeared to regress slightly, while tension patients improved significantly in the interim. On the basis of a 50% reduction in symptomatology, biofeedback treatment was significantly superior to relaxation for tension headaches, although this had not been true at the 3-mo assessment. Temperature training was at least as effective as EMG for both headache groups. In view of these results, biofeedback treatment is viewed less as placebo administration and more as a secondary reinforcer of a specific but unknown physiological response. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Migraines and other headaches: an approach to diagnosis and classification

Headache is a symptom that accounts for over 18 million visits to physicians each year. In an effort to resolve inconsistencies and problems with the differentiation of specific types of headache, the International Headache Society (IHS) has established a classification system. For each major type of headache, the IHS classification specifies diagnostic criteria and recognized subtypes where appropriate. Migraine headaches are commonly encountered in clinical practice. Recognition and accurate diagnosis of migraine headache depend on a thorough history, appropriate physical examination and diagnostic testing.     

Attempt at the classification of chronic and recurrent headaches

The authors describe a proposal of classification of chronic and recurrent headaches based on criteria different from those used as yet. The initial criterion of headache classification was its extent and location: 1) diffuse, 2) partial, 3) posterior, b) anterior, 3)localized. Another element is: 1) unequivical or 2) non-unequivical clinical pattern. Definite clinical entities, probable aetiological factors, or possible pathological mechanisms are referred to definite extent and localization, and unequivocal or non-unequivocal clinical patterns.     

Tendinitis and other chronic tendinopathies

OBJECTIVE: Infusing nitric oxide at a constant rate into a breathing circuit with intermittent mainstream flow causes formation of nitric oxide pools between successive breaths. We hypothesized that incomplete mixing of these pools can confound estimates of delivered nitric oxide concentrations. METHODS: Nitric oxide flowed at a constant rate into the upstream end of a standard adult breathing circuit connected to a lung model. One-milliliter gas samples were obtained from various sites within the breathing system and during various phases of the breathing cycle. These samples were aspirated periodically by a microprocessor controlled apparatus and analyzed using an electrochemical sensor. RESULTS: The pools of nitric oxide distorted into hollow parabolic cone shapes and remained unmixed during their propagation into the lungs. In our preparation, time-averaged nitric oxide concentrations were minimal 60 cm downstream of the infusion site (18 ppm) and maximal 15 cm upstream of the Y-piece (36 ppm). The concentrations were mid-range within the lung (23 ppm), yet were substantially less than predicted by assuming homogeneity of the gases (31 ppm). Generally, nitric oxide concentrations within the lung were different from all other sites tested. CONCLUSION: Incomplete mixing of nitric oxide confounds estimates of delivered nitric oxide concentrations. When nitric oxide is infused at a constant rate into a breathing circuit, we doubt that any sampling site outside the patient's lungs can reliably predict delivered nitric oxide concentrations. Strategies to ensure complete mixing and representative sampling of nitric oxide should be considered carefully when designing nitric oxide delivery systems.     

Risk factors between analgesic use and chronic nephropathy in Thailand

The aim is this study is to compare the longitudinal changes in IQ scores of females and males with fragile X syndrome and controls and to assess the impact on IQ of molecular variations of the FMR-1 gene in males. Medical records from the child development unit at a university-affiliated children's hospital were retrospectively reviewed. Chart review yielded 35 males with fragile X (19 with a fully methylated full mutation, 9 with a mosaic pattern, and 7 with a partially unmethylated full mutation) 16 females with fragile X and a full mutation, 9 female controls, and 9 male controls who had repeated standardized IQ testing separated by 7 months to 13 years. The differences between the first and last IQ scores from the same IQ test were compared by t tests and subsequently by analysis of variance. Overall, a significant IQ decline was seen in 10/35 (28%) of fragile X males, 0/9 (0%) of control males, 6/16 (36%) of fragile X females, and 1/9 (11%) of control females. The initial t tests and analysis of variance showed a significant difference in IQ (p = 0.02) between fragile X males and control males but did not show a significant difference between males and females with fragile X syndrome or between fragile X and control females. When an analysis of covariance was carried out with the initial IQ as a covariable, a significant difference persisted between fragile X and control males, with a greater IQ decline in fragile X males. There were limitations in using the same IQ test. A comparison among the molecular subgroups of males yielded a significant IQ decline in 3/9 (33%) of mosaic males, 6/19 (32%) of fully methylated full mutation males, and 1/7 (14%) of partially methylated full mutation males. An analysis of covariance using the initial IQ and the intertest interval as covariables demonstrated significant differences between the fragile X molecular subgroups and the controls. Our findings show that a substantial percentage of both male and female fragile X patients and female control patients demonstrated significant IQ decline. There was a significant difference in the IQ change between fragile X and control males. There were no significant differences between fragile X and female controls. There were also significant differences in IQ decline among males with different molecular patterns compared with controls. Males with a mosaic pattern versus control males had the most significant decline of the molecular subtypes. Although the numbers were limited, there was no significant IQ decline in males with less than 50% methylation of the full mutation. This suggests that a small amount of FMR-1 protein production, which is often seen in males with less than 50% methylation, protects against significant IQ decline.     

Channelopathies: a genetic explanation of migraine and other paroxysmal neurologic disorders

There is increasing evidence of involvement of genes coding for ion channels in the pathogenesis of paroxysmal neurological disorders. Recently for instance, mutations in the calcium channel gene on chromosome 19 were identified in migraine, ataxia, and epilepsy. With the current research into inherited 'channelopathies' a new approach has been established. A better understanding of the pathophysiology of paroxysmal neurological disorders may lead to new therapeutic strategies.     

High dose fluticasone propionate, 1 mg daily, versus fluticasone propionate, 2 mg daily, or budesonide, 1.6 mg daily, in patients with chronic severe asthma. International Study Group

Airway inflammation is now regarded as fundamental in the pathogenesis of asthma and treatment with inhaled corticosteroids has proved effective. There is a need for drugs in this category with higher topical potency but fewer side-effects than those presently available. A double-blind, parallel group study was conducted in 671 patients with severe asthma (already taking between 0.8-2.0 mg of inhaled corticosteroid daily) to compare the safety and efficacy of 6 weeks of treatment with inhaled fluticasone propionate (FP), 1 mg daily, to fluticasone propionate, 2 mg daily, and budesonide (BUD), 1.6 mg daily, delivered via a metered-dose inhaler. Peak expiratory flow (PEF), asthma symptoms, and usage of rescue medication were recorded daily by the patient. At each clinic visit (-2, 0, 3 and 6 weeks) morning serum cortisol levels, bone markers and spirometry were assessed. The changes in mean morning PEF from baseline (weeks 1-6) were: FP 2 mg daily +24 l.min-1; FP 1 mg daily +21 l.min-1; BUD 1.6 mg daily +13 l.min-1. A similar rank order for the three treatments was seen for evening PEF, clinic spirometry, reduction of diurnal PEF variation, symptom scores, and requirement for rescue bronchodilators. The mean serum cortisol levels remained well within the normal range in all three groups. Analysis of the geometric mean cortisol ratio (treatment/baseline ratio after 6 weeks treatment) showed a changed rank order, the values being: FP 1 mg daily 1.04; BUD 1.6 mg daily 0.97; FP 2 mg daily 0.88.(ABSTRACT TRUNCATED AT 250 WORDS)     

Alteration of central excitation circuits in chronic headache and analgesic misuse

Central excitatory circuits could be involved in the pathophysiology of pain; particularly, the genesis of chronic pain. The "second pain" is the sensation that follows the initial pain after an appropriate nociceptive stimulus. The second pain is amplified by repeating the stimulus after brief intervals (temporal summation). This phenomenon is the psychophysical correlate of the excitatory pain circuits. The temporal summation of the second pain was evaluated in four groups of subjects; one group affected by migraine without aura, one by episodic tension headache, one by chronic daily headache, and a group of healthy subjects. A percutaneous electrical shock was used as the nociceptive stimulus. The intensity of the second pain was significantly greater in the group of patients with chronic headache in comparison with the other groups. The patients with chronic headache were subdivided into three groups on the basis of their clinical history: a group with transformed migraine; a group with chronic headache ab initio, a form related to the first one; (both groups suffered from chronic daily headache with a frequent superimposition of episodes of migraine attacks) and the third group consisted of patients with chronic tension headache. The temporal summation of the second pain was altered in the first two groups. The patients with chronic migraine abused ergotamine given as a symptomatic drug. Those who were able to discontinue this drug were retested and reported a decrease of the second pain in comparison to the previous measurements. The results of the present study indicate that central excitatory circuits could be involved in the mechanism leading to the development of chronic daily headache.     

Menstruation, sex hormones, and migraine

All women with migraine are susceptible to the effects of hormonal changes. For a minority with menstrual migraine, fluctuating hormones of the normal ovarian cycle are a specific trigger, particularly during perimenopause. The author proposes that the term menstrual migraine should be restricted to migraine attacks occurring on day 1 +/- 2 days of the menstrual cycle with freedom from migraine during the rest of the cycle. This definition is compatible with the mechanism of estrogen withdrawal. Other mechanisms such as prostaglandin release also may be important for some women. The changing hormonal environment at various stages of life provides further evidence of the role of estrogen in migraine. Treatments that stabilize hormone levels in the form of estrogen supplementation for menstrual migraine, elimination of the pill-free week, and adequate, stable levels of estrogen for HRT, all are associated with an improvement in migraine. The control of the menstrual cycle, however, is extremely complex, and until further studies are undertaken using strict criteria, the mechanism of migraine triggered by hormonal events remains uncertain.     

The history, epidemiology, and classification of headaches in childhood

The history of headaches in children, their epidemiology, and their classifications are reviewed. Symptoms, prevalence, school absences, risk factors, and treatments are discussed. More data is needed regarding the epidemiology of tension headaches, headaches observed in the emergency room, and headaches observed in the setting of the primary care practitioner.     

Mandibular tori, migraine and temporomandibular disorders

In this study the presence of mandibular tori was related to conditions associated with parafunctional activity. Parafunction in the form of tooth clenching or grinding has been associated with temporomandibular disorders (TMD) and recently migraine. Patients attending a facial pain clinic in Belfast were assessed for the presence of tori and results compared to age and gender matched controls. The findings were that mandibular tori were present significantly more commonly in both migraineurs and TMD patients. The results support an association with parafunction in the aetiology of mandibular tori and suggest that tori are a useful marker of past or present parafunction in some patients.     

Comparison of ceftibuten once daily and amoxicillin-clavulanate three times daily in the treatment of acute exacerbations of chronic bronchitis

In medical practice, antibiotics are generally given empirically for the treatment of acute exacerbations of chronic bronchitis (AECB). To be effective, antibiotic therapy should be broad in spectrum, and it should also cover the common beta-lactamase-producing pathogens. In this multicenter, randomized, investigator-masked study, 469 patients with AECB were randomized (in a ratio of 2:1) to receive 400-mg oral ceftibuten capsules once daily or 500-mg amoxicillin-clavulanate tablets three times daily for 5 to 15 days. Patients receiving ceftibuten were further divided into those who took the capsule with a meal (fed) and those who took the capsule 1 hour before a meal (fasted). Clinical and microbiologic responses were evaluated after treatment at 0 to 6 days (end of treatment) and 7 to 21 days (follow-up). Overall clinical success was determined by cure/improvement of signs and symptoms of AECB at the end of treatment and at follow-up. Overall microbiologic assessment was graded as eradication, persistence, relapse, reinfection, colonization, superinfection, or unassessable. Tolerability was evaluated by grading observed adverse events. The mean duration of treatment was 10.4 days for patients who received ceftibuten and 10.1 days for patients who received amoxicillin-clavulanate. A total of 252 patients receiving ceftibuten and 117 patients receiving amoxicillin-clavulanate were evaluable for clinical efficacy, and 55 patients were evaluable for microbiologic response. Both treatments improved the signs and symptoms of bronchitis, and overall clinical success rates were equivalent for patients treated with ceftibuten (211 of 252 [84%]) and amoxicillin-clavulanate (93 of 117 [79%]) (95% confidence interval [CI], -4.5% to 13.6%). Overall microbiologic eradication rates were also similar for patients treated with ceftibuten (36 of 37 [97%]) and amoxicillin-clavulanate (12 of 14 [86%]) (95% CI, -5.2% to 21.2%). The most frequently reported treatment-related adverse events were gastrointestinal disturbances, which occurred in 15% (47 of 316) and 24% (36 of 152) of patients treated with ceftibuten and amoxicillin-clavulanate, respectively. No significant difference was observed in the ceftibutenfed and ceftibuten-fasted groups in overall clinical assessments of the clinical efficacy population and safety population. In conclusion, 400 mg oral ceftibuten once daily has a similar clinical success rate to 500 mg amoxicillin-clavulanate three times daily, with a trend toward fewer gastrointestinal side effects, in the treatment of patients with AECB.     

Helicobacter pylori, acid, and omeprazole revisited: bacterial eradication and rebound hypersecretion

Mouse blastocysts were exposed for 24 h to various concentrations of recombinant mouse tumor necrosis factor alpha (TNFalpha) and observed for their capacity to implant in vitro on a fibronectin-coated substrate or to develop in vivo after their transfer into surrogate females. Compared with findings in control blastocysts, exposure to TNFalpha resulted in a significant reduction in the average number of cells in the inner cell mass (ICM) lineage. This effect was associated with a significant increase in the frequency of cells identified as engaged in apoptosis by means of the terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling technique. No difference was found in the incidence of nuclear fragmentation between control and TNFalpha-exposed blastocysts. When TNFalpha-pretreated blastocysts were allowed to implant in vitro, significantly fewer embryos were able to maintain a structured ICM cluster at the center of the trophectoderm outgrowth. Although no difference was found in the average surface area of the outgrowths, implants derived from TNFalpha-treated blastocysts contained significantly fewer nuclei than implants from control embryos. After transfer into recipient mice, TNFalpha-pretreated blastocysts implanted at about the same rate as control embryos, but a significantly higher rate of resorption was found among fetuses after exposure to the cytokine. In addition, the weight of the surviving fetuses was significantly lower than for control fetuses. These data indicate that the impact of TNFalpha on blastocysts is specifically aimed at the ICM lineage and that TNFalpha decreases the ability of embryos to differentiate into fetuses after implantation.