Headache
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Comparative Study
Quantitative assessment of the tension-type headache and migraine severity continuum.
Two quantitative measures for Waters' tension-type headache and migraine severity continuum are proposed. To ensure face validity, symptoms and precipitants of this disorder were complied from the literature as a basis for the Auckland Migraine and Headache Inventory. This inventory was completed by 84 participants (mean age +/- SD, 26.0 +/- 9.7 years; range, 18 to 59 years) who complied with the criteria of the International Headache Society for migraine or tension-type headache. ⋯ These scores yielded significant internal reliability (r = .77 and .84), test-retest reliability (r = .86 and .74), and concurrent validity (r = .57) coefficients. The data, therefore, support the notion that the migraine headache index and the number of precipitants are reliable and valid indices of tension-type headache and migraine severity, suitable for participant selection and assessment of treatment. This study offers support for Waters' suggestion that tension-type headache and migraine are extremes of a severity continuum.
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One hundred consecutive patients, the majority suffering from bilateral chronic tension-type headache, investigated with lumbar puncture, were studied as to age, sex, body mass index, diagnosis, lumbar cerebrospinal fluid pressure, and signs of inflammation in the serum in relation to postlumbar puncture headache. Patients younger than 40 years of age were significantly more prone to develop postlumbar puncture headache than patients older than 40 years of age (P = 0.01). Sex, body mass index, cerebrospinal fluid pressure, and signs of inflammation in the serum were not related to the frequency of postlumbar puncture headache in the present study. ⋯ In a regression analysis with age, sex, and chronic tension-type headaches, only bilateral headache contributed significantly to the prediction of postlumbar puncture headache (P < 0.01). Age did not contribute apart from the common variance with chronic tension-type headache/no chronic tension-type headache. The results may indicate that postlumbar puncture headache and chronic tension-type headache have etiologic mechanisms in common, mechanisms presumably localized intracranially rather than extracranially.
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The aim of the present study was to examine the ability of pericranial muscle tenderness and the second exteroceptive suppression period to distinguish chronic tension-type headache sufferers, migraine sufferers, and controls in a young adult population utilizing a blind design. The second exteroceptive suppression periods were assessed using the methodology recommended by the European Headache Federation and were scored with an automated computer software program designed in our laboratory to provide reliable, standardized, and precise quantification of exteroceptive suppression periods and eliminate any influence of experimenter bias that may occur with manual scoring. Our sample consisted of 45 subjects diagnosed according to IHS criteria: 25 with chronic tension-type headache and 20 with migraine without aura. ⋯ Pericranial muscle tenderness was quite successful in distinguishing recurrent headache sufferers from controls, but failed to distinguish chronic tension-type headache sufferers from migraineurs. Our findings raise the possibility that pericranial muscle tenderness is present early in the development of chronic tension-type headache and migraine without aura, and thus might contribute to the etiology of headache disorders. Our findings also indicate that a shortened second exteroceptive suppression period is not a reliable marker for chronic tension-type headache in young adults.
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Refractory headache patients who require narcotic injections for acute attacks frequently utilize health care facilities. The experience is often unpleasant and costly to the patient and health care system. We have developed an oral narcotic protocol for home administration. ⋯ An annual cost savings of $1960 for office visits and $3024 for emergency department visits was realized. This was offset by an oral narcotic protocol medication cost of only $392. This treatment method has been well accepted by patients and has proven to be a safe and cost-effective approach to treating refractory migraine patients.
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Comparative Study
Headache and self-assessed depression scores in Singapore University undergraduates.
A self-administered questionnaire covering the diagnostic criteria of the International Headache Society was completed by 1208 undergraduates of the National University of Singapore to determine the prevalence and characteristics of headaches in this population. The relationship between headaches and depressive illness was investigated with the Zung Self-assessed Depression Scale. The mean age of respondents was 20.9 +/- 1.6 years; 50.3% were men and 46.4%, women. ⋯ The lifetime prevalence of headache in this population was 98.1%. Significantly higher mean Zung scores were found in subjects who had more intense and frequent headaches than in those without headaches and less severe symptoms, although the clinical relevance of this finding is uncertain. Zung scores did not differ significantly with diagnostic group, sex, or race.