Symptoms experienced in connection with mobile phone use

Headache in the international cohort study of mobile phone use and health (COSMOS) in the Netherlands and the United Kingdom

Headache is a common condition with a substantial burden of disease worldwide. Concerns have been raised over the potential impact of long-term mobile phone use on headache due to radiofrequency electromagnetic fields (RF-EMFs). We explored prospectively the association between mobile phone use at baseline (2009-2012) and headache at follow-up (2015-2018) by analysing pooled data consisting of the Dutch and UK cohorts of the Cohort Study of Mobile Phone Use and Health (COSMOS) (N = 78,437). Frequency of headache, migraine, and information on mobile phone use, including use of hands-free devices and frequency of texting, were self-reported. We collected objective operator data to obtain regression calibrated estimates of voice call duration. In the model mutually adjusted for call-time and text messaging, participants in the high category of call-time showed an adjusted odds ratio (OR) of 1.04 (95 % CI: 0.94-1.15), with no clear trend of reporting headache with increasing call-time. However, we found an increased risk of weekly headache (OR = 1.40, 95 % CI: 1.25-1.56) in the high category of text messaging, with a clear increase in reporting headache with increasing texting. Due to the negligible exposure to RF-EMFs from texting, our results suggest that mechanisms other than RF-EMFs are responsible for the increased risk of headache that we found among mobile phone users.

The effects of radiofrequency electromagnetic fields exposure on tinnitus, migraine and non-specific symptoms in the general and working population: A systematic review and meta-analysis on human observational studies

BACKGROUND

Applications emitting radiofrequency electromagnetic fields (RF-EMF; 100 kHz to 300 GHz) are widely used for communication (e.g. mobile phones), in medicine (diathermy) and in industry (RF heaters).

OBJECTIVES

The objective is to systematically review the effects of longer-term or repeated local and whole human body radiofrequency electromagnetic field (RF-EMF) exposure on the occurrence of symptoms. Primary hypotheses were tinnitus, migraine and headaches in relation to RF-EMF exposure of the brain, sleep disturbances and composite symptom scores in relation to whole-body RF-EMF exposure.

METHODS

Eligibility criteria: We included case-control and prospective cohort studies in the general population or workers estimating local or whole-body RF-EMF exposure for at least one week.

INFORMATION SOURCES

We conducted a systematic literature search in various databases including Web of Science and Medline. Risk of bias: We used the Risk of Bias (RoB) tool developed by OHAT adapted to the topic of this review.

SYNTHESIS OF RESULTS

We synthesized studies using random effects meta-analysis.

RESULTS

Included studies: We included 13 papers from eight distinct cohort and one case-control studies with a total of 486,558 participants conducted exclusively in Europe. Tinnitus is addressed in three papers, migraine in one, headaches in six, sleep disturbances in five, and composite symptom scores in five papers. Only one study addressed occupational exposure.

SYNTHESIS OF RESULTS

For all five priority hypotheses, available research suggests that RF-EMF exposure below guideline values does not cause symptoms, but the evidence is very uncertain. The very low certainty evidence is due the low number of studies, possible risk of bias in some studies, inconsistencies, indirectness, and imprecision. In terms of non-priority hypotheses numerous exposure-outcome combinations were addressed in the 13 eligible papers without indication for an association related to a specific symptom or exposure source.

DISCUSSION

Limitations of evidence: This review topic includes various challenges related to confounding control and exposure assessment. Many of these aspects are inherently present and not easy to be solved in future research. Since near-field exposure from wireless communication devices is related to lifestyle, a particular challenge is to differentiate between potential biophysical effects and other potential effects from extensive use of wireless communication devices that may compete with healthy behaviour such as sleeping or physical activity. Future research needs novel and innovative methods to differentiate between these two hypothetical mechanisms.

INTERPRETATION

This is currently the best available evidence to underpin safety of RF-EMF. There is no indication that RF-EMF below guideline values causes symptoms. However, inherent limitations of the research results in substantial uncertainty.

OTHER

Funding: This review was partially funded by the WHO radioprotection programme.

REGISTRATION

The protocol for this review has been registered in Prospero (reg no CRD42021239432) and published in Environment International (Röösli et al., 2021).

Review of the scientific evidence on the individual sensitivity to electromagnetic fields (EHS)

Part of the population considers themselves as sensitive to the man-made electromagnetic radiation (EMF) emitted by powerlines, electric wiring, electric home appliance and the wireless communication devices and networks. Sensitivity is characterized by a broad variety of non-specific symptoms that the sensitive people claim to experience when exposed to EMF. While the experienced symptoms are currently considered as a real life impairment, the factor causing these symptoms remains unclear. So far, scientists were unable to find causality link between symptoms experienced by sensitive persons and the exposures to EMF. However, as presented in this review, the executed to-date scientific studies, examining sensitivity to EMF, are of poor quality to find the link between EMF exposures and sensitivity symptoms of some people. It is logical to consider that the sensitivity to EMF exists but the scientific methodology used to find it is of insufficient quality. It is time to drop out psychology driven provocation studies that ask about feelings-based non-specific symptoms experienced by volunteers under EMF exposure. Such research approach produces only subjective and therefore highly unreliable data that is insufficient to prove, or to disprove, causality link between EHS and EMF. There is a need for a new direction in studying sensitivity to EMF. The basis for it is the notion of a commonly known phenomenon of individual sensitivity, where individuals' responses to EMF depend on the genetic and epigenetic properties of the individual. It is proposed here that new studies, combining provocation approach, where volunteers are exposed to EMF, and high-throughput technologies of transcriptomics and proteomics are used to generate objective data, detecting molecular level biochemical responses of human body to EMF.

Some thoughts on the possible health effects of electric and magnetic fields and exposure guidelines

Concerns about the possible health effects from exposure to weak electric and magnetic (EM) fields have been debated since the early 1960s. It is now well established that biological systems respond to exposure to weak EM fields at energy levels well below the current safety guidelines which result in modification of their functionality without significant changes in temperature. These observations are adding to the debate over what should be done to protect the users of cellular telecommunications systems. Experimental results showing both increases and decreases in cancer cell growth rates and concentration of reactive oxygen species for exposure to nano-Tesla magnetic fields at both radio frequencies (RF) and extra low frequencies (ELF) are cited in this paper. Some theoretical models on how variations in EM exposure can lead to different biological outcomes and how feedback and repair processes often mitigate potential health effects due to long-term exposure to low-level EM energy sources are presented. Of particular interest are the application of the radical pair mechanisms that affect polarization of electrons, and nuclear spins and the importance of time-delayed feedback loops and the timing of perturbations to oscillations in biological systems. These models help account for some of the apparently conflicting experimental results reported and suggest further investigation. These observations are discussed with particular emphasis on setting future safety guidelines for exposure to electromagnetic fields in cellular telecommunications systems. The papers cited are a very small fraction of those in the literature showing both biological effects and no effects from weak electric and magnetic fields.

Nomophobia and the psycho-physiological effects of PUBG gaming on medical college student’s health and academic performance

Introduction and Aim: Nomophobia is a psychological condition, where people have a fear of being detached from mobile phone connectivity. The medical college students are suffering from PUBG addiction which affects their psycho-physiological parameters. The aim is to assess the prevalence of nomophobia in the medical college students, to assess the stress and anxiety in the absence of smartphone and correlate it with the conduction velocity of median nerve. Materials and Methods: A cross-sectional study was conducted in the physiology department of a tertiary care teaching hospital for a period of 2 months involving 169 medical students using smartphones. For studying   nomophobia, the students in the study group were divided into groups A and B according to their smartphone usage and on the basis of a Smartphone Addiction Scale (SPAS) Questionnaire.   Results: Out of the 169 students, 80 were subjected for the assessment of the variability in the median nerve conduction velocity as a quantitative measurement to detect the decrease in the terminal latency index, motor distal latency and the conduction velocity due to excessive gaming or chronic smartphone usage. As per our hypothesis 94.37 % of the study sample had decreased terminal latency index and about 85.62 % of students had a decreased nerve conduction velocity. Conclusion: The prevalence of nomophobia in our study was 37.39 % as per the ICD-10 diagnostic criteria for dependence syndrome. Hence medical education to school-going children, teenagers and adolescents about the risks of excessive smartphone usage should be given as they are the most vulnerable to this disorder.

The effects of radiofrequency electromagnetic fields exposure on human self-reported symptoms: A protocol for a systematic review of human experimental studies

BACKGROUND

The technological applications of radiofrequency electromagnetic fields (RF-EMF) have been steadily increasing since the 1950s across multiple sectors exposing large proportions of the population. This fact has raised concerns related to the potential consequences to people's health. The World Health Organization (WHO) is assessing the potential health effects of exposure to RF-EMF and has carried out an international survey amongst experts, who have identified six priority topics to be further addressed through systematic reviews, whereof the effects on symptoms is one of them. We report here the systematic review protocol of experimental studies in humans assessing the effects of RF-EMF on symptoms.

OBJECTIVE

Our objectives are to assess the effects of exposure to electromagnetic fields (compared to no or lower exposure levels) on symptoms in human subjects. We will also assess the accuracy of perception of presence of exposure in volunteers with and without idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF).

ELIGIBILITY CRITERIA

We will search relevant literature sources (e.g. the Web of Science, Medline, Embase, Epistemonikos) for randomized trials (comparing at least two arms) and randomised crossover trials of RF-EMF exposure that have assessed the effects on symptoms. We will also include studies that have measured the accuracy of the perception of the presence or absence of exposure. We will include studies in any language.

STUDY APPRAISAL AND SYNTHESIS

Studies will be assessed against inclusion criteria by two independent reviewers. Data on study characteristics, participants, exposure, comparators and effects will be extracted using a specific template for this review, by two independent reviewers. Discrepancies will be solved by consensus. Risk of bias (ROB) will be assessed using the ROB Rating Tool for Human and Animal Studies and the level of confidence in the evidence of the exposure-outcome relations will be assessed using the GRADE approach. For the perception studies, we will use adapted versions of the ROB tool and GRADE assessment. Where appropriate, data will be combined using meta-analytical techniques.

The effects of radiofrequency electromagnetic fields exposure on tinnitus, migraine and non-specific symptoms in the general and working population: A protocol for a systematic review on human observational studies

BACKGROUND

Applications emitting radiofrequency electromagnetic fields (RF-EMF; 100 kHz to 300 GHz) are widely used for communication (e.g. mobile phones), in medicine (diathermy) and in industry (RF heaters). Concern has been raised that RF-EMF exposure affects health related quality of life, because a part of the population reports to experience a variety of symptoms related to low exposure levels below regulatory limits.

OBJECTIVES

To systematically review the effects of longer-term or repeated local and whole human body RF-EMF exposure on the occurrence of symptoms evaluating migraine, tinnitus, headaches, sleep disturbances and composite symptom scores as primary outcomes.

METHODS

We will follow the WHO handbook for guideline development. For the development of the systematic review protocol we considered handbook for conducting systematic reviews for health effects evaluations from the National Toxicology Program-Office of Health Assessment and Translation (NTP-OHAT) and COSTER (Recommendations for the conduct of systematic reviews in toxicology and environmental health research).

ELIGIBILITY CRITERIA

Peer-reviewed epidemiological studies in the general population or workers aiming to investigate the association between local or whole-body RF-EMF exposure for at least one week and symptoms are eligible for inclusion. Only cohort, case-control and panel studies will be included.

INFORMATION SOURCES

We will search the scientific literature databases Medline, Web of Science, PsycInfo, Cochrane Library, Epistemonikos and Embase, using a predefined search strategy. This search will be supplemented by a search in the EMF-Portal and checks of reference lists of relevant papers and reviews.

STUDY APPRAISAL AND SYNTHESIS METHOD

Data from included papers will be extracted according to predefined forms. Findings will be summarized in tables, graphical displays and in a narrative synthesis of the available evidence, complemented with meta-analyses. We will separately review effects of local, far field and occupational exposure.

RISK OF BIAS

The internal validity of included studies will be assessed using the NTP-OHAT Risk of Bias Rating Tool for Human and Animal Studies, elaborated to observational RF-EMF studies.

EVIDENCE APPRAISAL

To rate certainty of the evidence, we will use the OHAT GRADE-based approach for epidemiological studies.

FRAMEWORK AND FUNDING

This protocol concerns one of the ten different systematic reviews considered in a larger systematic review of the World Health Organization to assess potential health effects of exposure to RF-EMF in the general and working population.

REGISTRATION

PROSPERO CRD42021239432.

Effect of Radiofrequency Waves of Mobile Phones on Distortion Product Otoacoustic Emissions

Objective The prolonged exposure to electromagnetic fields of mobile phones can damage the cochlear hair cells, which can be detected by otoacoustic emission (OAE). To know the effect of mobile phones on hearing, the young volunteers were subjected to prolonged mobile phone usage and changes in OAE were recorded.

Materials and Methods Twenty-eight volunteers with normal hearing were made to talk one full hour continuously on the mobile phone. Distortion product otoacoustic emission (DPOAE) was measured prior to the usage of mobile phones and immediately after the use (post-exposure 1) and 24 hours after the use (post-exposure 2). The values were compared.

Results Out of the 28 volunteers, 20 were females and 8 were males. Twenty-one volunteers preferred the right ear while using mobile phones, 7 preferred the left ear. There was no statistically significant difference between the baseline DPOAE values and values of post-exposure 1 and 2 when only the preferred ear was taken into consideration. When the preferred ear was compared with nonpreferred ear, a statistically significant difference was found only in the low frequencies between the pre-exposure and post-exposure 1 values.

Conclusion This study shows there was no significant correlation between OAE and prolonged mobile phone exposure when the preferred ear was not considered.

Effects of mobile phone radiofrequency radiation on sperm quality

In the last decades, the universal use of mobile phones has contributed to radiofrequency electromagnetic radiation environmental pollution. The steady growth in mobile phone usage has raised concerns about the effects of phone radiation on male reproductive health. Epidemiological studies report a sharp decline in sperm counts in developing countries, and worldwide with c. 14% of couples having difficulties to conceive, many of which are attributed to a male infertility factor. Environment and lifestyle factors are known to contribute to male infertility. Exposure to heat, radiation, or radioactivity might induce damage to biological tissue organs, including the testis. Given the ubiquitous use of mobile phones, the potential adverse effects of the resulting environmental radiation needs to be elucidated further. It seems to be an apparent relationship between the increased exposure to mobile phone radiofrequency and sperm quality decline, but the evidence is not conclusive. Our review summarizes the evidence concerning the possible adverse effects of cell phone radiation on the male reproductive system, with a focus on sperm quality. Also, we critically analyze the effects of elevated testicular temperature and oxidative stress on male fertility and how these factors could interfere with the physiological activities of the testis.

Radiofrequency radiation: A possible threat to male fertility

Radiofrequency exposure from man-made sources has increased drastically with the era of advanced technology. People could not escape from such RF radiations as they have become the essential part of our routine life such as Wi-Fi, microwave ovens, TV, mobile phones, etc. Although non-ionizing radiations are less damaging than ionizing radiations but its long term exposure effect cannot be avoided. For fertility to be affected, either there is an alteration in germ cell, or its nourishing environment, and RF affects both the parameters subsequently, leading to infertility. This review with the help of in vitro and in vivo studies shows that RF could change the morphology and physiology of germ cells with affected spermatogenesis, motility and reduced concentration of male gametes. RF also results in genetic and hormonal changes. In addition, the contribution of oxidative stress and protein kinase complex after RFR exposure is also summarized which could also be the possible mechanism for reduction in sperm parameters. Further, some preventative measures are described which could help in reverting the radiofrequency effects on germ cells.

Adverse Effect of Mobile Phone on Hearing in Healthy Individuals: A Clinical Study

The mobile phone is a ubiquitous piece in this modern world. An estimated 85% of Americans, 80% of the British, and perhaps 75% of Indians use it, as of today. Mobile phones communicate by transmitting radio waves through a network of fixed antennas called base stations. Radio frequency waves are electromagnetic fields, and unlike ionizing radiation such as X-rays or gamma rays, can neither break chemical bonds nor cause ionization in the human body. 1000 participants from outpatient department of a tertiary care center over a period of one and a half years, were included in the study and were divided equally into case (> 1 year use) and control (< 1 year use) groups. Out of 500 cases, maximum 233(46.6%) subjects were using mobile since last 4-6 year and 134(26.8%) were using mobile since last 7-9 year and maximum 344(68.8%) subjects were using mobile 1-3 h/day and 145(29.0%) were using mobile 4-6 h/day.

Thermal effects of mobile phones on human auricle region

Mobile phones have become an indispensable utility to modern society, with international use increasing dramatically each year. The GSM signal operates at 900 MHz, 1800 MHz and 2250 MHz, may potentially cause harm to human tissue. Yet there is no in silico model to aid design these devices to protect from causing potential thermal effect. Here we present a model of sources of heating in a mobile phone device with experimental verification during the phone call. We have developed this mobile phone thermal model using first principles on COMSOL® Multiphysics modelling platform to simulate heating effect in human auricle region due to mobile phone use. In particular, our model considered both radiative and non-radiative heating from components such as the lithium ion battery, CPU circuitry and the antenna. The model showed the distribution and effect of the heating effect due to mobile phone use and considered impact of battery discharge rate, battery capacity, battery cathode material, biological tissue distance, antenna radio-wave frequency and intensity. Furthermore, the lithium ion battery heating was validated during experiments using temperature sensors with an excellent agreement between simulated and experimental data (<1% variation). Mobile phone heating during a typical call has also been simulated and compared with experimental infrared thermographic imaging. Importantly, we found that 1800 MHz frequency of data transmission showed the highest temperature increase in the fat/water phantom used in this simulation. We also successfully compared heating distribution in human auricle region during mobile phone use with clinical thermographic images with reasonable qualitative and quantitative agreements. In summary, our model provides a foundation to conceive thermal and other physical effects caused by mobile phone use and allow for the understanding of potential negative health effects thus supporting and promoting personalized and preventive medicine using thermography.

Musculoskeletal disorder and pain associated with smartphone use: A systematic review of biomechanical evidence

The number of smartphone users is growing dramatically. Using the smartphone frequently forces the users to adopt an awkward posture leading to an increased risk of musculoskeletal disorders and pain. The objective of this study is to conduct a systematic review of studies that assess the effect of smartphone use on musculoskeletal disorders and pain. A systematic literature search of AMED, CINAHL, PubMed, Proquest, ScienceDirect using specific keywords relating to smartphone, musculoskeletal disorders and pain was conducted. Reference lists of related papers were searched for additional studies. Methodological quality was assessed by two independent reviewers using the modified Downs and Black checklist. From 639 reports identified from electronic databases, 11 were eligible to include in the review. One paper was found from the list of references and added to the review. The quality scores were rated as moderate. The results show that muscle activity of upper trapezius, erector spinae and the neck extensor muscles are increased as well as head flexion angle, head tilt angle and forward head shifting which increased during the smartphone use. Also, smartphone use in a sitting position seems to cause more shift in head-neck angle than in a standing position. Smartphone usage may contribute to musculoskeletal disorders. The findings of the included papers should be interpreted carefully in light of the issues highlighted by the moderate-quality assessment scores.

Effects of very high-frequency sound and ultrasound on humans. Part II: A double-blind randomized provocation study of inaudible 20-kHz ultrasound

Some people have reported symptoms such as nausea, dizziness, and headaches that they attribute to ultrasound (US) emitted by devices in public places. The primary aim of the present study was to investigate whether inaudible US can provoke adverse symptoms compared to a sham presentation, under double-blind conditions. A second aim was to investigate whether the expectation of US being present could provoke adverse symptoms (a nocebo response). The US stimulus was a 20 kHz tone presented continuously for 20 min set to at least 15 dB below the participants' detection threshold, giving a typical sound pressure level (SPL) of 84 dB. No evidence that US provoked symptoms was found, but there was evidence of small nocebo effects. A case study on an individual with high self-reported sensitivity to US gave similar results. The present study did not reproduce the severe symptoms reported previously by some members of the public; this may be due to the SPL or duration of the stimulus, or strength of the nocebo stimulus. These findings cannot be used to predict outcomes from exposures to sounds that are audible to the individual in question, or to sounds with higher SPLs, longer durations, or different frequency content.

The Effect of a Single 30-Min Long Term Evolution Mobile Phone-Like Exposure on Thermal Pain Threshold of Young Healthy Volunteers

Although the majority of mobile phone (MP) users do not attribute adverse effects on health or well-being to MP-emitted radiofrequency (RF) electromagnetic fields (EMFs), the exponential increase in the number of RF devices necessitates continuing research aimed at the objective investigation of such concerns. Here we investigated the effects of acute exposure from Long Term Evolution (LTE) MP EMFs on thermal pain threshold in healthy young adults. We use a protocol that was validated in a previous study in a capsaicin-induced hyperalgesia model and was also successfully used to show that exposure from an RF source mimicking a Universal Mobile Telecommunications System (UMTS) MP led to mildly stronger desensitization to repeated noxious thermal stimulation relative to the sham condition. Using the same experimental design, we did not find any effects of LTE exposure on thermal pain threshold. The present results, contrary to previous evidence obtained with the UMTS modulation, are likely to originate from placebo/nocebo effects and are unrelated to the brief acute LTE EMF exposure itself. The fact that this is dissimilar to our previous results on UMTS exposure implies that RF modulations might differentially affect pain perception and points to the necessity of further research on the topic.

Investigating Associations Between Changes in Mobile Phone Use and Emotions Using the Experience Sampling Method: Pilot Study

Background

The use of mobile phones has become, especially for young people, an integrated part of everyday life. Using the experience sampling method (ESM) may provide further insight on the association between mobile phone use and mental health.

Objective

The objective of this study was to examine associations between mobile phone use and subtle changes in mental state.

Methods

The ESM-based PsyMate app was installed on the mobile phones of 2 healthy 20-year-old participants. Over a period of 3 months, participants rated their mental states at 10 semirandom moments in the flow of daily life. Each assessment included present state emotions, environmental circumstances, and phone use.

Results

Multilevel regression analyses indicated that an increase in mobile phone use was associated with a small increase in negative affect (particularly feeling bored and feeling lonely; P<.001) and small decreases in positive affect (P=.002) and concentration (P=.001). Treating the data as 2 separate N=1 studies revealed that the association with negative affect was present in both participants, whereas the associations with positive affect and concentration were evident in only 1 of the 2 participants.

Conclusions

This pilot study suggests that mobile phone use may be associated with person-specific and group-level changes in emotional state. A larger study is required to study these associations, possible causality, and factors driving underlying heterogeneity in the pattern of associations.

Trial registration

ClinicalTrials.gov NCT03221985; https://clinicaltrials.gov/ct2/show/NCT03221985 (archived by WebCite at http://www.webcitation.org/6zJnp61Wj)

Environmental Toxins and Male Fertility

PURPOSE OF REVIEW

Global industrialization has increased population exposure to environmental toxins. A global decline in sperm quality over the last few decades raises questions about the adverse impact of environmental toxins on male reproductive health.

RECENT FINDINGS

Multiple animal- and human-based studies on exposure to environmental toxins suggest a negative impact on semen quality, in terms of sperm concentration, motility, and/or morphology. These toxins may exert estrogenic and/or anti-androgenic effects, which in turn alter the hypothalamic-pituitary-gonadal axis (HPGA), induce sperm DNA damage, or cause sperm epigenetic changes. This chapter will discuss the most recent literature about the most common environmental toxins and their impact on spermatogenesis and its consequences on male fertility. Understanding the presence and underlying mechanism of these toxins will help us preserve the integrity of the male reproduction system and formulate better regulations against their indiscriminate use.

Radiation Effects of Mobile Phones and Tablets on the Skin: A Systematic Review

BACKGROUND

Skin health has become a worldwide concern. Most of the studies investigated the effect of mobile phone radiation on DNA and animals, but a few studies were carried out about skin diseases in mobile phone and tablet users. Few systematic studies have examined the relationship between mobile phone exposure and skin diseases.

METHODS

We evaluated the association between mobile phones and tablets and skin diseases. We checked databases including PubMed, Scopus, Springer, Cochrane, and Google Scholar from 1995 to 2013. The eligibility criteria were descriptive, and observational studies were in English and Persian language, and the subjects were of all ages and reported skin disease.

RESULTS

Most of the studies focused on signs and less on skin cancer. In total, 6 studies were included with 392119 participants with age over 25 years. In a nationwide cohort study in Denmark for BCC, the IRR (incidence rate ratios) estimates remained near unity among men and women. In the other studies, they reported an increase in temperature, hypersensitivity of warmth, facial dermatitis, angiosarcoma of the scalp, and burning sensations in the facial skin after mobile phone use on the exposed side and more within the auricle and behind/around the ear.

CONCLUSIONS

Overall evaluations showed that the level of evidence associated with the effects of radiation from the mobile phone and tablet on the skin is poor. This review shows a necessity for more studies in this area.

Mobile Phone Use and The Risk of Headache: A Systematic Review and Meta-analysis of Cross-sectional Studies

Headache is increasingly being reported as a detrimental effect of mobile phone (MP) use. However, studies aimed to investigate the association between MP use and headache yielded conflicting results. To assess the consistency of the data on the topic, we performed a systematic review and meta-analysis of the available cross-sectional studies. Published literature from PubMed and other databases were retrieved and screened, and 7 cross-sectional studies were finally included in this meta-analysis. The pooled odds ratio (OR) and 95% confidence interval (CI) were calculated. We found that the risk of headache was increased by 38% in MP user compared with non-MP user (OR, 1.38; 95% CI, 1.18–1.61, p < 0.001). Among MP users, the risk of headache was also increased in those who had longer daily call duration (2–15 min vs. <2 min: OR, 1.62; 95% CI, 1.34–1.98, p < 0.001; >15 min vs. <2 min: OR, 2.50; 95% CI, 1.76–3.54, p < 0.001) and higher daily call frequency (2–4 calls vs. <2 calls: OR, 1.37; 95% CI, 1.07–1.76, p < 0.001; >4 calls vs. <2 calls: OR, 2.52; 95% CI, 1.78–3.58, p < 0.001). Our data indicate that MP use is significantly associated with headache, further epidemiologic and experimental studies are required to affirm and understand this association.

Mobile Phone Headache: A Double Blind, Sham-Controlled Provocation Study

The objective was to test whether exposure to radio frequency (RF) fields from mobile phones may cause head pain or discomfort and whether it may influence physiological variables in individuals attributing symptoms to mobile phones, but not to electromagnetic fields in general. Seventeen eligible individuals, who experienced these symptoms in an open provocation test, took part in a double-blind, randomized provocation study with cross-over design. Sixty-five pairs of sham and mobile phone RF exposures were conducted. The increase in pain or discomfort (visual analogue scales) in RF sessions was 10.1 and in sham sessions 12.6 ( P = 0.30). Changes in heart rate or blood pressure were not related to the type of exposure ( P: 0.30-0.88). The study gave no evidence that RF fields from mobile phones may cause head pain or discomfort or influence physiological variables. The most likely reason for the symptoms is a nocebo effect.

Association between Exposure to Smartphones and Ocular Health in Adolescents

PURPOSE

Smartphone use has dramatically increased in recent years. Smartphones may have adverse health effects, particularly on the eyes, because users stare at the screen for a much longer time than they do with ordinary mobile phones. The objective of this study was to elucidate the relationship between smartphone use and ocular symptoms among adolescents.

METHODS

Information on smartphone use and ocular symptoms (blurring, redness, visual disturbance, secretion, inflammation, lacrimation and dryness) related to eye fatigue and strain from 715 adolescent subjects from three cities in Korea was obtained using a structured questionnaire. Ocular health was scored using number of ocular symptoms. Odds ratios (ORs), 95% confidence intervals (95% CIs) and p-values for ocular symptoms were calculated with binomial and multinomial logistic regression models.

RESULTS

Higher prevalence rates for ocular symptoms were observed in groups with greater exposure to smartphones (p < 0.05). Longer daily smartphone use was associated with a higher likelihood of having multiple ocular symptoms (5-7 symptoms out of 7 symptoms; p = 0.005). Excessive/intermittent use (>2 hours daily and ≤2 hours continuously) and excessive/persistent use (>2 hours daily and >2 hours continuously) compared to shorter use (<2 hours daily) were associated with multiple ocular symptoms (OR 2.18, 95% CI 1.09-4.39; OR 2.26, 95% CI 1.11-4.57, respectively). A higher lifetime exposure to smartphones was associated with a higher likelihood of having multiple ocular symptoms (OR 3.05, 95% CI 1.51-6.19; p = 0.001).

CONCLUSION

Increasing exposure to smartphones can have a negative impact on ocular health in adolescents.

Sleep health, messaging, headaches, and academic performance in high school students

AIM

We tested for associations of bedtime, sleep duration, instant messaging, and chronic headaches with hypersomnolence and academic performance in a sample of high school students in New Jersey, USA.

METHODS

Students were surveyed anonymously and asked to report their sleep and messaging habits, headache status, and overall grades.

RESULTS

We found that greater hypersomnolence was associated with later bedtimes, shorter sleep durations, and the presence of chronic headaches, but not with messaging after lights out. Also, we found that academic performance was lower in students who messaged after lights out, but it was not affected by headache status, bedtime, or sleep duration.

CONCLUSIONS

These results are consistent with other studies that have demonstrated associations between headaches and hypersomnolence and between instant messaging habits and academic performance. They also add to a growing literature on the relationships among use of electronic devices, sleep health, and academic performance by adolescents.

Effects of cell phone use on semen parameters: Results from the MARHCS cohort study in Chongqing, China

Epidemiological and experimental evidence for detrimental effects of cell phone use on semen quality is still equivocal. And that recruiting participants from infertility clinic not from general population may raise the possibility of a selection bias. To investigate effects of cell phone use on semen parameters in a general population,We screened and documented the cell phone use information of 794 young men from the Male Reproductive Health in Chongqing College students (MARHCS) cohort study in 2013, followed by 666 and 568 in 2014 and 2015, respectively. In the univariate regression analyses, we found that the daily duration of talking on the cell phone was significantly associated with decreased semen parameters, including sperm concentration [β coefficient=-6.32% per unit daily duration of talking on the cell phone (h); 95% confidence interval (CI), -11.94, -0.34] and total sperm count (-8.23; 95% CI, -14.38, -1.63) in 2013; semen volume (-8.37; 95% CI, -15.93, -0.13) and total sperm count (-16.59; 95% CI, -29.91, -0.73) in 2015]. Internet use via cellular networks was also associated with decreased sperm concentration and total sperm counts in 2013 and decreased semen volume in 2015. Multivariate analyses were used to adjust for the effects of potential confounders, and significant negative associations between internet use and semen parameters remained. Consistent but nonsignificant negative associations between talking on the cell phone and semen parameters persisted throughout the three study years, and the negative association was statistically significant in a mixed model that considered all three years of data on talking on the cell phone and semen quality. Our results showed that certain aspects of cell phone use may negatively affect sperm quality in men by decreasing the semen volume, sperm concentration, or sperm count, thus impairing male fertility.

Microwave frequency electromagnetic fields (EMFs) produce widespread neuropsychiatric effects including depression

Non-thermal microwave/lower frequency electromagnetic fields (EMFs) act via voltage-gated calcium channel (VGCC) activation. Calcium channel blockers block EMF effects and several types of additional evidence confirm this mechanism. Low intensity microwave EMFs have been proposed to produce neuropsychiatric effects, sometimes called microwave syndrome, and the focus of this review is whether these are indeed well documented and consistent with the known mechanism(s) of action of such EMFs. VGCCs occur in very high densities throughout the nervous system and have near universal roles in release of neurotransmitters and neuroendocrine hormones. Soviet and Western literature shows that much of the impact of non-thermal microwave exposures in experimental animals occurs in the brain and peripheral nervous system, such that nervous system histology and function show diverse and substantial changes. These may be generated through roles of VGCC activation, producing excessive neurotransmitter/neuroendocrine release as well as oxidative/nitrosative stress and other responses. Excessive VGCC activity has been shown from genetic polymorphism studies to have roles in producing neuropsychiatric changes in humans. Two U.S. government reports from the 1970s to 1980s provide evidence for many neuropsychiatric effects of non-thermal microwave EMFs, based on occupational exposure studies. 18 more recent epidemiological studies, provide substantial evidence that microwave EMFs from cell/mobile phone base stations, excessive cell/mobile phone usage and from wireless smart meters can each produce similar patterns of neuropsychiatric effects, with several of these studies showing clear dose-response relationships. Lesser evidence from 6 additional studies suggests that short wave, radio station, occupational and digital TV antenna exposures may produce similar neuropsychiatric effects. Among the more commonly reported changes are sleep disturbance/insomnia, headache, depression/depressive symptoms, fatigue/tiredness, dysesthesia, concentration/attention dysfunction, memory changes, dizziness, irritability, loss of appetite/body weight, restlessness/anxiety, nausea, skin burning/tingling/dermographism and EEG changes. In summary, then, the mechanism of action of microwave EMFs, the role of the VGCCs in the brain, the impact of non-thermal EMFs on the brain, extensive epidemiological studies performed over the past 50 years, and five criteria testing for causality, all collectively show that various non-thermal microwave EMF exposures produce diverse neuropsychiatric effects.

Electromagnetic radiation at 900 MHz induces sperm apoptosis through bcl-2, bax and caspase-3 signaling pathways in rats

Background

The decreased reproductive capacity of men is an important factor contributing to infertility. Accumulating evidence has shown that Electromagnetic radiation potentially has negative effects on human health. However, whether radio frequency electromagnetic radiation (RF-EMR) affects the human reproductive system still requires further investigation. Therefore, The present study investigates whether RF-EMR at a frequency of 900 MHz can trigger sperm cell apoptosis and affect semen morphology, concentration, and microstructure.

Methods

Twenty four rats were exposed to 900 MHz electromagnetic radiation with a special absorption rate of 0.66 ± 0.01 W/kg for 2 h/d. After 50d, the sperm count, morphology, apoptosis, reactive oxygen species (ROS), and total antioxidant capacity (TAC), representing the sum of enzymatic and nonenzymatic antioxidants, were investigated. Western blotting and reverse transcriptase PCR were used to determine the expression levels of apoptosis-related proteins and genes, including bcl-2, bax, cytochrome c, and capase-3.

Results

In the present study, the percentage of apoptotic sperm cells in the exposure group was significantly increased by 91.42 % compared with the control group. Moreover, the ROS concentration in exposure group was increased by 46.21 %, while the TAC was decreased by 28.01 %. Radiation also dramatically decreased the protein and mRNA expression of bcl-2 and increased that of bax, cytochrome c, and capase-3.

Conclusion

RF-EMR increases the ROS level and decreases TAC in rat sperm. Excessive oxidative stress alters the expression levels of apoptosis-related genes and triggers sperm apoptosis through bcl-2, bax, cytochrome c and caspase-3 signaling pathways.

The effects of electromagnetic fields on the number of ovarian primordial follicles: An experimental study

The aim of this study was to evaluate the effect of an electromagnetic field (EMF), generated close to the ovaries, on primordial follicles. A total of 16 rats were used in this study. The study group consisted of rats exposed to an EMF in the abdominal region for 15 min/d for 15 days. Both the study and control group were composed of eight rats. After the treatment period of 15 days, the ovaries of the rats were extracted, and sections of ovarian tissue were taken for histological evaluation. The independent samples t test was used to compare the two groups. In the study group, the means of the right and left ovarian follicle numbers were 34.00 ± 10.20 and 36.00 ± 10.53, respectively. The average total ovarian follicle number was 70.00 ± 19.03. In the control group, the means of the right and left ovarian follicle numbers were 78.50 ± 25.98 and 71.75 ± 29.66, respectively, and the average total ovarian follicle number was 150.25 ± 49.53. The comparisons of the means of the right and left ovarian follicle numbers and the means of the total ovarian follicle numbers between the study and control groups indicated that the study group had significantly fewer follicles (p < 0.001, p = 0.011, and p = 0.002, respectively). This study found a significant decrease in the number of ovarian follicles in rats exposed to an EMF. Further clinical studies are needed to reveal the effects of EMFs on ovarian reserve and infertility.

Effect of mobile telephones on sperm quality: a systematic review and meta-analysis

Mobile phones are owned by most of the adult population worldwide. Radio-frequency electromagnetic radiation (RF-EMR) from these devices could potentially affect sperm development and function. Around 14% of couples in high- and middle-income countries have difficulty conceiving, and there are unexplained declines in semen quality reported in several countries. Given the ubiquity of mobile phone use, the potential role of this environmental exposure needs to be clarified. A systematic review was therefore conducted, followed by meta-analysis using random effects models, to determine whether exposure to RF-EMR emitted from mobile phones affects human sperm quality. Participants were from fertility clinic and research centres. The sperm quality outcome measures were motility, viability and concentration, which are the parameters most frequently used in clinical settings to assess fertility. We used ten studies in the meta-analysis, including 1492 samples. Exposure to mobile phones was associated with reduced sperm motility (mean difference -8.1% (95% CI -13.1, -3.2)) and viability (mean difference -9.1% (95% CI -18.4, 0.2)), but the effects on concentration were more equivocal. The results were consistent across experimental in vitro and observational in vivo studies. We conclude that pooled results from in vitro and in vivo studies suggest that mobile phone exposure negatively affects sperm quality. Further study is required to determine the full clinical implications for both sub-fertile men and the general population.

Mobile phone use and health symptoms in children

BACKGROUND/PURPOSE

To investigate the mobile phone (MP) use for talking in relation to health symptoms among 2042 children aged 11-15 years in Taiwan.

METHODS

A nationwide, cross-sectional study, using the computer assisted telephone interview (CATI) technique, was conducted in 2009 to collect information on children's utilization of MPs and the perceived health symptoms reported by their parents.

RESULTS

The overall prevalence of MP use in the past month was estimated at 63.2% [95% confidence interval (CI) = 61.1-65.3%]. MP use was associated with a significantly increased adjusted odds ratio (AOR) for headaches and migraine (1.42, 95% CI = 1.12-1.81) and skin itches (1.84, 95% CI = 1.47-2.29). Children who regularly used MPs were also considered to have a health status worse than it was 1 year ago (β = 0.27, 95% CI = 0.17-0.37).

CONCLUSION

Although the cross-sectional design precludes the causal inference for the observed association, our study tended to suggest a need for more cautious use of MPs in children, because children are expected to experience a longer lifetime exposure to radiofrequency electromagnetic fields (RF-EMF) from MPs.

The risk of subjective symptoms in mobile phone users in Poland--an epidemiological study

OBJECTIVES

To assess the type and incidence of subjective symptoms related to the use of mobile phones in Polish users.

MATERIAL AND METHODS

The study was conducted in 2005 using a questionnaire survey. Although it has been quite a long time, up to now, no such data have been published for Poland. The questionnaire consisted of 53 questions concerning sex, age, education, general health, characteristics of a mobile phone (hand-held, loud-speaking unit) as well as the habits associated with its use (frequency and duration of calls, text messages, etc.) and complaints associated with using a mobile phone.

RESULTS

As many as 1800 questionnaires were sent. The response was obtained from 587 subjects aged 32.6 ± 11.3 (48.9% women, 51.1% men); the age did not differ significantly between men and women. The subjects owned a cell phone for an average of 3 years. Majority of the respondents used the phone intensively, i.e. daily (74%) or almost daily (20%). Headaches were reported significantly more often by the people who talked frequently and long in comparison with other users (63.2% of the subjects, p = 0.0029), just like the symptoms of fatigue (45%, p = 0.013). Also, the feeling of warmth around the ear and directly to the auricle was reported significantly more frequently by the intensive mobile phone users, compared with other mobile phone users (47.3%, p = 0.00004 vs. 44.6%, p = 0.00063, respectively). Most symptoms appeared during or immediately after a call and disappeared within 2 h after the call. Continuous headache, persisting for longer than 6 h since the end of a call, was reported by 26% of the subjects.

CONCLUSIONS

Our results show that the mobile phone users may experience subjective symptoms, the intensity of which depends on the intensity of use of mobile phones.

Cell phone usage and erectile function

INTRODUCTION

The objective of this pilot study was to report our experience concerning the effects of cell phone usage on erectile function (EF) in men.

MATERIAL AND METHODS

We recruited 20 consecutive men complaining of erectile dysfunction (ED) for at least six months (Group A), and another group of 10 healthy men with no complaints of ED (Group B). Anamnesis, basic laboratory investigations, and clinical examinations were performed. All men completed the German version of the Sexual Health Inventory for Men (SHIM) for evaluation of the International Index of Erectile Function (IIEF), as well as another questionnaire designed by our clinicians that assessed cell phone usage habits.

RESULTS

There was no significant difference between both groups regarding age, weight, height, and total testosterone (Table 1). The SHIM scores of Group A were significantly lower than that of Group B, 11.2 ±5 and 24.2 ±2.3, respectively. Total time spent talking on the cell phone per week was not significantly higher in Group A over B, 17.6 ±11.1 vs. 12.5 ±7 hours. Men with ED were found to carry their 'switched on' cell phones for a significantly longer time than those without ED, 4.4 ±3.6 vs. 1.8 ±1 hours per day.

CONCLUSIONS

We found a potential correlation with cell phone usage and a negative impact on EF. Further large-scale studies confirming our initial data and exploring the mechanisms involved in this phenomenon are recommended.

Are media warnings about the adverse health effects of modern life self-fulfilling? An experimental study on idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF)

OBJECTIVE

Medically unsubstantiated 'intolerances' to foods, chemicals and environmental toxins are common and are frequently discussed in the media. Idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF) is one such condition and is characterized by symptoms that are attributed to exposure to electromagnetic fields (EMF). In this experiment, we tested whether media reports promote the development of this condition.

METHODS

Participants (N=147) were randomly assigned to watch a television report about the adverse health effects of WiFi (n=76) or a control film (n=71). After watching their film, participants received a sham exposure to a WiFi signal (15 min). The principal outcome measure was symptom reports following the sham exposure. Secondary outcomes included worries about the health effects of EMF, attributing symptoms to the sham exposure and increases in perceived sensitivity to EMF.

RESULTS

82 (54%) of the 147 participants reported symptoms which they attributed to the sham exposure. The experimental film increased: EMF related worries (β=0.19; P=.019); post sham exposure symptoms among participants with high pre-existing anxiety (β=0.22; P=.008); the likelihood of symptoms being attributed to the sham exposure among people with high anxiety (β=.31; P=.001); and the likelihood of people who attributed their symptoms to the sham exposure believing themselves to be sensitive to EMF (β=0.16; P=.049).

CONCLUSION

Media reports about the adverse effects of supposedly hazardous substances can increase the likelihood of experiencing symptoms following sham exposure and developing an apparent sensitivity to it. Greater engagement between journalists and scientists is required to counter these negative effects.

Ringxiety and the Mobile Phone Usage Pattern among the Students of a Medical College in South India

AIMS

Technologies like mobile phones may not always work positively but they may have unforeseen adverse effects. This study was conducted to find the proportion of students who experienced ringxiety (phantom ringing) and other perceived effects, as well as the pattern of the mobile phone usage among college students.

METHOD

A cross-sectional study was carried out at Kasturba Medical College, Mangalore, south India, among 336 medical students by using a pre-tested, semi-structured questionnaire.

RESULTS

Among the total number of students, 335 students possessed mobile phones. Mostly, the persons whom they talked to on their phones were parents for 220 (51%) of the students. 48% (150) talked for less than half hour in a day and 41% (137) were high volume message users. "Ringxiety" was experienced by 34.5% (116) of the students and they were more likely to use their phones at restricted places like classrooms (99%) and libraries (60.3%). A significantly larger proportion of ringxiety sufferers also complained of hampered studies.

CONCLUSION

The pattern of mobile phone use among the medical students appeared to be problematic, as a fairly large proportion suffered from ringxiety, they reported getting very upset and they used their phones at restricted times and places. This problem needs to be recognized, all stakeholders must be made aware of the symptoms and measures must be taken to reduce it.

Prenatal and Postnatal Cell Phone Exposures and Headaches in Children

OBJECTIVE

Children today are exposed to cell phones early in life, and may be at the greatest risk if exposure is harmful to health. We investigated associations between cell phone exposures and headaches in children.

STUDY DESIGN

The Danish National Birth Cohort enrolled pregnant women between 1996 and 2002. When their children reached age seven years, mothers completed a questionnaire regarding the child's health, behaviors, and exposures. We used multivariable adjusted models to relate prenatal only, postnatal only, or both prenatal and postnatal cell phone exposure to whether the child had migraines and headache-related symptoms.

RESULTS

Our analyses included data from 52,680 children. Children with cell phone exposure had higher odds of migraines and headache-related symptoms than children with no exposure. The odds ratio for migraines was 1.30 (95% confidence interval: 1.01-1.68) and for headache-related symptoms was 1.32 (95% confidence interval: 1.23-1.40) for children with both prenatal and postnatal exposure.

CONCLUSIONS

In this study, cell phone exposures were associated with headaches in children, but the associations may not be causal given the potential for uncontrolled confounding and misclassification in observational studies such as this. However, given the widespread use of cell phones, if a causal effect exists it would have great public health impact.

Exposure to radiofrequency electromagnetic fields and sleep quality: a prospective cohort study

Background

There is persistent public concern about sleep disturbances due to radiofrequency electromagnetic field (RF-EMF) exposure. The aim of this prospective cohort study was to investigate whether sleep quality is affected by mobile phone use or by other RF-EMF sources in the everyday environment.

Methods

We conducted a prospective cohort study with 955 study participants aged between 30 and 60 years. Sleep quality and daytime sleepiness was assessed by means of standardized questionnaires in May 2008 (baseline) and May 2009 (follow-up). We also asked about mobile and cordless phone use and asked study participants for consent to obtain their mobile phone connection data from the mobile phone operators. Exposure to environmental RF-EMF was computed for each study participant using a previously developed and validated prediction model. In a nested sample of 119 study participants, RF-EMF exposure was measured in the bedroom and data on sleep behavior was collected by means of actigraphy during two weeks. Data were analyzed using multivariable regression models adjusted for relevant confounders.

Results

In the longitudinal analyses neither operator-recorded nor self-reported mobile phone use was associated with sleep disturbances or daytime sleepiness. Also, exposure to environmental RF-EMF did not affect self-reported sleep quality. The results from the longitudinal analyses were confirmed in the nested sleep study with objectively recorded exposure and measured sleep behavior data.

Conclusions

We did not find evidence for adverse effects on sleep quality from RF-EMF exposure in our everyday environment.

Cell phones and male infertility: a review of recent innovations in technology and consequences

Cell phones have become a vital part of everyday life. However, the health risks associated with their usage are often overlooked. Recently, evidence from several studies supports a growing claim that cell phone usage may have a detrimental effect on sperm parameters leading to decreased male fertility. Nonetheless, other studies showed no conclusive link between male infertility and cell phone usage. The ambiguity of such results is attributed to the lack of a centralized assay for measuring inflicted damage caused by cell phones. Study design, ethics, and reproducibility are all aspects which must be standardized before any conclusions can be made.

Effects of 1800-MHz radiofrequency fields on circadian rhythm of plasma melatonin and testosterone in male rats

Radiofrequency fields (RF) at 1800 MHz are known to affect melatonin (MEL) and testosterone in male rats, but it remains to be determined whether RF affected circadian rhythm of these plasma hormones. Male Sprague-Dawley rats were exposed to 1800-MHz RF at 208 μw/cm² power density (SAR: 0.5762 W/kg) at different zeitgeber (ZT) periods of the day, including 0 (ZT0), 4 (ZT4), 8 (ZT8), 12 (ZT12), 16 (ZT16), and 20 (ZT20) h. RF exposure was 2 h/d for 32 d. From each rat, the concentrations of plasma MEL and testosterone were determined in plasma after RF exposure and compared with controls. The results confirmed the existence of circadian rhythms in the synthesis of MEL and testosterone, but revealed an inverse relationship in peak phase of these rhythms. These rhythms were disturbed after exposure to RF, with the effect being more pronounced on MEL than testosterone. The most pronounced effect of RF exposure on MEL and testosterone appears to be in rats exposed to RF at ZT 16 and ZT0 h, respectively. Data suggest that regulation of testosterone is controlled by MEL and that MEL is more sensitive to RF exposure.

PREVALENCE OF CUMULATIVE TRAUMA DISORDERS IN CELL PHONE USERS

Purpose: In recent years, ownership and usage of cell phones have become widespread, especially amongst young people. The increasing use of text messaging on mobile phones has focused concern on possible musculoskeletal disorders for the users. Hence the purpose of this study was to find the prevalence of cumulative trauma disorders (CTDs) of the upper limb in cell phone users. Methods: A questionnaire-based survey was undertaken to detect the prevalence of CTDs in 1500 college students. Results: The response rate of the survey was 91.9%. Overall prevalence of CTD in the upper limb was found to be 18.5%. Maximum symptoms were noted in thumb (52%). Pain (61.7%) and fatigue (44.3%) were the two most common symptoms reported by the respondents. Conclusions: Mild form of CTD is present in students using cell phones and mainly depends on the pattern of phone usage.

Clinical features of headache associated with mobile phone use: a cross-sectional study in university students

BACKGROUND

Headache has been reported to be associated with mobile phone (MP) use in some individuals. The causal relationship between headache associated with MP use (HAMP) and MP use is currently undetermined. Identifying the clinical features of HAMP may help in clarifying the pathophysiology of HAMP and in managing symptoms of individuals with HAMP. The aim of the present study is to describe the clinical features of HAMP.

METHODS

A 14-item questionnaire investigating MP use and headache was administered to 247 medical students at Hallym University, Korea. Individual telephone interviews were subsequently conducted with those participants who reported HAMP more than 10 times during the last 1 year on the clinical features of HAMP. We defined HAMP as a headache attack during MP use or within 1 hour after MP use.

RESULTS

In total, 214 (86.6%) students completed and returned the questionnaire. Forty (18.9%) students experienced HAMP more than 10 times during the last 1 year in the questionnaire survey. In subsequent telephone interviews, 37 (97.4%) interviewed participants reported that HAMP was triggered by prolonged MP use. HAMP was usually dull or pressing in quality (30 of 38, 79.0%), localised ipsilateral to the side of MP use (32 of 38, 84.2%), and associated with a burning sensation (24 of 38, 63.2%).

CONCLUSION

We found that HAMP usually showed stereotyped clinical features including mild intensity, a dull or pressing quality, localisation ipsilateral to the side of MP use, provocation by prolonged MP use and often accompanied by a burning sensation.