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Ravan JR, Pattnaik JI, Samantray S. Algorithm-based approach to headache. J Family Med Prim Care 2023; 12:1775-1783. [PMID: 38024919 PMCID: PMC10657066 DOI: 10.4103/jfmpc.jfmpc_1553_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/22/2022] [Accepted: 10/04/2022] [Indexed: 12/01/2023] Open
Abstract
One of the most commonly encountered scenarios in any healthcare setting is a patient presenting with a headache. Yet, the assessment, diagnosis and treatment of headache disorders can be challenging and burdensome for even specialist doctors in medicine, psychiatry, oto-rhinology, neurology and so on. Apart from saving patient's and doctor's time as well as money, this article will buy leading time for better outcome and management of certain difficult headache disorders. The aim of this review is to simplify the approach to headache diagnosis for an early and proper referral. Literature search was done on PubMed and Google Scholar using key words. Only studies which were in English were considered. Sixty-one articles published from 1975 to 2022 were reviewed after screening for inclusion and exclusion criteria. It is very essential that a primary care physician is aware of the classification of headache. Red flag signs of high-risk headaches are essential for proper referral. It is also essential that we rule out secondary headaches as they are more life threatening. Vulnerable populations such as geriatric and paediatric populations require expert attention in case of headache disorders.
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Affiliation(s)
- Jayaprakash R. Ravan
- Department of Psychiatry, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Jigyansa I. Pattnaik
- Department of Psychiatry, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Swayanka Samantray
- Department of Psychiatry, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Kebede YT, Mohammed BD, Tamene BA, Abebe AT, Dhugasa RW. Medication overuse headache: a review of current evidence and management strategies. FRONTIERS IN PAIN RESEARCH 2023; 4:1194134. [PMID: 37614243 PMCID: PMC10442656 DOI: 10.3389/fpain.2023.1194134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 07/18/2023] [Indexed: 08/25/2023] Open
Abstract
The third edition of the International Classification of Headache Disorders (ICHD-3) defines medication-overuse headache (MOH) as a headache that develops when a person regularly uses acute or symptomatic headache medications excessively (10 or more, or 15 or more days per month, depending on the medication) for a period of time longer than 3 months. Even though it may not be reported as frequently as it actually is, it affects about 5% of the general population on average. It typically happens following repeated anti-pain medication use for pre-existing headache disorders, such as migraines. Anti-pains can also be used frequently in patients with pre-existing headache disorders for reasons other than treating headaches, such as psychological drug attachment. MOH is linked to a number of illnesses, such as anxiety, depression, and obsessive compulsive disorder (OCD). Both simple and complex types are possible. Additionally, there is no universal consensus on how to treat MOH, but drug discontinuation is the best course of action. Using the medical subject headings "Medication Overuse Headache," "Migraine Headache," "Tension Headache," "Chronification of Headache," and "Antipains," an all-language literature search was done on PubMed, Google Scholar, and Medline up until March 2023. We looked into the epidemiology, risk factors, pathophysiology, clinical characteristics, comorbidities, diagnosis, management, and preventative measures of MOH in the literature. This article focuses on the MOH research themes.
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Affiliation(s)
- Yabets Tesfaye Kebede
- School of Medicine, Faculty of Medical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Bekri Delil Mohammed
- School of Medicine, Faculty of Medical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Beimnet Ayenew Tamene
- School of Medicine, Faculty of Medical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Abel Tezera Abebe
- School of Medicine, Faculty of Medical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
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AlBarqi M, AlDablan M, AlBahr A, AlAmer M, AlNaim A, AlNaim A, Almaqhawi A. Prevalence, frequency, and disability of migraine headaches and tension headaches among the general population in the Eastern Region of Saudi Arabia. J Med Life 2022; 15:1371-1378. [PMID: 36567838 PMCID: PMC9762370 DOI: 10.25122/jml-2022-0176] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/10/2022] [Indexed: 12/27/2022] Open
Abstract
A tension-type headache (TTH) is a recurrent headache that is mild to moderate in intensity, unlike migraine (MH), which is accompanied by crippling effects of nausea, vomiting, photophobia, or phonophobia. TTH is more frequent than migraine, but it is less likely to cause severe pain and physical dysfunction. TTHs account for more lost workdays due to their prevalence. The study aimed to evaluate the prevalence, frequency, and disability of MHs and TTHs among the general population in the Eastern Region of Saudi Arabia. A cross-sectional study was employed using a validated questionnaire. The questionnaire implemented the HARDSHIP algorithm to diagnose MH and TTH and questions to correlate their prevalence to socio-demographic data, measurement of the level of disability, headache management, and treatment effectiveness using the chi-square test. The study reviewed 877 subjects (46.6% males vs. 53.4% females). 52.9% of the participants experienced headaches during the previous three months, and 35.6% experienced headaches recently. The most common type of headache was a probable MH (32.1%), followed by a TTH (26.9%), probable TTH (19.5%), and MH (15%). It was reported that some disability was attributed to 47% of MHs and 26% of TTHs. The most commonly used headache medication was paracetamol (53.5%). This study revealed that TTH and MH are common illnesses in Saudi Arabia's Eastern Region. TTH and MH are correlated with significant individual and social burdens, particularly for MH. Headache sufferers mostly manage their headaches using conventional over-the-counter methods.
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Affiliation(s)
- Mohammed AlBarqi
- Department of Family Medicine and Community, College of Medicine, King Faisal University, AlAhsa, Saudi Arabia
| | | | - Abdulelah AlBahr
- College of Medicine, King Faisal University, AlAhsa, Saudi Arabia,Corresponding Author: Abdulelah AlBahr, College of Medicine, King Faisal University, AlAhsa, Saudi Arabia. E-mail:
| | - Mohammed AlAmer
- College of Medicine, King Faisal University, AlAhsa, Saudi Arabia
| | | | - Abdullah AlNaim
- Department of Family Medicine and Community, College of Medicine, King Faisal University, AlAhsa, Saudi Arabia
| | - Abdullah Almaqhawi
- Department of Family Medicine and Community, College of Medicine, King Faisal University, AlAhsa, Saudi Arabia
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Sundström N, Lundin F, Arvidsson L, Tullberg M, Wikkelsø C. The demography of idiopathic normal pressure hydrocephalus: data on 3000 consecutive, surgically treated patients and a systematic review of the literature. J Neurosurg 2022; 137:1310-1320. [PMID: 35395629 DOI: 10.3171/2022.2.jns212063] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 02/07/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to describe the demographic characteristics of patients with idiopathic normal pressure hydrocephalus (iNPH) through an analysis of 3000 consecutive, surgically treated Swedish patients and a systematic review of the literature. METHODS Data on age, sex, comorbidities, diagnostic delay, initial symptoms, and severity of symptoms at diagnosis were extracted from the Swedish Hydrocephalus Quality Registry. In addition, a systematic PRISMA-based review of the literature published from database inception until August 2019 was performed using the PubMed, Cochrane, and Scopus databases on the basis of two concepts: normal pressure hydrocephalus and demography and their association with related terms. Of 1020 unique articles, 16 were eligible for study inclusion and were assessed for quality using the Newcastle-Ottawa Scale. Mean and weighted mean values were calculated. RESULTS The mean patient age at the time of surgery was 74.4 years, 79% of patients were in their 70s, and 60% of the patients were men. Almost 50% of the patients had symptoms from four main domains (i.e., balance, gait, cognition, and urinary dysfunction) at disease onset. Patients aged < 60 years (2%) reported more headaches and fewer balance problems than those aged ≥ 60. Women were more impaired in function than men at the time of diagnosis. Dementia (Mini-Mental State Examination score < 25) was found in 47% of the patients. Men had more diabetes, heart disease, hypertension, and stroke than women, and comorbidity correlated with increased impairment. The incidence of surgery for iNPH was 20%-40% of the disease incidence according to survey and operation-based studies. CONCLUSIONS Most iNPH patients undergo surgery in their 70s. Those aged < 60 years show slightly different symptomatology and probably present with a specific disease entity, indicating that the lower age limit for iNPH should be 60 years. iNPH patients have severe impairment preceded by a long diagnostic delay. Even though the included study designs differed, the systematic review showed that the disorder has a very low treatment incidence. The importance of diagnosing and treating iNPH is further emphasized by the fact that iNPH may account for a considerable part of all cases of dementia.
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Affiliation(s)
- Nina Sundström
- 1Department of Radiation Sciences, Radiation Physics, Biomedical Engineering, Umeå University, Umeå
| | - Fredrik Lundin
- Departments of2Neurology and
- 3Biomedical and Clinical Sciences, Linköping University, Linköping
| | - Lisa Arvidsson
- 4Department of Neurosurgery, Karolinska University Hospital, Stockholm
- 5Department of Clinical Neuroscience, Karolinska Institutet, Stockholm; and
| | - Mats Tullberg
- 6Hydrocephalus Research Unit, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carsten Wikkelsø
- 6Hydrocephalus Research Unit, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Friedman SA, Masters-Israilov A, Robbins MS. Secondary Headache Disorders: Approach, Workup, and Special Considerations for Select Populations. Semin Neurol 2022; 42:418-427. [PMID: 36220127 DOI: 10.1055/s-0042-1757753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Headache is one of the most common diagnoses in neurology. A thorough understanding of the clinical presentation of secondary headache, which can be life-threatening, is critical. This review provides an overview of the diagnostic approach to a patient with headache, including discussion of "red," "orange," and "green" flags. We emphasize particular scenarios to help tailor the clinical workup to individual circumstances such as in pregnant women, when particular attention must be paid to the effects of blood pressure and hypercoagulability, as well as in older adults, where there is a need for higher suspicion for an intracranial mass lesion or giant cell arteritis. Patients with risk factors for headache secondary to alterations in intracranial pressure, whether elevated (e.g., idiopathic intracranial hypertension) or decreased (e.g., cerebrospinal fluid leak), may require more specific diagnostic testing and treatment. Finally, headache in patients with COVID-19 or long COVID-19 is increasingly recognized and may have multiple etiologies.
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Affiliation(s)
- Sarah A Friedman
- Department of Neurology, Weill Cornell Medicine and New York Presbyterian, New York, New York
| | - Alina Masters-Israilov
- Department of Neurology, Weill Cornell Medicine and New York Presbyterian, New York, New York
| | - Matthew S Robbins
- Department of Neurology, Weill Cornell Medicine and New York Presbyterian, New York, New York
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Questionnaire-Based Survey during COVID-19 Vaccination on the Prevalence of Elderly’s Migraine, Chronic Daily Headache, and Medication-Overuse Headache in One Japanese City—Itoigawa Hisui Study. J Clin Med 2022; 11:jcm11164707. [PMID: 36012946 PMCID: PMC9409693 DOI: 10.3390/jcm11164707] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/06/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The prevalence of headache disorders, migraine, chronic daily headache (CDH), and medication-overuse headache (MOH) among the elderly in Japan has not been sufficiently investigated. We performed a questionnaire-based survey and revealed 3-month headache prevalence and headaches’ characteristics. Methods: The population aged over 64 was investigated in Itoigawa during their third coronavirus disease 2019 vaccination. Migraine, MOH was defined as The International Classification of Headache Disorders Third edition. CDH was defined as a headache occurring at least 15 days per month. K-means++ were used to perform clustering. Results: Among 2858 valid responses, headache disorders, migraine, CDH, and MOH prevalence was 11.97%, 0.91%, 1.57%, and 0.70%, respectively. Combined-analgesic and non-opioid analgesic were widely used. Only one migraineur used prophylactic medication. We performed k-means++ to group the 332 MOH patients into four clusters. Cluster 1 seemed to have tension-type headache-like headache characteristics, cluster 2 seemed to have MOH-like headache characteristics, cluster 3 seemed to have severe headaches with comorbidities such as dyslipidemia, stroke, and depression, and cluster 4 seemed to have migraine-like headache characteristics with photophobia and phonophobia. Conclusions: This is the largest prevalence survey in the Japanese elderly. Headache disorders are still the elderly’s burden. Clustering suggested that severe headaches associated with some comorbidities may be unique to the elderly.
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Togha M, Karimitafti MJ, Ghorbani Z, Farham F, Naderi-Behdani F, Nasergivehchi S, Vahabi Z, Ariyanfar S, Jafari E. Characteristics and comorbidities of headache in patients over 50 years of age: a cross-sectional study. BMC Geriatr 2022; 22:313. [PMID: 35399063 PMCID: PMC8994908 DOI: 10.1186/s12877-022-03027-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 04/04/2022] [Indexed: 01/04/2023] Open
Abstract
Abstract
Background
Although headache is a common complaint in younger individuals, it is one of the most common complaints among persons over the age of 50 and is a significant cause of morbidity. As there are differences in the causes and types of headache, the diagnosis and management of headache in older adults differ from that in younger individuals.
Methods
In this cross-sectional study, 570 patients ≥ 50 years were recruited at a university affiliated tertiary headache center between 2016 and 2019. Demographic data, headache characteristics, and comorbid medical conditions were recorded. The presence of depression was explored using the Beck Depression Inventory. The patients were evaluated using the STOP-BANG scale to determine the risk of obstructive sleep apnea.
Results
The mean age of the patients was 57.7 years. Seventy-three percent of the patients had primary headache disorders, with the most prevalent types being migraine, followed by tension-type headache. Secondary headaches were primarily the result of overuse of medication, cervical spine disease, and hypertension. Patients with medication-overuse headache were significantly more likely to suffer from hypothyroidism and gastrointestinal problems such as bleeding/ulcers. Irritable bowel syndrome was also more common in patients with medication-overuse headaches and migraines. The risk for obstructive sleep apnea was intermediate in 45.2% of the patients with hypertension-induced headache, but was lower in the majority of others. There was a high tendency for moderate-to-severe depression in the participants; however, the Beck Depression Inventory scores were significantly higher in medication-overuse headache patients.
Conclusion
Proper treatment of headache in middle-aged and older adults requires the recognition of secondary causes, comorbid diseases, and drug induced or medication overuse headaches. Special attention should be paid to depression and obstructive sleep apnea in such patients suffering from headache disorders.
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Riggins N, Paris L. Legal Aspects of Migraine in the Workplace. Curr Pain Headache Rep 2022; 26:863-869. [PMID: 36399233 PMCID: PMC9829618 DOI: 10.1007/s11916-022-01095-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE OF REVIEW This study explores legal aspects of migraine in the workplace. While the high prevalence of migraine is well-documented, its effects on the livelihoods of those living with the disease are less understood. Because migraine symptoms are often invisible, discussions concerning migraine in the workplace can be challenging. What are the rights of persons with migraine in the workplace? Time off may provide a brief respite, but it is not a long-term solution. Claiming disability for migraine has challenges, including barriers to doing so and required paperwork. How can persons with migraine remain employed and productive? How can persons with migraine receive accommodation from their employer or take time off to treat their condition? RECENT FINDINGS Many employers offer comprehensive benefit packages that allow for sick days, time off, mental health days, and accommodations that may give persons with migraine temporary reprieve. However, it may not be sufficient, particularly for those with chronic migraine. Further, not all employers offer comprehensive benefits. Employees with migraine may need to seek protection under the law. Our research closely examines the primary legal avenues that persons with migraine may pursue while living and working with migraine. In exploring the legal aspects of migraine, we couple our exploration with relevant case law. Through this lens, we conclude that migraine is becoming less stigmatized and more legitimized in the eyes of the court. It is the belief of the authors that at least some of the change in the attitude towards migraine is the result of strong patient advocacy and significant advances in research over the past several years.
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Affiliation(s)
- Nina Riggins
- UCSD Headache Center, University of California, San Diego, USA.
- UCSD Medical School, San Diego, CA, USA.
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9
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Is there a link between headache and cognitive disorders? A systematic review. Rev Neurol (Paris) 2021; 178:285-290. [PMID: 34689981 DOI: 10.1016/j.neurol.2021.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/21/2021] [Accepted: 07/30/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The overall prevalence of headaches decreases with age; however headaches remain frequent in aged individuals who are also affected by other disorders such as cognitive decline. Despite the high frequency of both conditions in these persons, the association between headaches and cognitive decline is underexplored, underdiagnosed and poorly understood. OBJECTIVE In the present article, we aim to provide a comprehensive review of existing data concerning the link between headache and cognitive decline. METHODS We undertook a systematic literature review to report articles that focus on headaches (including all types of headaches) and neurocognitive disorders of degenerative causes. RESULTS Only 9 studies have explored the association between headaches and neurocognitive decline. Methods were highly variable from population-based study to short series of patients using either database or questionnaire during consultation. Studies focusing on Familial Alzheimer's Disease revealed a very high prevalence of headaches in mutation carrier patients compared to non-carrier patients. CONCLUSION The association between headaches and cognitive decline is underexplored. Future studies are needed to address the pathophysiological mechanisms to improve the treatment of these underestimated headaches.
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10
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Wang YF, Yu CC, Kuan AS, Chen SP, Wang SJ. Association between suicidal risks and medication-overuse headache in chronic migraine: a cross-sectional study. J Headache Pain 2021; 22:36. [PMID: 33971819 PMCID: PMC8112025 DOI: 10.1186/s10194-021-01248-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background Behaviors of substance dependence are common among patients with medication-overuse headache (MOH). Whether MOH, like other substance use disorders, is associated with an increased risk for suicide is unknown. Methods In this cross-sectional study, newly diagnosed chronic migraine (CM) patients with or without coexisting MOH were enrolled prospectively. Headache diagnoses were made through face-to-face interviews by headache specialists, and a specifically designed questionnaire was used to collect demographics, headache profiles, Migraine Disability Assessment, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, etc. Suicidal ideation and prior suicide attempt were specifically questioned. Results In total, 603 CM patients (485F/118M, mean age 42.03 ± 12.18 years) were recruited, including 320 with MOH (257F/63M, mean age 42.8 ± 11.7 years) (53.1%), and 214 (35.5%) and 81 (13.4%) had suicidal ideation and prior suicide attempt, respectively. Among CM patients, the presence of MOH increased the risks of suicidal ideation (odds ratio [OR] = 1.75 [95% CI = 1.20–2.56], p = 0.004) and prior suicide attempt (OR = 1.88 [1.09–3.24], p = 0.024), after controlling for demographics, headache profile, disabilities, symptoms of anxiety and depression, and sleep quality. Conclusions In CM patients, MOH is associated with an increased risk for suicidal ideation and prior suicide attempt, which deserves attention for clinicians taking care of headache patients. However, further studies are needed to determine the causal relationship, as well as the underlying pathophysiology.
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Affiliation(s)
- Yen-Feng Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-Chun Yu
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ai Seon Kuan
- School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Department Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Pin Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shuu-Jiun Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan. .,School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan. .,Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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11
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Nidadavolu LS, Walston JD. Underlying Vulnerabilities to the Cytokine Storm and Adverse COVID-19 Outcomes in the Aging Immune System. J Gerontol A Biol Sci Med Sci 2021; 76:e13-e18. [PMID: 32841329 PMCID: PMC7546042 DOI: 10.1093/gerona/glaa209] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Indexed: 12/20/2022] Open
Abstract
Older adults are far more vulnerable to adverse health outcomes and mortality after contracting COVID-19. There are likely multiple age-related biological, clinical, and environmental reasons for this increased risk, all of which are exacerbated by underlying age-associated changes to the immune system as well as increased prevalence of chronic disease states in older adults. Innate immune system overactivity, termed the cytokine storm, appears to be critical in the development of the worst consequences of COVID-19 infection. Pathophysiology suggests that viral stimulation of the innate immune system, augmented by inflammatory signals sent from dying cells, ramps up into a poorly controlled outpouring of inflammatory mediators. Other aging-related changes in cells such as senescence as well as higher prevalence of chronic disease states also likely ramp up inflammatory signaling. This in turn drives downstream pathophysiological changes to pulmonary, cardiovascular, skeletal muscle, and brain tissues that drive many of the adverse health outcomes observed in older adults. This article provides an overview of the underlying etiologies of innate immune system activation and adaptive immune system dysregulation in older adults and how they potentiate the consequences of the COVID-19-related cytokine storm, and possible uses of this knowledge to develop better risk assessment and treatment monitoring strategies.
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Affiliation(s)
- Lolita S Nidadavolu
- Biology of Healthy Aging Program, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jeremy D Walston
- Biology of Healthy Aging Program, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Medicine, Kyung Hee University, Seoul, South Korea
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Schramm S, Tenhagen I, Schmidt B, Holle-Lee D, Naegel S, Katsarava Z, Jöckel KH, Moebus S. Prevalence and risk factors of migraine and non-migraine headache in older people - results of the Heinz Nixdorf Recall study. Cephalalgia 2020; 41:649-664. [PMID: 33269953 DOI: 10.1177/0333102420977183] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The prevalence of migraine and non-migraine headache declines with age. METHODS Data from the third visit (2011-2015) of the population-based Heinz Nixdorf Recall study were analysed (n = 2038, 51% women, 65-86 years). Possible risk factors for headache activity (obesity, education, smoking, sports, alcohol, partnership status, living alone, having children, sleep quality, depression, hypertension, diabetes mellitus, stroke, coronary heart disease, medication), and headache symptoms were assessed. We estimated the lifetime prevalence and the prevalence of current active headache of migraine with and without aura, and non-migraine headache. The associations between possible risk factors and headache activity (active vs. inactive) were estimated by age and sex-adjusted odds ratios and 95% confidence intervals (OR [95% CI]) using multiple logistic regression. RESULTS The lifetime prevalence of migraine was 28.6% (n = 584). One hundred and ninety-two (9.4%) had still-active migraine, 168 (3.5%) had migraine with aura, and 416 (5.9%) had migraine without aura. One hundred and sixty-eight (8.2%) had "episodic infrequent migraine, 0-8 headache days/month", 10 (0.5%) had "episodic frequent migraine, 9-14 headache days/month", and five (0.2%) had "chronic migraine, ≥15 headache days/month". Overall, 10 (0.5%) had "chronic headache, any headache on ≥15 days/month". Female gender and younger age were the most important associated migraine risk factors. Depression (1.62 [1.06; 2.47]) and poor sleep (1.06 [1.00; 1.12]) were associated with migraine and headache activity in general. Antihypertensives were associated with headache remission (0.80 [0.64; 1.00]). Additionally, undertaking less sports (0.72 [0.51; 1.03]) was associated with higher migraine activity. CONCLUSIONS Headaches and migraines are not rare in the older population. They are related to mood and sleep disturbance, and migraine even to less physical activity. Antihypertensives are related to headache remission.
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Affiliation(s)
- Sara Schramm
- Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Isabell Tenhagen
- Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Dagny Holle-Lee
- Department of Neurology, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Steffen Naegel
- Department of Neurology, University of Duisburg-Essen, University Hospital Essen, Essen, Germany.,Clinic and Polyclinic for Neurology, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Zaza Katsarava
- Department of Neurology, University of Duisburg-Essen, University Hospital Essen, Essen, Germany.,Department of Neurology, Evangelical Hospital Unna, Unna, Germany.,EVEX Medical Corporation, Tbilisi, Georgia.,Sechenov University Moscow, Moscow, Russian Federation
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Susanne Moebus
- Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
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Berti A, Moura MC, Sechi E, Squizzato F, Costanzo G, Chen JJ, Warrington KJ. Beyond Giant Cell Arteritis and Takayasu's Arteritis: Secondary Large Vessel Vasculitis and Vasculitis Mimickers. Curr Rheumatol Rep 2020; 22:88. [PMID: 33159612 DOI: 10.1007/s11926-020-00965-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW To provide an overview of mimickers of large vessel vasculitis (LVV), by the main presenting manifestation, i.e., systemic, vascular, and cranial manifestations. RECENT FINDINGS The main differential diagnoses in patients with giant cell arteritis (GCA) and Takayasu arteritis (TAK) presenting with systemic manifestations (i.e., fever, anorexia, weight loss, night sweats, arthralgia/myalgia, and/or increased inflammatory indexes) are neoplastic, infectious, or other inflammatory conditions. In patients with vascular manifestations (such as peripheral ischemia, vascular stenoses, or aneurysms), atherosclerosis and non-inflammatory vascular diseases should be excluded. In those presenting with predominant cranial symptoms (i.e., temporal headache, jaw claudication, scalp tenderness, transient or permanent vision loss), other causes of headache, cerebrovascular accidents, optic neuropathy, and neuromuscular syndromes need to be considered. The diagnosis of LVV maybe challenging, especially when patients present with atypical or incomplete clinical forms. In these cases, a multidisciplinary approach is strongly recommended.
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Affiliation(s)
- Alvise Berti
- Rheumatology Department, Santa Chiara Regional Hospital and Department of Cellular, Computational and Integrative Biology (CIBIO), University of Trento, Largo Madaglie D'Oro 9, 38121, Trento, Italy. .,Thoracic Disease Research Unit, Pulmonary and Critical Care, Mayo Clinic, Rochester, MN, USA.
| | - Marta Casal Moura
- Thoracic Disease Research Unit, Pulmonary and Critical Care, Mayo Clinic, Rochester, MN, USA
| | - Elia Sechi
- Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | | | - Giulia Costanzo
- Allergy and Clinical Immunology, University of Cagliari, Cagliari, Italy
| | - John J Chen
- Ophthalmology and Neurology, Mayo Clinic, Rochester, MN, USA
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14
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Toom K, Braschinsky M, Obermann M, Katsarava Z. Secondary headache attributed to exposure to or overuse of a substance. Cephalalgia 2020; 41:443-452. [PMID: 32819151 DOI: 10.1177/0333102420942238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Secondary headaches attributed to exposure to or the overuse of a substance are classified under chapter eight in the International Classification of Headache Disorders 3rd edition. Three distinct sub-chapters consider: 1. Headache attributed to exposure to a substance, 2. Medication overuse headache, and 3. Headache attributed to substance withdrawal. Headache attributed to exposure to a substance refers to a headache with onset immediately or within hours after the exposure, while medication overuse headache is a headache occurring on 15 or more days per month that has developed as a consequence of regular usage of acute headache medication(s) for more than three consecutive months in a patient with a pre-existing primary headache disorder. The withdrawal of caffeine, oestrogen, and opioids is most often associated with the development of headache. DISCUSSION Despite the current headache classification, there is no certainty of a causal relationship between the use of any substance and the development of headache. Some substances are likely to provoke headache in patients that suffer from a primary headache disorder like migraine, tension-type headache or cluster headache, while others were described to cause headache even in people that generally do not get headaches. Toxic agents, such as carbon monoxide (CO) are difficult to investigate systematically, while other substances such as nitric oxide (NO) were specifically used to induce headache experimentally. If a patient with an underlying primary headache disorder develops a headache, in temporal relation to exposure to a substance, which is significantly worse than the usual headache it is considered secondary. This is even more the case if the headache phenotype is different from the usually experienced headache characteristics. Medication overuse headache is a well-described, distinct disease entity with only marginally understood pathophysiology and associated psychological factors. Managing medication overuse headache patients includes education, detoxification, prophylactic treatments and treating comorbidities, which is reflected in available guidelines. Viewing medication overuse headache as a separate entity helps clinicians and researchers better recognise, treat and study the disorder. CONCLUSION Identification of substances that may cause or trigger secondary headache is important in order to educate patients and health care professionals about potential effects of these substances and prevent unnecessary suffering, as well as deterioration in quality of life. Treatment in case of medication overuse and other chronic headache should be decisive and effective.
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Affiliation(s)
- Kati Toom
- Neurology Clinic, Tartu University Hospital, Tartu, Estonia.,Estonian Headache Society, Tartu, Estonia
| | - Mark Braschinsky
- Neurology Clinic, Tartu University Hospital, Tartu, Estonia.,Estonian Headache Society, Tartu, Estonia
| | - Mark Obermann
- Center for Neurology, Asklepios Hospitals Schildautal, Seesen, Germany.,Evangelical Hospital Unna, Unna, Germany
| | - Zara Katsarava
- Evangelical Hospital Unna, Unna, Germany.,Department of Neurology, University of Duisburg-Essen, Essen, Germany.,EVEX Medical Corporation, Tbilisi, Republic of Georgia.,IM Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
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15
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Stauffer VL, Turner I, Kemmer P, Kielbasa W, Day K, Port M, Quinlan T, Camporeale A. Effect of age on pharmacokinetics, efficacy, and safety of galcanezumab treatment in adult patients with migraine: results from six phase 2 and phase 3 randomized clinical trials. J Headache Pain 2020; 21:79. [PMID: 32576229 PMCID: PMC7310276 DOI: 10.1186/s10194-020-01148-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/09/2020] [Indexed: 12/20/2022] Open
Abstract
Background Migraine clinical profile may change with age, making it necessary to verify that migraine treatments are equally safe and effective in older patients. These analyses evaluated the effects of patient age on the pharmacokinetics (PK), efficacy, and safety of galcanezumab for prevention of migraine. Methods Analyses included efficacy data from three double-blind phase 3 clinical trials: two 6-month studies in episodic migraine (EVOLVE-1, EVOLVE-2: N = 1773) and one 3-month study in chronic migraine (REGAIN:N = 1113). Patients were randomized 2:1:1 to placebo, galcanezumab 120 mg, or galcanezumab 240 mg. Safety and PK data included additional phase 2 and phase 3 trials for a larger sample size of patients > 60 years (range = 18–65 for all studies). Subgroup analyses assessed efficacy measures, adverse event (AE) occurrence, and cardiovascular measurement changes by patient age group. Galcanezumab PK were evaluated using a population analysis approach, where age was examined as a potential covariate on apparent clearance (CL/F) and apparent volume of distribution (V/F) of galcanezumab. Results Numbers of baseline monthly migraine headache days were similar across age groups. There were no statistically significant treatment-by-age group interactions for any efficacy measures, except in episodic migraine studies where older patients appeared to have a larger reduction than younger patients in the number of monthly migraine headache days with acute medication use. Age (18–65) had a minimal effect on CL/F, and no effect on V/F. Galcanezumab-treated patients ≥60 years experienced no clinically meaningful increases in blood pressure and no increased frequency in treatment-emergent AEs, discontinuations due to AEs, serious adverse events (SAEs) overall, or cardiovascular SAEs, compared to age-matched placebo-treated patients. Conclusions Age (up to 65 years) does not affect efficacy in migraine prevention and has no clinically meaningful influence on galcanezumab PK to warrant dose adjustment. Furthermore, older galcanezumab-treated patients experienced no increases in frequency of AEs or increases in blood pressure compared with age-matched placebo-treated patients. Trial registrations EVOLVE-1 (NCT02614183, registered 23 November 2015), EVOLVE-2 (NCT02614196, 23 November 2015), REGAIN (NCT02614261, 23 November 2015), ART-01 (NCT01625988, 20 June 2012, ), I5Q-MC-CGAB (NCT02163993, 12 June 2014, ), I5Q-MC-CGAJ (NCT02614287, 23 November 2015, ), all retrospectively registered.
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Affiliation(s)
| | - Ira Turner
- Center for Headache Care and Research, Island Neurological Associates, a division of ProHEALTHcare Associates, Plainview, NY, USA
| | - Phebe Kemmer
- Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN, USA
| | - William Kielbasa
- Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN, USA
| | - Kathleen Day
- Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN, USA
| | - Martha Port
- Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN, USA
| | - Tonya Quinlan
- Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN, USA
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16
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Abstract
Headache is the most common neurologic symptom and affects nearly half the world's population at any given time. Although the prevalence declines with age, headache remains a common neurologic complaint among elderly populations. Headaches can be divided into primary and secondary causes. Primary headaches comprise about two-thirds of headaches among the elderly. They are defined by clinical criteria and are diagnosed based on symptom pattern and exclusion of secondary causes. Primary headaches include migraine, tension-type, trigeminal autonomic cephalalgias, and hypnic headache. Secondary headaches are defined by their suspected etiology. A higher index of suspicion for a secondary headache disorder is warranted in older patients with new-onset headache. They are roughly 12 times more likely to have serious underlying causes and, frequently, have different symptomatic presentations compared to younger adults. Various imaging and laboratory evaluations are indicated in the presence of any "red flag" signs or symptoms. Head CT is the procedure of choice for acute headache presentations, and brain MRI for those with chronic headache complaints. Management of headache in elderly populations can be challenging due to the presence of multiple medical comorbidities, polypharmacy, and differences in drug metabolism and clearance.
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Affiliation(s)
- Robert G Kaniecki
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
| | - Andrew D Levin
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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17
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Müller B, Dresler T, Gaul C, Glass Ä, Jürgens TP, Kropp P, Ruscheweyh R, Straube A, Förderreuther S. More Attacks and Analgesic Use in Old Age: Self-Reported Headache Across the Lifespan in a German Sample. Front Neurol 2019; 10:1000. [PMID: 31749752 PMCID: PMC6843053 DOI: 10.3389/fneur.2019.01000] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/02/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Reliable population-based data on the prevalence and characteristics of primary headache across the lifespan are essential. However, robust data are lacking. Methods: We utilized questionnaire data from a random general population sample in Germany, that comprised 2,478 participants aged ≥14 years. A standardized questionnaire addressing headache and headache treatment was filled in during the face-to-face survey. Results: The 6-month prevalence of self-reported headache in the total sample amounted to 39.0% (known diagnosis of migraine 7.2%; tension-type headache 12.4%; another diagnosis or unknown diagnosis 23.4%). Age-specific prevalence rates were 37.9% (14–34 years), 44.6% (35–54 years), 38.5% (55–74 years), and 26.9% (≥75 years). Compared to age group 14–34, participants aged 35–54 were more (OR = 1.29, 95%-CI 1.05–1.60, p = 0.018) and those aged ≥75 were less (OR = 0.55, 95%-CI 0.40–0.76, p < 0.001) likely to have any headache. Of the participants with headache, 79.5% reported headache on <4 days per month, 15.6% on 4–14 days per month and 4.9% on >14 days per month. The frequency of headache did not differ significantly between age groups in men [χ(3, N = 384)2 = 1.45, p > 0.05], but in women [χ(3, N = 651)2 = 21.57, p < 0.001]: women aged ≥75 years were over-represented in the group reporting 4–14 headache days per month. The analgesic use (days per month) differed significantly between age groups among participants with headache on <4 days per month and on >14 days per month: 1.8 (14–34 years), 2.5 (35–54 years), 3.2 (55–74 years), and 3.4 (≥75 years), respectively 7.9 (14–34 years), 11.4 (35–54 years), 18.4 (55–74 years), and 22.8 (≥75 years). Conclusions: In general, the prevalence of headache decreases with age. However, older women suffer from more frequent attacks and older participants take analgesics on more days per month than younger participants. This might put them at risk of medication overuse which may lead to medication overuse headache. More research is needed to understand these specifics in headache frequency and treatment behavior in older people.
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Affiliation(s)
- Britta Müller
- Institute of Medical Psychology and Medical Sociology, University Medicine Rostock, Rostock, Germany
| | - Thomas Dresler
- Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,LEAD Graduate School & Research Network, University of Tübingen, Tübingen, Germany
| | - Charly Gaul
- Migraine and Headache Clinic Königstein, Königstein, Germany
| | - Änne Glass
- Institute for Biostatistics and Informatics in Medicine and Ageing Research, University Medicine Rostock, Rostock, Germany
| | - Tim P Jürgens
- Department of Neurology, University Medicine Center Rostock, Rostock, Germany
| | - Peter Kropp
- Institute of Medical Psychology and Medical Sociology, University Medicine Rostock, Rostock, Germany
| | - Ruth Ruscheweyh
- Department of Neurology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Andreas Straube
- Department of Neurology, Ludwig Maximilian University of Munich, Munich, Germany
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18
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Westergaard ML, Lau CJ, Allesøe K, Gjendal ST, Jensen RH. Monitoring chronic headache and medication-overuse headache prevalence in Denmark. Cephalalgia 2019; 40:6-18. [DOI: 10.1177/0333102419876909] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objectives To study chronic headache and medication-overuse headache (MOH) prevalence; to identify groups with high prevalence of these conditions; and to identify the most frequently used pain medications among respondents with chronic headache. Background Chronic headache and MOH prevalence in Denmark were last estimated in 2010. Methods In this cross-sectional study, 104,950 individuals aged ≥16 years were randomly sampled for the 2017 Danish Capital Region Health Survey. Responses to questions about headache and use of acute pain medications were linked to demographic registries. MOH was defined as headache ≥15 days/month plus self-report of use of pain medications ≥10 or 15 days/month, in the last three months. Weighted prevalence proportions were calculated. Results Among 55,185 respondents, chronic headache prevalence was 3.0% (95% CI: 2.3–3.2) and MOH prevalence was 2.0% (95% CI: 1.8–2.1). Both conditions were more common among females and the middle-aged. Respondents on social welfare or receiving early retirement pensions had the highest prevalences. Among those with chronic headache, 44.7% overused over-the-counter analgesics for headache; paracetamol 41.5%; a combination of different pain relievers 25.3%; ibuprofen 21.9%; opioids 17.0%; combination preparations 14.3%; and triptans 9.1%. Conclusions The highest prevalence of chronic headache and MOH was seen among people with low socioeconomic position. Overuse of paracetamol was most common. Reported opioid use was higher than expected. Groups with high prevalence of MOH should be the focus of public health interventions on rational use of OTC and prescription pain medications.
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Affiliation(s)
| | - Cathrine Juel Lau
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Karen Allesøe
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Signe Thorup Gjendal
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
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19
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Andreassen SN, Ben Ezra M, Scheibye-Knudsen M. A defined human aging phenome. Aging (Albany NY) 2019; 11:5786-5806. [PMID: 31408848 DOI: 10.18632/aging.102166] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 08/05/2019] [Indexed: 06/10/2023]
Abstract
Aging is among the most complex phenotypes that occur in humans. Identifying the interplay between different age-associated features is undoubtedly critical to our understanding of aging and thus age-associated diseases. Nevertheless, what constitutes human aging is not well characterized. Towards this end, we mined millions of PubMed abstracts for age-associated terms, enabling us to generate a detailed description of the human aging phenotype. We discovered age-associated features in clusters that can be broadly associated with previously defined hallmarks of aging, consequently identifying areas where interventions could be pursued. Importantly, we validated the newly discovered features by manually verifying the prevalence of these features in combined cohorts describing 76 million individuals, allowing us to stratify features in aging that appear to be the most prominent. In conclusion, we propose a comprehensive landscape of human aging: the human aging phenome.
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Affiliation(s)
- Søren Norge Andreassen
- Center for Healthy Aging, Department of Cellular and Molecular Medicine University of Copenhagen, Denmark
| | - Michael Ben Ezra
- Center for Healthy Aging, Department of Cellular and Molecular Medicine University of Copenhagen, Denmark
| | - Morten Scheibye-Knudsen
- Center for Healthy Aging, Department of Cellular and Molecular Medicine University of Copenhagen, Denmark
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20
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Chen PK, Wang SJ. Medication Overuse and Medication Overuse Headache: Risk Factors, Comorbidities, Associated Burdens and Nonpharmacologic and Pharmacologic Treatment Approaches. Curr Pain Headache Rep 2019; 23:60. [DOI: 10.1007/s11916-019-0796-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Abstract
Primary headaches are one of the most prevalent neurological disorders and can occur during a wide range of lifespan. Primary headaches, especially migraine, are cyclic disorders with a complex sequence of symptoms within every headache attack. There is no systematic review of whether these symptoms changes during lifespan. Indeed, the clinical presentation of migraine shows an age-dependent change with a significantly shorter duration of the attacks and occurrence of different paroxysmal symptoms, such as vomiting, abdominal pain or vertigo, in childhood and, in contrast, largely an absence of autonomic signs and a more often bilateral headache in the elderly. The age-dependent differences in the clinical presentation are less distinct in cluster headache and, especially, in tension-type headache. The differences in the clinical presentation are in agreement with the idea that the connectivity of hypothalamic areas with different brainstem areas, especially the central parasympathetic areas, is important for the clinical manifestation of migraine, as well as, the change during lifespan.
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Affiliation(s)
- Andreas Straube
- Department of Neurology, University Hospital LMU, Ludwig-Maximilians-University, 81377, Munich, Germany.
| | - Anna Andreou
- Headache Research, Wolfson CARD, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,The Headache Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
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22
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Cho SJ, Kim BK, Kim BS, Kim JM, Kim SK, Moon HS, Cha MJ, Park KY, Sohn JH, Chu MK, Song TJ. Associations of Elderly Onset Headache With Occurrence of Poor Functional Outcome, Cardiovascular Disease, and Cognitive Dysfunction During Long-term Follow-up. Ann Geriatr Med Res 2018; 22:176-183. [PMID: 32743270 PMCID: PMC7387621 DOI: 10.4235/agmr.18.0032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/08/2018] [Accepted: 10/25/2018] [Indexed: 01/03/2023] Open
Abstract
Background Although the frequency and intensity of headaches decrease in older adults, headaches in this population are still an important neurological disorder. The purpose of this study was to investigate the associations of headache characteristics in older adults with the development of cardiovascular disease and cognitive dysfunction. Methods We prospectively enrolled 125 older (≥65 years old) patients with headache who were making their first visit to outpatient clinics and who had no prior history of cognitive dysfunction from 11 hospitals in Korea between August 2014 and February 2015. We investigated the occurrence of newly developed/or recurrent headache, cardiovascular disease, cognitive dysfunction, and poor functional outcomes. Results The mean age of all included patients was 72.6 years, 68.8% were women, and 43 (34.4%) had newly developed/or recurrent headache during follow-up. During a median follow-up of 31 months (interquartile range, 28–34 months), 21 participants (16.8%) experienced cardiovascular disease, and 26 (20.8%) developed cognitive dysfunction. Upon multivariate analysis and after adjusting for sex, age, and other factors, presence of newly developed/or recurrent headache was found to be associated with cardiovascular disease (hazard ratio [HR], 4.03; 95% confidence interval [CI], 1.28–12.61; p=0.017) and frequency of headache for the recent 3 months was related with cognitive dysfunction (HR, 1.05; 95% CI, 1.00–1.09; p=0.017) and poor functional outcomes (HR, 1.06; 95% CI, 1.01–1.11; p=0.011). Conclusion Our study demonstrated that there is an increased risk of cardiovascular disease, cognitive dysfunction, and poor functional outcomes in older patients with frequent, newly developed, or recurrent headache.
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Affiliation(s)
- Soo-Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Byung-Kun Kim
- Department of Neurology, Eulji University School of Medicine, Seoul, Korea
| | - Byung-Su Kim
- Department of Neurology, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea
| | - Jae-Moon Kim
- Department of Neurology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Soo-Kyoung Kim
- Department of Neurology, Gyeongsang National University Hospital, Jinju, Korea
| | - Heui-Soo Moon
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myoung-Jin Cha
- Department of Neurology, National Police Hospital, Seoul, Korea
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jong-Hee Sohn
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University College of Medicine, Seoul, Korea
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23
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Yin JH, Tsai CL, Lee PJ, Chou CH, Chen SY, Chung CH, Chien WC, Lin CC, Sung YF, Yang FC, Tsai CK, Lee JT. Age-specific and gender-dependent impact of primary headache disorders on dementia risk: Population-based longitudinal study. Medicine (Baltimore) 2018; 97:e13789. [PMID: 30593163 PMCID: PMC6314725 DOI: 10.1097/md.0000000000013789] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 11/29/2018] [Indexed: 01/03/2023] Open
Abstract
Dementia is a global burden of public health. Headache disorders are the third most common cause of disability worldwide and common problems in the elderly population. Few studies focused on the relationship between primary headache disorders (PHDs) and cognitive status, and the results remain controversial. The aim of this countrywide, population-based, retrospective study was to investigate potential association between PHDs and dementia risk.We enrolled 1346 cases with PHDs to match the 5384 individuals by age, gender and co-morbidities. The definition of PHDs, dementia, and risk factors of dementia was identified according to The International Classification of Diseases, Ninth Revision, Clinical Modification. Cox regression was administered for estimating hazard ratios (HR) for dementia.During more than 5 years of follow-up, PHDs individuals had 1.52 times (P <.05) greater risk to develop all dementia compared with individuals without PHDs. Elderly (aged ≥65 years) patients with PHDs displayed significantly higher risk to develop all dementia (P <.01) and non-Alzheimer non-vascular dementia (NAVD) P <.01). Female PHDs individuals were at higher risk of suffering from all dementia (P <.05) and NAVD (P <.05). The influence of PHDs on all dementia was highest in the first 2 years of observation.The results indicated PHDs are linked to a temporarily increased risk for dementia, mainly NAVD, with age-specific and gender-dependent characteristics.
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Affiliation(s)
- Jiu-Haw Yin
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center
- Division of Neurology, Department of Medicine, Cheng Hsin General Hospital
| | - Chia-Lin Tsai
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center
| | - Pei-Jung Lee
- Departments of Nursing, Tri-Service General Hospital, National Defense Medical Center
| | - Chung-Hsing Chou
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei
| | - Shao-Yuan Chen
- Department of Neurology, Cardinal Tien Hospital
- Department of Hyperbaric Medicine, Cardinal Tien Hospital
- School of Medicine, Fu-Jen Catholic University, New Taipei City
| | - Chi-Hsiang Chung
- Taiwanese Injury Prevention and Safety Promotion Association
- School of Public Health, National Defense Medical Center
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Chun-Chieh Lin
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center
| | - Yueh-Feng Sung
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center
| | - Fu-Chi Yang
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center
| | - Chia-Kuang Tsai
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center
| | - Jiunn-Tay Lee
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei
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24
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Hextrum S, Biller J. Clinical Distinction of Cerebral Ischemia and Triaging of Patients in the Emergency Department. Neuroimaging Clin N Am 2018; 28:537-549. [DOI: 10.1016/j.nic.2018.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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25
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Vandenbussche N, Laterza D, Lisicki M, Lloyd J, Lupi C, Tischler H, Toom K, Vandervorst F, Quintana S, Paemeleire K, Katsarava Z. Medication-overuse headache: a widely recognized entity amidst ongoing debate. J Headache Pain 2018; 19:50. [PMID: 30003412 PMCID: PMC6043466 DOI: 10.1186/s10194-018-0875-x] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 06/13/2018] [Indexed: 12/30/2022] Open
Abstract
Medication overuse in primary headache disorders is a worldwide phenomenon and has a role in the chronification of headache disorders. The burden of disease on individuals and societies is significant due to high costs and comorbidities. In the Third Edition of the International Classification of Headache Disorders, medication-overuse headache is recognized as a separate secondary entity next to mostly primary headache disorders, although many clinicians see the disease as a sole complication of primary headache disorders. In this review, we explore the historical background of medication-overuse headache, its epidemiology, phenomenology, pathophysiology and treatment options. The review explores relevant unanswered questions and summarizes the current debates in medication-overuse headache.
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Affiliation(s)
- Nicolas Vandenbussche
- Headache Group, Department of Basic and Clinical Neuroscience, King’s College London, and NIHR-Wellcome Trust King’s Clinical Research Facility, King’s College Hospital, Denmark Hill, London, SE5 9PJ UK
| | - Domenico Laterza
- Department of Neuroscience, St. Agostino Estense Hospital, University of Modena and Reggio Emilia, via P. Giardini 1355, 41100 Modena, Italy
| | - Marco Lisicki
- Headache Research Unit, Université de Liège, Liège, Belgium
| | - Joseph Lloyd
- Headache Research-Wolfson CARD, King’s College London, London, UK
| | - Chiara Lupi
- Headache Centre, Careggi University Hospital, Health Sciences Department, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - Hannes Tischler
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Kati Toom
- Department of Neurology, Tartu University Clinics, Tartu, Estonia
- Estonian Headache Society, Tartu, Estonia
| | | | - Simone Quintana
- Headache Center, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Koen Paemeleire
- Department of Neurology, Ghent University Hospital, Corneel Heymanslaan 10, B-9000 Ghent, Belgium
| | - Zaza Katsarava
- Evangelical Hospital Unna and University of Duisburg-Essen, Duisburg, Germany
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Diener HC, Holle D, Dresler T, Gaul C. Chronic Headache Due to Overuse of Analgesics and Anti-Migraine Agents. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:365-370. [PMID: 29932046 PMCID: PMC6039717 DOI: 10.3238/arztebl.2018.0365] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 10/30/2017] [Accepted: 03/15/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND The frequent or regular use of analgesics and anti-migraine drugs can make headache more frequent and induce the transformation of episodic to chronic headache. Chronic headache due to medication overuse is defined as headache that is present on ≥ 15 days per month for at least three months in a patient who previously suffered from primary headaches, and who takes analgesics on ≥ 15 days per month or anti-migraine drugs (triptans or ergot alkaloids), opioid drugs, or combined analgesics on ≥ 10 days per month. METHODS This review is based on pertinent articles published up to December 2017 that were retrieved by a selective search in PubMed employing the terms "medication overuse AND headache" and "medication overuse headache." RESULTS The prevalence of medication overuse headache in the general population in Germany is 0.7% -1%. This disorder is more common in women and in persons suffering from comorbid mental disorders or other painful conditions. The treatment of medication overuse headache consists of three steps. Patient education and counseling are given with the goal of reducing the intake of medication for acute headache treatment. The ensuing headache prophylaxis is with topiramate, amitriptyline, or onabotulinum toxin A. If these treatment strategies fail, a drug holiday is recommended. This can be in the outpatient, day clinic, or inpatient setting, depending on the severity of the condition and its comorbidities. CONCLUSION Patients who frequently take acute medication to treat headache episodes must be identified early in order to avoid headache chronification and medication overuse headache. The suggested treatment algorithm is still in need of validation by randomized trials.
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Affiliation(s)
| | - Dagny Holle
- Department of Neurology and West German Headache Center, Essen
| | - Thomas Dresler
- Department of Psychiatry and Psychotherapy, University Hospital and Faculty of Medicine, Tübingen LEAD Graduate School & Research Network, University of Tübingen
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Helliwell T, Muller S, Hider SL, Prior JA, Richardson JC, Mallen CD. Challenges of diagnosis and management of giant cell arteritis in general practice: a multimethods study. BMJ Open 2018; 8:e019320. [PMID: 29431135 PMCID: PMC5829930 DOI: 10.1136/bmjopen-2017-019320] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND In the UK, general practitioners (GPs) are usually the first medical contact for patients with suspected giant cell arteritis (GCA). While rare, it is critical not to miss, as delayed treatment can lead to significant complications including permanent visual loss. To date, little is known about the approach and challenges to diagnosis and management of GCA by GPs. OBJECTIVE To investigate the diagnosis and management of patients with suspected GCA in UK general practice. DESIGN AND PARTICIPANTS A multimethods approach was taken, comprising a postal survey of 5000 randomly selected UK GPs and semistructured telephone interviews of 24 GPs from across the UK. SETTING UK general practice. RESULTS 1249 questionnaires were returned. 879 responders (70%) indicated that they had diagnosed and managed a patient with GCA. A variety of clinical features were used to identify GCA. 21.9% suggested that they would exclude GCA as a diagnosis if headache was absent and around one-third do not routinely initiate glucocorticoid treatment prior to referral. Significant regional variations in referral pathways were reported. Thematic analysis of interview transcripts highlighted fears relating to a missed diagnosis of GCA and the non-specific nature of early GCA presentation. Accessing specialist care was highlighted as challenging by many GPs and that a national standard fast-track pathway is lacking to support this patient group. Additionally there were significant concerns regarding potential adverse effects relating to long-term treatment with glucocorticoids. CONCLUSION GPs appear to over-rely on headache to identify GCA and marked geographical differences in management, with conflicting referral pathways and difficulties in accessing appropriate services exist in the UK. A national standard for fast-tracking patients with suspected GCA to relevant specialists would be beneficial to improve care and outcomes for patients with GCA.
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Affiliation(s)
- Toby Helliwell
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, UK
| | - Sara Muller
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, UK
| | - Samantha L Hider
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, UK
- Department of Rheumatology, Haywood Rheumatology Centre, Keele, UK
| | - James A Prior
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, UK
| | - Jane C Richardson
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, UK
| | - Christian D Mallen
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, UK
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Beckmann Y, Gökçe S, Zorlu N, Türe HS, Gelal F. Longitudinal assessment of gray matter volumes and white matter integrity in patients with medication-overuse headache. Neuroradiol J 2018; 31:150-156. [PMID: 29384424 DOI: 10.1177/1971400918756374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background Medication-overuse headache is a common clinical entity, but neuroimaging studies investigating volumetric and microstructural alterations of the brain in medication-overuse headache are rare. Therefore, in the current longitidunal study we evaluated gray matter volume and white matter integrity in patients with medication-overuse headache before and after drug withdrawal. Methods A prospective study evaluated 27 patients with medication-overuse headache and 27 age-, sex-, and education-matched healthy adults. High-resolution T1-weighted magnetic resonance imaging and diffusion tensor imaging were obtained from the control group and medication-overuse headache patients before and six months after drug withdrawal. Tract-based spatial statistics of multiple diffusivity indices and voxel-based morphometry were employed to investigate white and gray matter abnormalities. Results No correlation was found between age, gender, education and smoking status in both groups. The most commonly overused medications were simple analgesics (96.3%) and combined analgesics (3.7%). The mean duration of the history of medication overuse and headaches was 56.7 ± 63.5 months. White matter diffusional and gray matter morphological alterations including volume, fractional anisotropy, radial diffusivity, and axial diffusivity analyses showed no significant relationship in the patients before and six months after withdrawal of analgesics. Also no difference was observed between the patients versus controls. Conclusion Our data demonstrated no structural alterations within the brain in medication-overuse headache.
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Affiliation(s)
- Yesim Beckmann
- 1 Department of Neurology, 226844 Katip Çelebi Universitesi , Atatürk Training and Research Hospital, Turkey
| | - Sevgin Gökçe
- 1 Department of Neurology, 226844 Katip Çelebi Universitesi , Atatürk Training and Research Hospital, Turkey
| | - Nabi Zorlu
- 2 Department of Psychiatry, 226844 Katip Çelebi Universitesi , Atatürk Training and Research Hospital, Turkey
| | - H Sabiha Türe
- 1 Department of Neurology, 226844 Katip Çelebi Universitesi , Atatürk Training and Research Hospital, Turkey
| | - Fazıl Gelal
- 3 Department of Radiology, 226844 Katip Çelebi Universitesi , Atatürk Training and Research Hospital, Turkey
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Starling AJ. Diagnosis and Management of Headache in Older Adults. Mayo Clin Proc 2018; 93:252-262. [PMID: 29406202 DOI: 10.1016/j.mayocp.2017.12.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/07/2017] [Accepted: 12/06/2017] [Indexed: 01/03/2023]
Abstract
Headache is a common, disabling neurologic problem in all age groups, including older adults. In older adults, headache is most likely a primary disorder, such as tension-type headache or migraine; however, there is a higher risk of secondary causes, such as giant cell arteritis or intracranial lesions, than in younger adults. Thus, based on the headache history, clinical examination, and presence of headache red flags, a focused diagnostic evaluation is recommended, ranging from blood tests to neuroimaging, depending on the headache characteristics. Regardless of the primary or secondary headache disorder diagnosis, treatment options may be limited in older patients and may need to be tailored to the presence of comorbid medical conditions. The purpose of this review is to provide an update on the management of headache in older adults, from diagnosis to treatment.
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Ekenze OS, Ezeala-Adikaibe BA, Orjioke C, Mbadiwe N, Ijoma UN, Onyekonwu C, Ezeala-Adikaibe NP, Onodugo O, Anyim O, Okpara T, Nwatu CB, Onwuekwe IO. Prevalence and Pattern of Migraine, Tension Type Headache and Chronic Daily Headache among Medical and Nursing Students in Enugu, South East Nigeria. Health (London) 2018. [DOI: 10.4236/health.2018.1010099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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de Rijk P, Resseguier N, Donnet A. Headache Characteristics and Clinical Features of Elderly Migraine Patients. Headache 2017; 58:525-533. [PMID: 29235107 DOI: 10.1111/head.13247] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 11/21/2017] [Accepted: 11/22/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To investigate the headache characteristics and clinical features of elderly migraine patients at a tertiary headache center. METHODS We retrospectively reviewed 239 records of migraine patients, over the age of 64 at the first visit, who had migraine as defined by the International Classification of Headache Disorders 3rd edition (beta version) from 2006 to 2015 based on the Marseille registry at Timone Hospital. RESULTS 13.8% (33/239) patients had migraine with aura only, 13.0% (31/239) had both diagnoses. Of the patients who presented with migraine with aura, 13.4% (32/239) presented with aura without headache. Unilateral pain location was reported by 58.6% (140/239) of patients and the throbbing type of pain was present in 50.2% (120/239) of our study group. Photo- and phonophobia were observed in 77.4% (185/239) and 79.5% (190/239) of patients. Seventy-nine out of 239 (30.1%) patients were found to have probable medication overuse. Within this group, 31.65% (25/79) overused triptan and 70.9% (56/79) overused combination analgesics. We found higher frequencies of migraine for patients whose age at onset of migraine was younger than 18 years, and low frequency migraine was reported more frequently in the later onset group (P = .0357). DISCUSSION We assess the headache characteristics of elderly migraine patients who were seen at our tertiary headache center and report the high frequency of probable medication overuse headache in this study group. Finally, we suggest that age of onset is an important factor in the clinical profile of these patients.
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Affiliation(s)
- Pablo de Rijk
- Centre d'évaluation et de traitement de la douleur, Hopital La Timone, France
| | - Noémie Resseguier
- Aix-Marseille Univ, Service d'épidémiologie et d'économie de la santé - Assistance Publique Hôpitaux de Marseille, France
| | - Anne Donnet
- Centre d'évaluation et de traitement de la douleur, Hopital La Timone, France.,INSERM, Marseille, France.,FHU INOVPAIN, Marseille, France
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Ing EB, Lahaie Luna G, Toren A, Ing R, Chen JJ, Arora N, Torun N, Jakpor OA, Fraser JA, Tyndel FJ, Sundaram AN, Liu X, Lam CT, Patel V, Weis E, Jordan D, Gilberg S, Pagnoux C, Ten Hove M. Multivariable prediction model for suspected giant cell arteritis: development and validation. Clin Ophthalmol 2017; 11:2031-2042. [PMID: 29200816 PMCID: PMC5703153 DOI: 10.2147/opth.s151385] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose To develop and validate a diagnostic prediction model for patients with suspected giant cell arteritis (GCA). Methods A retrospective review of records of consecutive adult patients undergoing temporal artery biopsy (TABx) for suspected GCA was conducted at seven university centers. The pathologic diagnosis was considered the final diagnosis. The predictor variables were age, gender, new onset headache, clinical temporal artery abnormality, jaw claudication, ischemic vision loss (VL), diplopia, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and platelet level. Multiple imputation was performed for missing data. Logistic regression was used to compare our models with the non-histologic American College of Rheumatology (ACR) GCA classification criteria. Internal validation was performed with 10-fold cross validation and bootstrap techniques. External validation was performed by geographic site. Results There were 530 complete TABx records: 397 were negative and 133 positive for GCA. Age, jaw claudication, VL, platelets, and log CRP were statistically significant predictors of positive TABx, whereas ESR, gender, headache, and temporal artery abnormality were not. The parsimonious model had a cross-validated bootstrap area under the receiver operating characteristic curve (AUROC) of 0.810 (95% CI =0.766–0.854), geographic external validation AUROC’s in the range of 0.75–0.85, calibration pH–L of 0.812, sensitivity of 43.6%, and specificity of 95.2%, which outperformed the ACR criteria. Conclusion Our prediction rule with calculator and nomogram aids in the triage of patients with suspected GCA and may decrease the need for TABx in select low-score at-risk subjects. However, misclassification remains a concern.
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Affiliation(s)
- Edsel B Ing
- Department of Ophthalmology and Vision Sciences, University of Toronto Medical School, Toronto
| | | | - Andrew Toren
- Department of Ophthalmology, University of Laval, Quebec, QC
| | - Royce Ing
- Toronto Eyelid, Strabismus and Orbit Surgery Clinic, Toronto, ON, Canada
| | - John J Chen
- Mayo Clinic, Department of Ophthalmology and Neurology
| | - Nitika Arora
- Mayo Clinic, Department of Ophthalmology, Rochester, MN
| | - Nurhan Torun
- Department of Surgery, Division of Ophthalmology, Harvard Medical School, Boston, MA
| | | | - J Alexander Fraser
- Department of Clinical Neurological Sciences and Ophthalmology, Western University, London
| | - Felix J Tyndel
- Department of Medicine, University of Toronto Medical School, Toronto, ON, Canada
| | - Arun Ne Sundaram
- Department of Medicine, University of Toronto Medical School, Toronto, ON, Canada
| | - Xinyang Liu
- Department of Medicine, Fudan University Shanghai Medical College, Shanghai, People's Republic of China
| | - Cindy Ty Lam
- Department of Ophthalmology and Vision Sciences, University of Toronto Medical School, Toronto
| | - Vivek Patel
- Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ezekiel Weis
- Departments of Ophthalmology, Universities of Alberta and Calgary, Edmonton and Calgary, AB
| | - David Jordan
- Department of Ophthalmology, University of Ottawa, Ottawa, ON
| | - Steven Gilberg
- Department of Ophthalmology, University of Ottawa, Ottawa, ON
| | | | - Martin Ten Hove
- Department of Ophthalmology, Queen's University, Kingston, ON
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Maksimova MY, Сhochlova TY, Mota LA. [Medication overuse headache]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:99-102. [PMID: 29053129 DOI: 10.17116/jnevro20171179199-102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Rebound headache (RH) is a chronic daily headache which occurs when analgesics, triptans, ergotamines are taken frequently (more than 15 days/month for more than 3 months) to relieve headaches. The prevalence of RH is 1 to 4% in the general population. RH commonly occurs in patients with migraine and tension-type headache. The deficit of central sensitization and psychological factors play an important role in initiating and maintaining of RH. Treatment of noofen for 2 months is effective in 75% of patients with RH.
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Affiliation(s)
- M Yu Maksimova
- Research Center of Neurology, Moscow, Russia; Evdokimov Moscow State Medical and Dental University, Moscow, Russia
| | - T Yu Сhochlova
- Evdokimov Moscow State Medical and Dental University, Moscow, Russia
| | - L A Mota
- Research Center of Neurology, Moscow, Russia
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Scher AI, Rizzoli PB, Loder EW. Medication overuse headache: An entrenched idea in need of scrutiny. Neurology 2017; 89:1296-1304. [PMID: 28821684 DOI: 10.1212/wnl.0000000000004371] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/10/2017] [Indexed: 12/31/2022] Open
Abstract
It is a widely accepted idea that medications taken to relieve acute headache pain can paradoxically worsen headache if used too often. This type of secondary headache is referred to as medication overuse headache (MOH); previously used terms include rebound headache and drug-induced headache. In the absence of consensus about the duration of use, amount, and type of medication needed to cause MOH, the default position is conservative. A common recommendation is to limit treatment to no more than 10 or 15 days per month (depending on medication type) to prevent headache frequency progression. Medication withdrawal is often recommended as a first step in treatment of patients with very frequent headaches. Existing evidence, however, does not provide a strong basis for such causal claims about the relationship between medication use and frequent headache. Observational studies linking treatment patterns with headache frequency are by their nature confounded by indication. Medication withdrawal studies have mostly been uncontrolled and often have high dropout rates. Evaluation of this evidence suggests that only a minority of patients required to limit the use of symptomatic medication may benefit from treatment limitation. Similarly, only a minority of patients deemed to be overusing medications may benefit from withdrawal. These findings raise serious questions about the value of withholding or withdrawing symptom-relieving medications from people with frequent headaches solely to prevent or treat MOH. The benefits of doing so are smaller, and the harms larger, than currently recognized. The concept of MOH should be viewed with more skepticism. Until the evidence is better, we should avoid dogmatism about the use of symptomatic medication. Frequent use of symptom-relieving headache medications should be viewed more neutrally, as an indicator of poorly controlled headaches, and not invariably a cause.
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Affiliation(s)
- Ann I Scher
- From the Department of Preventive Medicine and Biostatistics (A.I.S.), Uniformed Services University, Bethesda, MD; and Department of Neurology (P.B.R., E.W.L.), Brigham and Women's Hospital, Boston, MA.
| | - Paul B Rizzoli
- From the Department of Preventive Medicine and Biostatistics (A.I.S.), Uniformed Services University, Bethesda, MD; and Department of Neurology (P.B.R., E.W.L.), Brigham and Women's Hospital, Boston, MA
| | - Elizabeth W Loder
- From the Department of Preventive Medicine and Biostatistics (A.I.S.), Uniformed Services University, Bethesda, MD; and Department of Neurology (P.B.R., E.W.L.), Brigham and Women's Hospital, Boston, MA
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Henning V, Katsarava Z, Obermann M, Moebus S, Schramm S. Remission of chronic headache: Rates, potential predictors and the role of medication, follow-up results of the German Headache Consortium (GHC) Study. Cephalalgia 2017; 38:551-560. [PMID: 28944686 DOI: 10.1177/0333102417699180] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives To estimate remission rates of chronic headache (CH), focusing on potential predictors of headache remission and medication. Methods We used data from the longitudinal population-based German Headache Consortium (GHC) Study (n = 9,944, 18-65 years). Validated questionnaires were used at baseline (t0, 2003-2007, response rate: 55.2%), first follow-up after 1.87 ± 0.39 years (t1, 37.2%) and second follow-up after 3.26 ± 0.60 years (t2, 38.8%) to assess headache type and frequency, use of analgesics and anti-migraine drugs, medication overuse, education, BMI, smoking and alcohol consumption. CH was defined as ≥ 15 headache days/month at t0 over three months. Outcomes were: CH remission (<15 headache days/month at both follow-ups), CH persistence (≥ 15 headache days/month at both follow-ups); all others were considered as partially remitted. To estimate predictors of remission, univariate and multiple logistic regression were calculated. Results At baseline, 255 (2.6%) participants were identified with CH. Of these, 158 (62.0%) participants responded at both follow-ups. Remission was observed in 58.2% of participants, partial remission in 17.7% and persistence in 24.1%. Remission was associated with female sex (adjusted odds ratio: 3.10, 95% confidence interval: 1.06-9.08) and no medication overuse (4.16, 1.45-11.94) compared to participants with persistent CH; participants with higher headache frequency at t0 were less likely to remit (0.90, 0.84-0.97). Medication, age, education, BMI, smoking and drinking showed no effects on remission. Similar results were observed for partial remission. Conclusion The majority of CH participants remitted from CH. Female sex, no overuse of pain medication and lower headache frequency were associated with remission.
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Affiliation(s)
- Verena Henning
- 1 Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany
| | - Zaza Katsarava
- 2 Department of Neurology, Evangelical Hospital, Unna, Germany.,3 Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Mark Obermann
- 4 Center for Neurology, Asklepios Hospitals Schildautal, Seesen, Germany
| | - Susanne Moebus
- 1 Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany
| | - Sara Schramm
- 1 Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany
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The PACE study: lifetime and past-year prevalence of headache in Parma's adult general population. Neurol Sci 2017; 38:789-795. [PMID: 28210911 DOI: 10.1007/s10072-017-2845-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 02/08/2017] [Indexed: 10/20/2022]
Abstract
Headache is a widespread disorder and therefore it has a strong impact on quality of life. In the present work we focused on lifetime and past-year prevalence of headache in general and by gender, in a population-based sample in Parma. A total of 904 subjects representative of Parma's adult general population were interviewed face-to-face by a physician from the Parma Headache Centre, using a validated questionnaire. The lifetime prevalence of headache was 69.1%, i.e. 75.8% in women and 60.6% in men; the crude past-year prevalence of headache was 42.8%, i.e. 52.0% in women and 31.1% in men. Both lifetime and past-year prevalence rates were significantly higher in females than in males (odds ratio, respectively, 2.0 and 2.4). In our study, past-year prevalence decreased after age 50 in both genders. Most people suffer from one headache subtype. In over 80% of cases, headache starts before age 40 and therefore people were not very likely to develop headache after 50 years. The past-year and lifetime prevalence rate of headache in general that we found in our study falls within the lower range of values for headache prevalence in European countries. Further researches need to be set in the Italian epidemiological background.
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Uthaikhup S, Assapun J, Watcharasaksilp K, Jull G. Effectiveness of physiotherapy for seniors with recurrent headaches associated with neck pain and dysfunction: a randomized controlled trial. Spine J 2017; 17:46-55. [PMID: 27497890 DOI: 10.1016/j.spinee.2016.08.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/03/2016] [Accepted: 08/02/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT A previous study demonstrated that in seniors, the presence of cervical musculoskeletal impairment was not specific to cervicogenic headache but was present in various recurrent headache types. Physiotherapy treatment is indicated in those seniors diagnosed with cervicogenic headache but could also be adjunct treatment for those with cervical musculoskeletal signs who are suspected of having transitional headaches. PURPOSE This study aimed to determine the effectiveness of a physiotherapy program for seniors with recurrent headaches associated with neck pain and cervical musculoskeletal dysfunction, irrespective of the headache classification. STUDY DESIGN This is a prospective, stratified, randomized controlled trial with blinded outcome assessment. PATIENT SAMPLE Sixty-five participants with recurrent headache, aged 50-75 years, were randomly assigned to either a physiotherapy (n=33) or a usual care group (n=32). OUTCOME MEASURES The primary outcome was headache frequency. Secondary outcomes were headache intensity and duration, neck pain and disability, cervical range of motion, quality of life, participant satisfaction, and medication intake. METHODS Participants in the physiotherapy group received 14 treatment sessions. Participants in the usual care group continued with their usual care. Outcome measures were recorded at baseline, 11 weeks, 6 months, and 9 months. This study was funded by a government research fund of $6,850. No conflict of interest is declared. RESULTS There was no loss to follow-up for the primary outcome measure. Compared with usual care, participants receiving physiotherapy reported significant reductions in headache frequency immediately after treatment (mean difference -1.6 days, 95% confidence interval [CI] -2.5 to -0.6), at 6-month follow-up (-1.7 days, 95% CI -2.6 to -0.8), and at 9-month follow-up (-2.4 days, 95% CI -3.2 to -1.5), and significant improvements in all secondary outcomes immediately posttreatment and at 6- and 9-month follow-ups, (p<.05 for all). No adverse events were reported. CONCLUSIONS Physiotherapy treatment provided benefits over usual care for seniors with recurrent headache associated with neck pain and dysfunction.
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Affiliation(s)
- Sureeporn Uthaikhup
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, 110 Intawaroroj Rd, Sripoom, Chiang Mai, Thailand 50200; Research Center in Back, Neck and Other Joint Pain and Human Performance, Khon Kaen University, 123 Moo 16 Mittraphap Rd, Khon Kaen, Thailand 40002.
| | - Jenjira Assapun
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, 110 Intawaroroj Rd, Sripoom, Chiang Mai, Thailand 50200
| | - Kanokwan Watcharasaksilp
- Department of Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroroj Rd, Sripoom, Chiang Mai, Thailand 50200
| | - Gwendolen Jull
- Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane, Australia 4072
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Giménez-Roldán S. Cajal's unbearable cephalalgias: The consequences of a misdiagnosis. Rev Neurol (Paris) 2016; 172:680-688. [PMID: 28029372 DOI: 10.1016/j.neurol.2016.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 05/16/2016] [Accepted: 09/27/2016] [Indexed: 01/03/2023]
Abstract
Around the age of 66 Cajal consulted neurologist Nicolas Achúcarro complaining of "unbearable cephalalgias". He had not ever suffered from headaches. The diagnosis of early arteriosclerosis that was considered at the time a physiological, irreversible ailment of ageing had a strong emotional impact on Cajal. Comorbid depression, insomnia and self-treatment with escalating doses of Veronal® (barbital), a short-acting barbiturate, presumably aggravated the situation. Exposure to warm environments and being involved in tense discussions were identified as triggering factors of the headaches. Achúcarro and Cajal were probably assuming scientific concepts at the time, such as cerebral congestion, increased temperature at the cerebral cortex during mental activity and vasoconstriction and vasodilatation phenomena. Up to his death aged 82, no evidence was discovered of any organic nervous system disorder. Cajal remained anxious up to the end of his life fearing an impending cerebral haemorrhage. The diagnosis was followed by profound lifestyle changes such as social isolation, which forced him to leave his laboratory. Cajal's cephalalgias marked in some way the end of the Spanish school of neurohistology.
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Feleppa M, Fucci S, Bigal ME. Primary Headaches in an Elderly Population Seeking Medical Care for Cognitive Decline. Headache 2016; 57:209-216. [PMID: 27933636 DOI: 10.1111/head.13003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To assess the prevalence of specific headache disorders in a population older than 65 years seeking consultation due to memory problems or cognitive impairment. METHODS We verified the occurrence of headache symptoms and the impact of headaches on daily life. Headaches were classified as per the International Classification of Headache Disorders, 2nd edition (ICHD-2). All patients were screened with the Mini-Mental State Examination (MMSE), followed by the Selective Reminding Test and neuroimaging. Participants with severe cognitive impairment or dementia were excluded. RESULTS A total of 1,237 patients (51.6% women), with mean age of 75.6 years (SD = 6.9) were screened from January 2006 to December 2014. Of them, 302 (24.4%) patients suffered from headaches. Most common individual diagnoses were probable migraine (13.8%), episodic tension-type headache (3.4%), and episodic migraine (3.0%). Chronic migraine or probable chronic migraine happened in 3.5%, while chronic tension-type headache affected 0.6%. Most patients with headaches routinely used symptomatic medications (55.6%). Mean MMSE scores were similar in patients with or without headaches, or with different headache diagnoses. CONCLUSIONS Headache disorders overall, frequent headaches, and headaches requiring treatment are commonly seen in the elderly seeking care for cognitive decline and should be properly assessed and managed.
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Hascalovici JR, Robbins MS. Peripheral Nerve Blocks for the Treatment of Headache in Older Adults: A Retrospective Study. Headache 2016; 57:80-86. [PMID: 27901275 DOI: 10.1111/head.12992] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 08/18/2016] [Accepted: 09/08/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The objective of this study is to provide demographical and clinical descriptions of patients age 65 years old and older who were treated with peripheral nerve blocks (PNBs) at our institution and evaluate the safety and efficacy of this treatment. BACKGROUND Headache disorders are common, disabling chronic neurological diseases that often persist with advancing age. Geriatric headache management poses unique therapeutic challenges because of considerations of comorbidity, drug interactions, and adverse effects. Peripheral nerve blocks are commonly used for acute and short-term prophylactic treatment for headache disorders and may be a safer alternative to standard pharmacotherapy in this demographic. DESIGN We performed a single center, retrospective chart review of patients at least 65 years of age who received peripheral nerve blocks for headache management over a 6 year period. RESULTS Sixty-four patients were mostly female (78%) with an average age of 71 years (range 65-94). Representative headache diagnoses were chronic migraine 50%, episodic migraine 12.5%, trigeminal autonomic cephalalgia 9.4%, and occipital neuralgia 7.8%. Average number of headache days/month was 23. Common comorbidities were hypertension 48%, hyperlipidemia 42%, arthritis 27%, depression 47%, and anxiety 33%. Eighty-nine percent were prescribed at least 1 medication fulfilling the Beers criteria. The average number of peripheral nerve blocks per patient was 4. Peripheral nerve blocks were felt to be effective in 73% for all headaches, 81% for chronic migraine, 75% for episodic migraine, 67% for chronic tension type headache, 67% for new daily persistent headache, and 60% for occipital neuralgia. There were no adverse events related to PNBs reported. CONCLUSIONS PNBs might be a safe and effective alternative headache management strategy for older adults. Medical and psychiatric comorbidities, medication overuse, and Beers list medication rates were extraordinarily high, giving credence to the use of peripherally administered therapies in the geriatric population that may be better tolerated and safer.
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Affiliation(s)
- Jacob R Hascalovici
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Matthew S Robbins
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
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Mazzotta G, Gallai V, Alberti A, Billeci AMR, Coppola F, Sarchielli P. Characteristics of Migraine in an Out-Patient Population Over 60 Years of Age. Cephalalgia 2016; 23:953-60. [PMID: 14984227 DOI: 10.1046/j.1468-2982.2003.00616.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
One hundred and sixty-three consecutive patients (129 females and 34 males) over 60 years of age attending the Headache Centre of the University of Perugia in the period January 2000-December 2001 were included in the study. One hundred and fifty-two (93.3%) were affected by a primary headache disorder. According to the 1988 IHS Criteria, their prevailing attacks could be diagnosed as migraine without aura (MwoA) in 57.2% of cases ( n = 87) and as migraine with aura (MwA) in 11.8% of cases ( n = 18). Attacks both in MwoA and MwA were unilateral and of severe-to-moderate intensity in 45% and 50% of cases. Head pain was referred as pulsating by 56% and 38.9% of MwoA patients MwA patients, respectively. Aggravation with routine daily activities was present in 72.4% and 61.1% in MwoA and MwA patient groups. The most frequent accompanying symptoms were photophobia and phonophobia. Headache attacks were of shorter duration in MwA patients, but in 3.4% of MwoA patients attacks lasted between 2 and 4 h. Of patients affected by MwA, 55% referred, together with the typical attacks, symptoms of aura not followed by headache. A worsening of headache in the last 5 years was reported by 67.8% and 44.4% of MwoA and MwA patients, respectively. Of the patients with MwoA, 86.2% ( n = 75), and 83.3% ( n = 15) of those with MwA used symptomatic drugs for their attacks. In the majority of cases they took more than one analgesic or non steroidal anti-inflammatory drug. A total of 51.7% of patients with MwoA and 55.5% of patients with MwA were under prophylactic treatment. Preventive drugs included antidepressants, beta-blockers, calcium channel antagonists and antiepileptic drugs. The choice of symptomatic or prophylactic drugs was made, in the majority of cases, on the basis of concomitant diseases.
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Affiliation(s)
- G Mazzotta
- Department of Neuroscience, University of Perugia, Italy
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Song TJ, Kim YJ, Kim BK, Kim BS, Kim JM, Kim SK, Moon HS, Cha MJ, Park KY, Sohn JH, Chu MK, Cho SJ. Characteristics of Elderly-Onset (≥65 years) Headache Diagnosed Using the International Classification of Headache Disorders, Third Edition Beta Version. J Clin Neurol 2016; 12:419-425. [PMID: 27819415 PMCID: PMC5063867 DOI: 10.3988/jcn.2016.12.4.419] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 02/04/2016] [Accepted: 02/05/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND AND PURPOSE New-onset headache in elderly patients is generally suggestive of a high probability of secondary headache, and the subtypes of primary headache diagnoses are still unclear in the elderly. This study investigated the characteristics of headache with an older age at onset (≥65 years) and compared the characteristics between younger and older age groups. METHODS We prospectively collected demographic and clinical data of 1,627 patients who first visited 11 tertiary hospitals in Korea due to headache between August 2014 and February 2015. Headache subtype was categorized according to the International Classification of Headache Disorders, Third Edition Beta Version. RESULTS In total, 152 patients (9.3%, 106 women and 46 men) experienced headache that began from 65 years of age [elderly-onset group (EOG)], while the remaining 1,475 patients who first experienced headache before the age of 65 years were classified as the younger-age-at-onset group (YOG). Among the primary headache types, tension-type headache (55.6% vs. 28.8%) and other primary headache disorders (OPH, 31.0% vs. 17.3%) were more common in the EOG than in the YOG, while migraine was less frequent (13.5% vs. 52.2%) (p=0.001) in the EOG. Among OPH, primary stabbing headache (87.2%) was more frequent in the EOG than in the YOG (p=0.032). The pain was significantly less severe (p=0.026) and the frequency of medication overuse headache was higher in EOG than in YOG (23.5% vs. 7.6%, p=0.040). CONCLUSIONS Tension-type headache and OPH headaches, primarily stabbing headache, were more common in EOG patients than in YOG patients. The pain intensity, distribution of headache diagnoses, and frequency of medication overuse differed according to the age at headache onset.
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Affiliation(s)
- Tae Jin Song
- Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea
- Department of Neurology, Yonsei University School of Medicine, Seoul, Korea
| | - Yong Jae Kim
- Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Byung Kun Kim
- Department of Neurology, Eulji University School of Medicine, Seoul, Korea
| | - Byung Su Kim
- Department of Neurology, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea
| | - Jae Moon Kim
- Department of Neurology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Soo Kyoung Kim
- Department of Neurology, Gyeongsang National University Hospital, Jinju, Korea
| | - Heui Soo Moon
- Department of Neurology, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myoung Jin Cha
- Department of Neurology, National Police Hospital, Seoul, Korea
| | - Kwang Yeol Park
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jong Hee Sohn
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Min Kyung Chu
- Department of Neurology, Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Soo Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.
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Zhang Y, Shi Z, Hock D, Yue W, Liu S, Zhang Y, Liu S, Zhao L, Lu H, Guan Y, Wang X, Wsiniewski T, Ji Y. Prevalence of primary headache disorders in a population aged 60 years and older in a rural area of Northern China. J Headache Pain 2016; 17:83. [PMID: 27619363 PMCID: PMC5020010 DOI: 10.1186/s10194-016-0672-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 08/31/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Primary headache disorders are among the most common neurological complaints worldwide, and are significant causes of disability. Data are limited on the prevalence of primary headaches among individuals aged 60 years and older in China. The purpose of our study was to investigate the prevalence and characteristics of primary headaches among people aged 60 years and older in a rural area of northern China. METHODS A door-to-door survey was conducted in Ji County of Tianjin Province. A total of 5248 residents aged 60 years and older were visited from 2014 to 2015, unannounced, and basic sociodemographic and headache diagnostic information was collected via a questionnaire. Primary headache was classified tension-type headaches, migraines, chronic headache, and unclassified headache. RESULTS The 1-year prevalence for primary headaches in Ji county is 10.30 %. The 1-year prevalence of tension-type headaches, migraines, chronic headache, and unclassified headache is 2.02 %, 0.85 %, 3.79 %, and 3.63 %. The 1-year prevalence of primary headache was higher in women than in men. The 1-year prevalence of primary headache was decreased with increasing age. The 1-year prevalence of tension-type headaches and chronic headache were decreased with higher education. Headache in the elderly was mild to moderate and not serious. CONCLUSIONS In a population older than 60 years of age in rural, northern China, we found the 1-year prevalence of primary headache was 10.30 %, of tension-type headaches was 2.02 %, of migraines was 0.85 %, of chronic headache was 3.79 %, and of unclassified headache was 3.63 %. The prevalence of all of these was much lower than those observed in previous studies examining prevalence rates in the general population. The results of our study also indicated that women are more likely to have primary headache than men. We also found that chronic headache was frequent among the elderly. Participants with higher education levels were more predisposed than healthy participants to tension-type headaches. We also found that respondents who did not participate in social activities had a decreased predisposition for primary headache in general, as well as for unclassified headache. Lastly, we found that participants who had heart disease were more likely than healthy participants to experience primary headache, tension-type headache, chronic headache, and unclassified headache.
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Affiliation(s)
- Yajing Zhang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China.,Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Huanhu Hospital, Jizhao Road 6, Tianjin, Jinnan, 300060, China
| | - Zhihong Shi
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China.,Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Huanhu Hospital, Jizhao Road 6, Tianjin, Jinnan, 300060, China
| | - Duncan Hock
- Morsani College of Medicine, University of South Floride, Tampa, USA
| | - Wei Yue
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China.,Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Huanhu Hospital, Jizhao Road 6, Tianjin, Jinnan, 300060, China
| | - Shuling Liu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China.,Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Huanhu Hospital, Jizhao Road 6, Tianjin, Jinnan, 300060, China
| | - Ying Zhang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China.,Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Huanhu Hospital, Jizhao Road 6, Tianjin, Jinnan, 300060, China
| | - Shuai Liu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China.,Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Huanhu Hospital, Jizhao Road 6, Tianjin, Jinnan, 300060, China
| | - Lei Zhao
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China.,Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Huanhu Hospital, Jizhao Road 6, Tianjin, Jinnan, 300060, China
| | - Hui Lu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China.,Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Huanhu Hospital, Jizhao Road 6, Tianjin, Jinnan, 300060, China
| | - Yalin Guan
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China.,Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Huanhu Hospital, Jizhao Road 6, Tianjin, Jinnan, 300060, China
| | - Xiaodan Wang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China.,Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Huanhu Hospital, Jizhao Road 6, Tianjin, Jinnan, 300060, China
| | - Thomas Wsiniewski
- Departments of Neurology(Aging and Dementia Division), Pathology and Psychiatry, NYU Pearl Barlow Center of Memory Evaluation and Treatment, New York, NY, USA
| | - Yong Ji
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China. .,Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Huanhu Hospital, Jizhao Road 6, Tianjin, Jinnan, 300060, China.
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Westergaard ML, Munksgaard SB, Bendtsen L, Jensen RH. Medication-overuse headache: a perspective review. Ther Adv Drug Saf 2016; 7:147-58. [PMID: 27493718 DOI: 10.1177/2042098616653390] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Medication-overuse headache (MOH) is a debilitating condition in which frequent and prolonged use of medication for the acute treatment of pain results in the worsening of the headache. The purpose of this paper is to review the most recent literature on MOH and discuss future avenues for research. MOH accounts for a substantial share of the global burden of disease. Prevalence is often reported as 1-2% but can be as high as 7% overall, with higher proportions among women and in those with a low socioeconomic position. Management consists of withdrawing pain medication, focusing on prophylactic and nonmedical treatments, and limiting acute symptomatic medication. Stress reduction and lifestyle interventions may support the change towards rational pain medication use. Support, follow up, and education are needed to help patients through the detoxification period. There is fertile ground for research in MOH epidemiology, pathophysiology, and neuroimaging. Randomized and long-term follow-up studies on MOH treatment protocols are needed. Further focused research could be of major importance for global health.
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Affiliation(s)
- Maria Lurenda Westergaard
- Danish Headache Center, Rigshospitalet - Glostrup, University of Copenhagen, Nordre Ringvej 67, Område Nord Bygning 14, 2600 Glostrup, Denmark
| | - Signe Bruun Munksgaard
- Danish Headache Center, Rigshospitalet - Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Lars Bendtsen
- Danish Headache Center, Rigshospitalet - Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Rigmor Højland Jensen
- Danish Headache Center, Rigshospitalet - Glostrup, University of Copenhagen, Glostrup, Denmark
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Kavuk I, Weimar C, Kim BT, Gueneyli G, Araz M, Klieser E, Limmroth V, Diener HC, Katsarava Z. One-Year Prevalence and Socio-Cultural Aspects of Chronic Headache in Turkish Immigrants and German Natives. Cephalalgia 2016; 26:1177-81. [PMID: 16961782 DOI: 10.1111/j.1468-2982.2006.01186.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of this research was to study the prevalence of chronic headache (CH) and associated socio-cultural factors in Turkish immigrants and native Germans. Five hundred and twenty-three Turkish and German company employees were screened using a standard questionnaire. Those who suffered from headaches were also examined by a neurologist. Complete data were available for 471 (90%) subjects. Thirty-four participants (7.2%) had CH. Two independent factors for association with CH could be identified: overuse of acute headache medication (OR = 72.5; 95% CI 25.9-202.9), and being a first-generation Turkish immigrant compared with native Germans (OR = 4.4; 95% CI 1.4-13.7). In contrast, the factor associated with chronic headache was not increased in second-generation Turkish immigrants. Medication overuse was significantly more frequent in first-generation Turkish immigrants (21.6%) compared with second-generation Turkish immigrants (3.3%) and native Germans (3.6%; X2 = 38.0, P < 0.001). First-generation Turkish immigrants did not contact headache specialists at all, compared with 2.8% of second-generation Turkish immigrants and 8.8% of native Germans ( X2 = 118.4, P < 0.001). Likewise no first-generation Turkish immigrant suffering from CH received headache preventive treatment, compared with 6.6% of native Germans ( X2 = 19.1, P = 0.014). The data from this cross-sectional study reveal a high prevalence of chronic headache as well as a very low utilization of adequate medical care in first-generation Turkish immigrants in Germany.
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Affiliation(s)
- I Kavuk
- Department of Neurology, University of Essen, Essen, Germany.
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Abstract
Although migraine is less prevalent in older than in younger age groups, the absolute increase in the number of subjects in older age groups may lead to an increase in the total number of migraine patients. Consequently, more elderly migraine patients may seek medical attention. In this review, the epidemiology and clinical aspects of migraine in the age group of ≥60 years are summarized, with special attention to comorbidity. The review will focus on treatment choices in elderly migraine patients. These must be based on knowledge of mechanisms of physiological and pathological ageing.
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Affiliation(s)
- J Haan
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.
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Abstract
The prevalence of headache decreases in elderly age groups; however, headache remains a significant issue with unique diagnostic and therapeutic considerations in this population. While primary headache disorders such as migraine and tension-type headache still occur in the majority of cases, secondary headaches are more common with advancing age. Additionally, several rare primary headache disorders, such as hypnic headache and primary cough headache, occur more frequently in an elderly population and have distinct treatments. In this review, we provide an updated overview of the common, concerning, and unique headache disorders affecting the elderly.
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Affiliation(s)
- Thomas P Bravo
- Department of Neurology, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA,
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Donnet A, Braunstein D, Pradel V, Sciortino V, Allaria-Lapierre V, Micallef J, Lanteri-Minet M. Ergot Use and Overuse: A Pharmacoepidemiology Retrospective Cohort Study. Headache 2016; 56:547-54. [DOI: 10.1111/head.12776] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 12/02/2015] [Accepted: 12/03/2015] [Indexed: 11/28/2022]
Affiliation(s)
- A. Donnet
- Centre d’évaluation et de traitement de la douleur, Hôpital Timone, Pôle Neurosciences Cliniques; Hôpital de la Timone; Marseille France
- INSERM/UdA, U1107, Neuro-Dol; Clermont-Ferrand France
| | - D. Braunstein
- Aix Marseille Université, CNRS 7289-Institut de Neurosciences Timone, Centre d'Evaluation et d'Information sur la Pharmacodépendance & Addictovigilance PACA-Corse, Service de Pharmacologie Médicale et Clinique, AP-HM; Marseille France
| | - V. Pradel
- Aix Marseille Université, CNRS 7289-Institut de Neurosciences Timone, Centre d'Evaluation et d'Information sur la Pharmacodépendance & Addictovigilance PACA-Corse, Service de Pharmacologie Médicale et Clinique, AP-HM; Marseille France
| | - V. Sciortino
- Direction Régionale du Service Médical de l'Assurance Maladie Provence-Alpes-Côte d'Azur et Corse (CNAMTS); Marseille France
| | - V. Allaria-Lapierre
- Direction Régionale du Service Médical de l'Assurance Maladie Provence-Alpes-Côte d'Azur et Corse (CNAMTS); Marseille France
| | - J. Micallef
- Aix Marseille Université, CNRS 7289-Institut de Neurosciences Timone, Centre d'Evaluation et d'Information sur la Pharmacodépendance & Addictovigilance PACA-Corse, Service de Pharmacologie Médicale et Clinique, AP-HM; Marseille France
| | - M. Lanteri-Minet
- INSERM/UdA, U1107, Neuro-Dol; Clermont-Ferrand France
- Département d'Evaluation et Traitement de la Douleur; Pôle Neurosciences Cliniques du CHU de Nice, Hôpital Cimiez; Nice France
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Allena M, Steiner TJ, Sances G, Carugno B, Balsamo F, Nappi G, Andrée C, Tassorelli C. Impact of headache disorders in Italy and the public-health and policy implications: a population-based study within the Eurolight Project. J Headache Pain 2015; 16:100. [PMID: 26627710 PMCID: PMC4666849 DOI: 10.1186/s10194-015-0584-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 11/21/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Migraine, tension-type headache (TTH) and medication-overuse headache (MOH) are disabling lifelong illnesses. The Eurolight project, a partnership activity within the Global Campaign against Headache, assessed the impact of headache disorders in ten countries in Europe using a structured questionnaire coupled with various sampling methods. Here we present the findings from the Italian population. METHODS Questionnaires were distributed to a stratified sample (N = 3500) of the adult (18-65 years) inhabitants of Pavia province (1.05 % of the general population), randomly selected in cooperation with the local health service. Questions included demographic and diagnostic enquries, and assessment of various aspects of impact and health-care utilisation. RESULTS Altogether 500 questionnaires were returned of which 487 were adequately completed for analysis (58 % female, 42 % male). Among these, gender-adjusted lifetime prevalence of headache was 82.5 %, higher in females than in males (91.2 % vs 72.4 %; p < 0.0001). Gender-adjusted 1-year prevalence was 74.2 % (females 87.7 %, males 61.1 %; p < 0.0001). The most prevalent headache type was migraine (gender-adjusted 1-year prevalence 42.9 %; females 54.6 %, males 32.5 %; p < 0.0001), followed by TTH (28.6 %; no gender-related difference); all causes of headache on ≥15 days/month were reported by 7.0 % of participants (females 10.6 %, males 2.0 %; p = 0.0002), of whom 2.1 %,, all female (p = 0.0064) concomitantly overused acute medications (therefore probable MOH). Only 16.6 % of responders reporting headache had received a diagnosis from a doctor, and very few (2.4 %) were taking preventative medications. Headache had negative impacts on different aspects of life: education, career and earnings, family and social life. Each person with headache had lost, on average, 2.3 days from paid work and 2.4 days from household work, and missed social occasions on 1.2 days, in the preceding 3 months. An increasing gradient for impact was observed from episodic to chronic forms of headache. CONCLUSIONS Our study reveals that in Italy, as in other countries, migraine, TTH and MOH are highly prevalent and are associated with significant personal impact. These findings have important implications for health policy in Italy.
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Affiliation(s)
- M Allena
- Headache Science Center, C. Mondino National Neurological Institute, Via Mondino 2, 27100, Pavia (I), Italy
| | - T J Steiner
- Department of Neuroscience, Norwegian University of Science and Technology, Edvard Griegs Gate, Trondheim, NO-7491, Norway
- Division of Brain Sciences, Imperial College London, London, UK
| | - G Sances
- Headache Science Center, C. Mondino National Neurological Institute, Via Mondino 2, 27100, Pavia (I), Italy
| | - B Carugno
- Azienda Sanitaria Locale (ASL), Pavia, Italy
| | - F Balsamo
- Headache Science Center, C. Mondino National Neurological Institute, Via Mondino 2, 27100, Pavia (I), Italy
| | - G Nappi
- Headache Science Center, C. Mondino National Neurological Institute, Via Mondino 2, 27100, Pavia (I), Italy
| | - C Andrée
- Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - C Tassorelli
- Headache Science Center, C. Mondino National Neurological Institute, Via Mondino 2, 27100, Pavia (I), Italy.
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.
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