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Alharbi AS, Alharbi OF, Qutub FL, Albogami WM, Aljuhnie MA, Alharbi AE, Alqahtani WN, Babateen O. Assessment of the Prevalence and Level of Awareness of Medication Overuse Headache Among the General Population in Makkah City, Saudi Arabia. Cureus 2023; 15:e37985. [PMID: 37223197 PMCID: PMC10202447 DOI: 10.7759/cureus.37985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Medication overuse headache (MOH) is a secondary headache condition caused by consistently using more medication than necessary to treat headache symptoms. MOH is defined as a headache that occurs for 15 or more days per month in a patient with a pre-existing primary headache, and it develops as a result of regular overuse of symptomatic headache medication for more than three months. Patients with headaches often use simple pain medication for 15 or more days per month (e.g., non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol) and 10 or more days per month of opioids, triptans, and combination analgesics, but when there is no relief from these medications, the headache progression can lead to a cycle of consuming more medication with increased pain, which can lead to MOH. OBJECTIVE This study aimed to assess the prevalence and awareness of MOH among the general population of Makkah, Saudi Arabia. METHODS A cross-sectional study was conducted between December 2022 and March 2023 using a self-administered online questionnaire disseminated through social media. Data were collected from females and males 18 years of age and older living in Makkah, Saudi Arabia. RESULTS Overall, 715 individuals completed the questionnaire, 497 of whom were female (69.5%). The average age of the participants was 32.9 years (±13.3 years). The prevalence of MOH among those who reported having experienced headaches throughout their lifetimes was estimated to be 4.5%. Only 134 people (18.7%) were determined to be aware of MOH. CONCLUSION This study demonstrated that the general population of Makkah has a high prevalence of MOH and low levels of MOH awareness.
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Affiliation(s)
- Abdullah S Alharbi
- Department of Medicine and Surgery, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Omar F Alharbi
- Department of Medicine and Surgery, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Fadi L Qutub
- Department of Medicine and Surgery, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Warif M Albogami
- Department of Medicine and Surgery, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Mohammed A Aljuhnie
- Department of Medicine and Surgery, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Abdullah E Alharbi
- Department of Medicine and Surgery, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Wed N Alqahtani
- Department of Medicine and Surgery, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Omar Babateen
- Department of Physiology, College of Medicine, Umm Al-Qura University, Makkah, SAU
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2
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Simmonds L, Mehta D, Cheema S, Matharu M. Epidemiology of migraine. HANDBOOK OF CLINICAL NEUROLOGY 2023; 198:31-38. [PMID: 38043969 DOI: 10.1016/b978-0-12-823356-6.00017-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Migraine affects over a billion people worldwide and brings with it a huge burden of disability. It is a disease which disproportionally affects the working age population which heightens its economic impact, both at the individual family level and the societal level. Women are significantly more affected by migraine at every age and in all social and geographical groups. At the most severe end of the spectrum, chronic migraine is associated with poorer overall physical and mental health as well as increased risk of unemployment and lower household income. Estimates of the incidence and prevalence of migraine vary with sex, race, ethnicity, geography, socioeconomic, and educational status, suggesting there are many factors at play. In many cases, it is not clear whether these factors are causative of migraine, the effects of migraine, or (as is most likely) a combination of both. Future studies should aim to clarify these links, so that modifiable factors can be addressed where possible and those at risk of developing chronic migraine might receive targeted treatment at an early stage.
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Affiliation(s)
- Lucy Simmonds
- Headache and Facial Pain Group, University College London (UCL) Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
| | - Dwij Mehta
- Headache and Facial Pain Group, University College London (UCL) Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Sanjay Cheema
- Headache and Facial Pain Group, University College London (UCL) Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Manjit Matharu
- Headache and Facial Pain Group, University College London (UCL) Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
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3
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Steiner TJ, Birbeck GL, Jensen RH, Martelletti P, Stovner LJ, Uluduz D, Leonardi M, Olesen J, Katsarava Z. The Global Campaign turns 18: a brief review of its activities and achievements. J Headache Pain 2022; 23:49. [PMID: 35448941 PMCID: PMC9022610 DOI: 10.1186/s10194-022-01420-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 04/10/2022] [Indexed: 01/11/2023] Open
Abstract
The Global Campaign against Headache, as a collaborative activity with the World Health Organization (WHO), was formally launched in Copenhagen in March 2004. In the month it turns 18, we review its activities and achievements, from initial determination of its strategic objectives, through partnerships and project management, knowledge acquisition and awareness generation, to evidence-based proposals for change justified by cost-effectiveness analysis.
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Affiliation(s)
- Timothy J Steiner
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Edvard Griegs gate, Trondheim, Norway. .,Division of Brain Sciences, Imperial College London, London, UK.
| | - Gretchen L Birbeck
- UTH Neurology Research Office, University of Zambia, Lusaka, Zambia.,Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Rigmor H Jensen
- Department of Neurology, Danish Headache Centre, University of Copenhagen, Rigshospitalet-Glostrup, Glostrup, Denmark
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Lars Jacob Stovner
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Edvard Griegs gate, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, Norwegian Advisory Unit On Headaches,, St Olavs Hospital, Trondheim, Norway
| | - Derya Uluduz
- Neurology Department, Istanbul University Cerrahpaşa School of Medicine, Istanbul, Turkey
| | - Matilde Leonardi
- Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico C Besta, NeurologyMilan, Italy
| | - Jes Olesen
- Department of Neurology, Danish Headache Centre, University of Copenhagen, Rigshospitalet-Glostrup, Glostrup, Denmark
| | - Zaza Katsarava
- Centre of Neurology, Geriatric Medicine and Early Rehabilitation, Evangelical Hospital, Unna, Germany.,Medical Faculty, University of Essen, Essen, Germany
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4
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Schembri E, Barrow M, McKenzie C, Dawson A. The evolving classifications and epidemiological challenges surrounding chronic migraine and medication overuse headache: a review. Korean J Pain 2022; 35:4-13. [PMID: 34966007 PMCID: PMC8728549 DOI: 10.3344/kjp.2022.35.1.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/15/2021] [Indexed: 11/05/2022] Open
Abstract
Changes in diagnostic criteria, for example, the various International Classification of Headache Disorders criteria, would lead to changes in the outcomes of epidemiological studies. International Classification of Headache Disorders-1 was based mainly on expert opinion, yet most of the diagnostic criteria were reliable and valid, but it did not include chronic migraine. In its second version, the classification introduced chronic migraine, but this diagnosis resembled more a high-frequency migraine rather than the actual migraine transformation process. It also introduced medication overuse headache, but it necessitated analgesic withdrawal and subsequent headache improvement to be diagnosed as such. Hence patients having medication overuse headache could only be diagnosed in retrospect, which was an awkward situation. Such restrictive criteria for chronic migraine and medication overuse headache omitted a high proportion of patients. International Classification of Headache Disorders-3 allows a diagnosis of medication overuse headache due to combination analgesics if taken for at least 10 days per month for more than three months. Hence the prevalence rate of medication overuse headache and chronic migraine can increase compared to the previous version of the headache classification. Different criteria have been used across studies to identify chronic migraine and medication overuse headache, and therefore the information acquired from previous studies using earlier criteria becomes uncertain. Hence much epidemiological research would need to be interpreted cautiously or repeated with the most updated criteria, since the subjects in studies that apply the latest criteria may be phenotypically different from those in older studies.
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Affiliation(s)
| | - Michelle Barrow
- Pain Management Centre, Overdale Hospital, St. Helier, Jersey
| | - Christopher McKenzie
- Department of Anaesthesia, Critical Care and Pain Medicine, University of Edinburgh, Edinburgh, UK
| | - Andrew Dawson
- Department of Anaesthesia, Critical Care and Pain Medicine, University of Edinburgh, Edinburgh, UK
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5
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Mingels S, Granitzer M. Cross-Sectional Study of Headache in Flemish Children and Adolescents. Child Neurol Open 2022; 9:2329048X221140783. [DOI: 10.1177/2329048x221140783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/11/2022] [Accepted: 11/03/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Although headache is common in pediatrics, data for the Flemish population are missing. We explored headache-prevalence, and its association with communication-technology (CT) and physical activity (PA) in Flemish children and adolescents. Methods: A cross-sectional exploratory school-based questionnaire study was designed. Flemish boys and girls (5–18 years) completed a symptom-questionnaire. Primary outcomes: sociodemographic background, headache-prevalence, headache-characteristics, CT-use and PA characteristics (self-report). Secondary outcomes: associations between headache-characteristics, age, gender, and CT-use and PA-characteristics. Results: Four hundred twenty-four questionnaires were analysed: 5–7-years: n = 58; 8–11-years: n = 84; 12–15-years: n = 137; 16–18-years: n = 145. Fifty-five percent suffered from headache. Prevalence increased with age. More 16–18-year girls versus boys had headache. CT-use was the main headache-provocateur. Headache prevalence was significantly higher in a frequently physical active population. Conclusion: Our results suggest presence of headache in Flemish children and adolescents. PA-level associates with headache prevalence. However, children and adolescents with headache did not report more CT-use compared to controls.
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Affiliation(s)
- Sarah Mingels
- REVAL Rehabilitation Research Centre, Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Leuven University, Leuven, Belgium
| | - Marita Granitzer
- REVAL Rehabilitation Research Centre, Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
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Alkarrash MS, Shashaa MN, Kitaz MN, Rhayim R, Alhasan MM, Alassadi M, Aldakhil A, Alkhamis M, Ajam M, Douba M, Banjah B, Ismail A, Zazo A, Zazo R, Abdulwahab M, Alkhamis A, Arab A, Alameen MH, Farfouti MT. Migraine and tension-type headache among undergraduate medical, dental and pharmaceutical students of University of Aleppo: a cross-sectional study. BMJ Neurol Open 2021; 3:e000211. [PMID: 34712954 PMCID: PMC8515458 DOI: 10.1136/bmjno-2021-000211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/29/2021] [Indexed: 01/03/2023] Open
Abstract
Introduction Headache disorders are among the most common 10 causes of disability worldwide according to the global burden of disease survey 2010. Headache is also wildly common among universities students when compared with other populations. The purpose of this study is to assess headache prevalence among Aleppo University medical, dental and pharmaceutical undergraduate students. Methods A questionnaire-based cross-sectional study was conducted among medical, dental and pharmaceutical students at Aleppo University, Syria. We determined the type of headache according to the International Classification of Headache Disorder-III. The total number of participants was 2068. A χ2 test was used to evaluate the association between the categorical outcomes. P<0.05 was considered significant. Results Out of 2068 participants, 1604 (77.6%) were medical students, 205 (9.9%) were dental students and 259 (12.5%) were pharmaceutical students. The effect on daily activities was higher in chronic tension headache (96.7%) and migraine without aura (94.6%) than migraine with aura (91.3) and episodic tension headache (85.1%). Out of 1191 who had a headache, only 188 (15.9%) had a medical consultation. Conclusions There was no a statistically significant difference in prevalence of tension headache and migraine according to faculties. There was a statistically significant difference in patients with migraine according to academic year, living with family and smoking. The effect on daily activities was higher in chronic tension-type headache and migraine without aura. There is a significant lack of medical consultation among students and most of them took over the counter analgesics depending on personal choice.
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Affiliation(s)
| | | | | | - Roaa Rhayim
- Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic
| | | | - Maya Alassadi
- Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic
| | - Ahmad Aldakhil
- Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic
| | - Mohamad Alkhamis
- Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic
| | - Mohanad Ajam
- Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic
| | - Mohamad Douba
- Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic
| | - Bashar Banjah
- Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic
| | - Ahmad Ismail
- Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic
| | - Aya Zazo
- Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic
| | - Rama Zazo
- Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic
| | - Majd Abdulwahab
- Faculty of Pharmacy, University of Aleppo, Aleppo, Syrian Arab Republic
| | - Ali Alkhamis
- Faculty of Pharmacy, University of Aleppo, Aleppo, Syrian Arab Republic
| | - Abdullah Arab
- Faculty of Dentistry, University of Aleppo, Aleppo, Syrian Arab Republic
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Ali SHK, Raja KWA, Irfan N, Habeeb M, Ismail Y. Antioxidants Supplementation in Acute Amitriptyline Abuse for Pain. Appl Biochem Biotechnol 2021; 194:556-569. [PMID: 34699040 DOI: 10.1007/s12010-021-03721-7] [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: 07/27/2021] [Accepted: 10/08/2021] [Indexed: 11/28/2022]
Abstract
The fundamental aim of this study is to establish the role of antioxidant supplementation in alleviating acute amitriptyline induced oxidative stress. The effect of supplementation was compared on treatment of acute amitriptyline intoxication cases for pain management, with alpha lipoic acid (ALA) alone or with vitamin C, with that of healthy individuals (group I), and those receiving only routine standard treatment (RST) as control (group II). A total of 132 human subjects divided into 5 groups were supplemented with either placebo, RST, RST with vitamin C, RST with ALA, or RST with vitamin C, and ALA. Results of this study revealed that the decrease in the level of oxidative stress and enzyme activity was observed among those supplemented with either alpha lipoic acid alone or along with vitamin C, with a slightly more decrease in the latter group. P value of < 0.001 was considered statistically significant. The percentage of benefit of treatment on supplementation with vitamin C and alpha lipoic acid showed a marked increase in group V cases after supplementation with both in combination. The results provided that the oxidative stress induced by acute amitriptyline poisoning is comparatively decreased by supplementation with antioxidants like alpha lipoic acid and vitamin C, than those only on routine standard treatment.
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Affiliation(s)
- S Hameed Kadar Ali
- School of Social Sciences, BSA Crescent Institute of Science and Technology, Chennai, 600048, India.
| | - K Wasim Ali Raja
- Sri Lakshmi Narayana Institute of Medical Sciences, Puducherry, 605502, India
| | - N Irfan
- Crescent School of Pharmacy, BSA Crescent Institute of Science and Technology, Chennai, 600048, India
| | - Mohammad Habeeb
- Crescent School of Pharmacy, BSA Crescent Institute of Science and Technology, Chennai, 600048, India
| | - Y Ismail
- Crescent School of Pharmacy, BSA Crescent Institute of Science and Technology, Chennai, 600048, India
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8
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Westergaard ML, Lau CJ, Allesøe K, Andreasen AH, Jensen RH. Poor social support and loneliness in chronic headache: Prevalence and effect modifiers. Cephalalgia 2021; 41:1318-1331. [PMID: 34162255 DOI: 10.1177/03331024211020392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To explore the prevalence of poor social support and loneliness among people with chronic headache, and how these might be effect modifiers in the relationships between chronic headache and stress, medication overuse, and self-rated health. BACKGROUND Poor social support and loneliness are consistently linked to worse health outcomes. There are few epidemiologic studies on their effect on headache. METHODS The Danish Capital Region Health Survey, a cross-sectional survey, was conducted in 2017. Participants were asked about headache, pain medication use, social support, loneliness, perceived stress, and self-rated health. Data were accessed from sociodemographic registers. Logistic regression analyses were performed to test for effect modification. RESULTS The response rate was 52.6% (55,185 respondents) and was representative of the target population. People with chronic headache were more likely to report poor social support and loneliness compared to those without chronic headache (p < 0.0001 for both). Odds ratios for the combination of chronic headache and poor social support were very high for stress (odds ratio 8.1), medication overuse (odds ratio 21.9), and poor self-rated health (odds ratio 10.2) compared to those without chronic headache and with good social support. Those who reported both chronic headache and loneliness had a very high odds ratio for stress (odds ratio 14.4), medication overuse (odds ratio 20.1), and poor self-rated health (odds ratio 15.9) compared to those without chronic headache and low loneliness score. When adjusted for sociodemographic factors, poor social support and loneliness were not significant effect modifiers in almost all these associations. Loneliness was a significant effect modifier in the association between chronic headache and medication overuse, but exerted greater effect among those who did not report they were lonely. CONCLUSION Poor social support and loneliness were prevalent among people with chronic headache. The combination of chronic headache and poor social support or loneliness showed higher odds ratios for stress, medication overuse, and poor self-rated health compared to those with good social support and low loneliness scores. The effect of loneliness in the relationship between chronic headache and medication overuse warrants further study.
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Affiliation(s)
| | - Cathrine Juel Lau
- Center for Clinical Research and Prevention, Bispebjerg og Frederiksberg Hospital, Frederiksberg, Denmark
| | - Karen Allesøe
- Center for Clinical Research and Prevention, Bispebjerg og Frederiksberg Hospital, Frederiksberg, Denmark.,Department of Occupational and Social Medicine, Copenhagen University Hospital Holbæk, Holbæk, Denmark
| | - Anne Helms Andreasen
- Center for Clinical Research and Prevention, Bispebjerg og Frederiksberg Hospital, Frederiksberg, Denmark
| | - Rigmor Højland Jensen
- Danish Headache Center, Rigshospitalet‒Glostrup, University of Copenhagen, Glostrup, Denmark
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Krishnan A, Chowdhury D. Burden, Disability and Public Health Importance of Headache Disorders in India. Neurol India 2021; 69:S4-S9. [PMID: 34003143 DOI: 10.4103/0028-3886.315984] [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: 11/04/2022]
Abstract
Headache disorders, characterized by recurrent headache, are among the most common disorders of the nervous system. The aim of this study was to document epidemiological and economic burden due to headache globally and in India and suggest a public health approach to address headache disorders for India. We reviewed the available literature on burden due to headache, its management using a primary health care approach and health system barriers, with special emphasis on India. Globally, it has been estimated that prevalence of current headache disorder (symptomatic within last year) among adults is about 50%, around 30% report migraine and headache on 15 or more days every month affects 1.7-4% people. The Global Burden of Disease Study 2016 estimated that migraine caused 45·1 million (95% UI 29·0-62·8) and tension-type headache 7·2 million (95% UI 4·6-10·5) years of life lived with disability. Limited data available in India support such high burden. These studies also indicate high diagnostic and treatment gaps for headache disorders in India. Major challenges in addressing headache disorders effectively in India are low perceived severity, absence of burden data, lack of standard treatment protocols for headache disorders and primary care models for neurological disorders in developing country context. There needs to be a better appreciation of the burden and a public health approach among all stakeholders, if burden of headache disorders is to be addressed effectively in India.
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Affiliation(s)
- Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Debashish Chowdhury
- Department of Neurology, GB Pant Institute of Post graduate Medical Education and Research, New Delhi, India
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Exposure to first-person shooter videogames is associated with multisensory temporal precision and migraine incidence. Cortex 2020; 134:223-238. [PMID: 33291047 DOI: 10.1016/j.cortex.2020.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 10/03/2020] [Accepted: 10/19/2020] [Indexed: 02/06/2023]
Abstract
Adaptive interactions with the environment require optimal integration and segregation of sensory information. Yet, temporal misalignments in the presentation of visual and auditory stimuli may generate illusory phenomena such as the sound-induced flash illusion, in which a single flash paired with multiple auditory stimuli induces the perception of multiple illusory flashes. This phenomenon has been shown to be robust and resistant to feedback training. According to a Bayesian account, this is due to a statistically optimal combination of the signals operated by the nervous system. From this perspective, individual susceptibility to the illusion might be moulded through prolonged experience. For example, repeated exposure to the illusion and prolonged training sessions partially impact on the reported illusion. Therefore, extensive and immersive audio-visual experience, such as first-person shooter videogames, should sharpen individual capacity to correctly integrate multisensory information over time, leading to more veridical perception. We tested this hypothesis by comparing the temporal profile of the sound-induced illusion in a group of expert first-person shooter gamers and a non-players group. In line with the hypotheses, gamers experience significantly narrower windows of illusion (~87 ms) relative to non-players (~105 ms), leading to higher veridical reports in gamers (~68%) relative to non-players (~59%). Moreover, according to recent literature, we tested whether audio-visual intensive training in gamers could be related to the incidence of migraine, and found that its severity may be directly proportioned to the time spent on videogames. Overall, these results suggest that continued training within audio-visual environments such as first-person shooter videogames improves temporal discrimination and sensory integration. This finding may pave the way for future therapeutic strategies based on self-administered multisensory training. On the other hand, the impact of intensive training on visual-related stress disorders, such as migraine incidence, should be taken into account as a risk factor during therapeutic planning.
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Parikh SK, Burkett JG, Silberstein SD. A comprehensive overview and safety evaluation of fremanezumab as a preventive therapy for migraine. Expert Opin Drug Saf 2020; 19:537-543. [DOI: 10.1080/14740338.2020.1737673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Simy K. Parikh
- Jefferson Headache Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - John G. Burkett
- Allegheny Health Network Headache Center, Pittsburgh, PA, USA
| | - Stephen D. Silberstein
- Jefferson Headache Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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12
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Desouky DE, Zaid HA, Taha AA. Migraine, tension-type headache, and depression among Saudi female students in Taif University. J Egypt Public Health Assoc 2019; 94:7. [PMID: 30774147 PMCID: PMC6351506 DOI: 10.1186/s42506-019-0008-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 01/10/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Studies done in Saudi Arabia showed a high prevalence of headache among university students. Limited research was done to assess the relationship between headache and psychiatric disorders. The aim of this study was to assess the prevalence and association between migraine, tension-type headache, and depression among Saudi female students in Taif University. PARTICIPANTS AND METHODS A cross-sectional study using self-administered questionnaires about headache and depression was conducted at the Taif University on 1340 female students in the academic year 2016-2017. The Beck Depression Inventory, the ID Migraine™ screening tool, and the criteria of the International Headache Society were used to investigate the depressive symptoms and headache types. RESULTS The self-reported headache prevalence was 68.4%, and the prevalence of migraine, tension-type headache (TTH), and depression was 32.5%, 29.5%, and 6.2%, respectively. The main migraine trigger was stress or anxiety; 86.6% of migraineurs had a positive family history, and only 11.9% sought medical care for headache. Of students with TTH, 61.1% reported family history and only 12.4% sought medical care. Paracetamol was the commonly used analgesic for all headache types. Medical students and students in older grades showed significantly higher levels of all headache types. Depression prevalence was significantly higher among migraineurs and students who suffered higher headache frequencies. CONCLUSION The study demonstrated a high prevalence of headache among the studied students and an association between headache and depression. The study calls for increasing awareness towards headache and the importance of seeking medical consultation. Management strategies should be planned for the observed headache and depression comorbidity.
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Affiliation(s)
- Dalia E. Desouky
- Department of Family and Community Medicine, College of Medicine, Taif University, Alsalama street, Taif city, Saudi Arabia
- Department of Public Health and Community Medicine, Faculty of Medicine, Menoufia University, Shibin El Kom, Egypt
| | - Hany A. Zaid
- Department of Family and Community Medicine, College of Medicine, Taif University, Alsalama street, Taif city, Saudi Arabia
| | - Azza A. Taha
- Department of Family and Community Medicine, College of Medicine, Taif University, Alsalama street, Taif city, Saudi Arabia
- Department of Public Health and Community Medicine, Faculty of Medicine, Menoufia University, Shibin El Kom, Egypt
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Foiadelli T, Piccorossi A, Sacchi L, De Amici M, Tucci M, Brambilla I, Marseglia GL, Savasta S, Verrotti A. Clinical characteristics of headache in Italian adolescents aged 11-16 years: a cross-sectional questionnaire school-based study. Ital J Pediatr 2018; 44:44. [PMID: 29618369 PMCID: PMC5885291 DOI: 10.1186/s13052-018-0486-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/26/2018] [Indexed: 12/16/2022] Open
Abstract
Background The purpose of this study was to determine headache characteristics, impact on daily activities and medication attitudes among a large sample of adolescents in Italy. Methods Secondary school classes were randomly selected from a national stratified multistage sampling. Data regarding socio-familial factors, headache characteristics, impact on daily activities and medication use were recorded with an anonymous multiple-choice questionnaire. Results The survey involved 2064 adolescents. 1950 questionnaires were considered for analysis. Study population included 944 males (48.4%) and 1006 females (51.6%), aged between 11 and 16 years (mean 13.5 ± 1.87). Headache prevalence was 65.9%. Mean age at headache onset was 8.33 years. 9.8% suffered from headache > 1/week, 14.3% > 1/month, 24.2% monthly and 17.7% less than monthly. The mean duration of a headache episode was less than 30 min in 32.9%, 1 hour in 28.1%, 2 hours in 19.3% and several hours in 19.5%. Pain intensity was moderate in 52.2% and severe in 9.5%. School represented the main trigger factor (67%). Impact on daily activities was noted in 57.5%. 69.2% of adolescents reported the use of pain relievers. Up to 5.7% declared self-medication, while only 20.6% followed a physician’s prescription. Female adolescents experienced headache more frequently (70.2% vs 60%) and more intensely than male peers. Girls had a higher family history of headache, could more frequently identify a trigger factor, and were more affected into their daily activities than boys. Conclusions Population-based studies of headache disorders are important, as they inform needs assessment and underpin service policy for a disease that is a public-health priority. Headache has a high prevalence among adolescents and carries a significant burden in terms of impact on daily activities and use of medication. Furthermore, underdiagnose is common, while trigger factors are often detectable. Special consideration should be given to female adolescents and self-medication attitudes.
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Affiliation(s)
- Thomas Foiadelli
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pediatric Clinic, I.R.C.C.S. Policlinico "S. Matteo" Foundation, 27100, Pavia, Italy.
| | - Alessandra Piccorossi
- Department of Pediatrics, University of L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Lucia Sacchi
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Mara De Amici
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pediatric Clinic, I.R.C.C.S. Policlinico "S. Matteo" Foundation, 27100, Pavia, Italy
| | | | - Ilaria Brambilla
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pediatric Clinic, I.R.C.C.S. Policlinico "S. Matteo" Foundation, 27100, Pavia, Italy
| | - Gian Luigi Marseglia
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pediatric Clinic, I.R.C.C.S. Policlinico "S. Matteo" Foundation, 27100, Pavia, Italy
| | - Salvatore Savasta
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pediatric Clinic, I.R.C.C.S. Policlinico "S. Matteo" Foundation, 27100, Pavia, Italy
| | - Alberto Verrotti
- Department of Pediatrics, University of L'Aquila, San Salvatore Hospital, L'Aquila, Italy
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Xavier MKA, Pitangui ACR, Silva GRR, Oliveira VMAD, Beltrão NB, Araújo RCD. Prevalence of headache in adolescents and association with use of computer and videogames. CIENCIA & SAUDE COLETIVA 2017; 20:3477-86. [PMID: 26602725 DOI: 10.1590/1413-812320152011.19272014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 10/01/2014] [Indexed: 01/03/2023] Open
Abstract
The aim of this study was to determine the prevalence of headache in adolescents and its association with excessive use of electronic devices and games. The sample comprised 954 adolescents of both sexes (14 to 19 years) who answered a questionnaire about use of computers and electronic games, presence of headache and physical activity. The binary and multinomial logistic regression, with significance level of 5% was used for inferential analysis. The prevalence of headache was 80.6%. The excessive use of electronics devices proved to be a risk factor (OR = 1.21) for headache. Subjects aged between 14 and 16 years were less likely to report headache (OR = 0.64). Regarding classification, 17.9% of adolescents had tension-type headache, 19.3% had migraine and 43.4% other types of headache. The adolescents aged form 14 to 16 years had lower chance (OR ≤ 0.68) to report the tension-type headache and other types of headache. The excessive use of digital equipment, electronic games and attending the third year of high school proved to be risk factors for migraine-type development (OR ≥ 1.84). There was a high prevalence of headache in adolescents and high-time use of electronic devices. We observed an association between excessive use of electronic devices and the presence of headache, and this habit is considered a risk factor, especially for the development of migraine-type.
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15
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Riediger C, Schuster T, Barlinn K, Maier S, Weitz J, Siepmann T. Adverse Effects of Antidepressants for Chronic Pain: A Systematic Review and Meta-analysis. Front Neurol 2017; 8:307. [PMID: 28769859 PMCID: PMC5510574 DOI: 10.3389/fneur.2017.00307] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 06/13/2017] [Indexed: 01/01/2023] Open
Abstract
Background Antidepressants are widely used in the treatment of chronic pain. Applied doses are lower than those needed to unfold an antidepressive effect. While efficacy of antidepressants for chronic pain has been reported in large randomized-controlled trials (RCT), there is inconsistent data on adverse effects and tolerability. We aimed at synthesizing data from RCT to explore adverse effect profiles and tolerability of antidepressants for treatment of chronic pain. Methods Systematic literature research and meta-analyses were performed regarding side effects and safety of different antidepressants in the treatment of chronic pain according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The National Center for Biotechnology Information library and MEDLINE were searched. Randomized placebo-controlled trials were included in quantitative data synthesis. Results Out of 1,975 screened articles, 33 papers published between 1995 and 2015 were included in our review and 23 studies were included in the meta-analyses. A higher risk for adverse effects compared to placebo was observed in all antidepressants included in our analyses, except nortriptyline. The most prevalent adverse effects were dry mouth, dizziness, nausea, headache, and constipation. Amitriptyline, mirtazapine, desipramine, venlafaxine, fluoxetine, and nortriptyline showed the highest placebo effect-adjusted risk of adverse effects. Risk for withdrawal due to adverse effects was highest in desipramine (risk ratio: 4.09, 95%-confidence interval [1.31; 12.82]) followed by milnacipran, venlafaxine, and duloxetine. The most common adverse effects under treatment with antidepressants were dry mouth, dizziness, nausea, headache, and constipation followed by palpitations, sweating, and drowsiness. However, overall tolerability was high. Each antidepressant showed distinct risk profiles of adverse effects. Conclusion Our synthesized data analysis confirmed overall tolerability of low-dose antidepressants for the treatment of chronic pain and revealed drug specific risk profiles. This encompassing characterization of adverse effect profiles might be useful in defining multimodal treatment regimens for chronic pain which also consider patients’ comorbidities and co-medication.
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Affiliation(s)
- Carina Riediger
- Department of General, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Center for Clinical Research and Management Education, Division of Health Care Sciences, Dresden International University, Dresden, Germany
| | - Tibor Schuster
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Kristian Barlinn
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Sarah Maier
- Department of General, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Center for Clinical Research and Management Education, Division of Health Care Sciences, Dresden International University, Dresden, Germany.,Department of Pedriatric Oncology, University Hospital Eppendorf, Universität Hamburg, Hamburg, Germany
| | - Jürgen Weitz
- Department of General, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Timo Siepmann
- Center for Clinical Research and Management Education, Division of Health Care Sciences, Dresden International University, Dresden, Germany.,Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
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16
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Pei P, Liu L, Zhao L, Cui Y, Qu Z, Wang L. Effect of electroacupuncture pretreatment at GB20 on behaviour and the descending pain modulatory system in a rat model of migraine. Acupunct Med 2016; 34:127-35. [PMID: 26438555 PMCID: PMC4853588 DOI: 10.1136/acupmed-2015-010840] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND While electroacupuncture (EA) pretreatment has been found to ameliorate migraine-like symptoms, the underlying mechanisms remain poorly understood. Emerging evidence suggests that the brainstem descending pain modulatory system, comprising the periaqueductal grey (PAG), raphe magnus nucleus (RMg), and trigeminal nucleus caudalis (TNC), may be involved in migraine pathophysiology. We hypothesised that EA would ameliorate migraine-like symptoms via modulation of this descending system. METHODS We used a conscious rat model of migraine induced by repeated electrical stimulation of the dura. Forty male Sprague-Dawley rats were randomly assigned to one of four groups: an EA group, which received EA at GB20 following dural stimulation; a sham acupuncture (SA) group, which received manual acupuncture at a non-acupuncture point following dural stimulation; a Model group, which received dural stimulation but no acupuncture; and a Control group, which received neither dural stimulation nor acupuncture (electrode implantation only). HomeCageScan was used to measure effects on behaviour, and immunofluorescence staining was used to examine neural activation (c-Fos immunoreactivity) in the PAG, RMg, and TNC. RESULTS Compared to the Model group, rats in the EA group showed a significant increase in exploratory, locomotor and eating/drinking behaviour (p<0.01) and a significant decrease in freezing-like resting and grooming behaviour (p<0.05). There was a significant increase in the mean number of c-Fos neurons in the PAG, RMg, and TNC in Model versus Control groups (p<0.001); however, this was significantly attenuated by EA treatment (p<0.001). There were no significant differences between the SA and Model groups in behaviour or c-Fos immunoreactivity. CONCLUSIONS EA pretreatment ameliorates behavioural changes in a rat model of recurrent migraine, possibly via modulation of the brainstem descending pathways.
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Affiliation(s)
- Pei Pei
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, PR China
| | - Lu Liu
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, PR China
| | - Luopeng Zhao
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, PR China
| | - Yingxue Cui
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, PR China
| | - Zhengyang Qu
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, PR China
| | - Linpeng Wang
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, PR China
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17
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Queiroz LP, Silva Junior AA. The Prevalence and Impact of Headache in Brazil. Headache 2015; 55 Suppl 1:32-8. [DOI: 10.1111/head.12511] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2014] [Indexed: 01/03/2023]
Affiliation(s)
- Luiz P. Queiroz
- Department of Neurology; Universidade Federal de Santa Catarina; Florianopolis Brazil
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18
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Valença MM, da Silva AA, Bordini CA. Headache Research and Medical Practice in Brazil: An Historical Overview. Headache 2015; 55 Suppl 1:4-31. [DOI: 10.1111/head.12512] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2014] [Indexed: 12/28/2022]
Affiliation(s)
- Marcelo Moraes Valença
- Neurology and Neurosurgery Unit; Department of Neuropsychiatry; Federal University of Pernambuco; Recife Brazil
- Neurology and Neurosurgery Unit, Hospital Esperança; Brazil
| | - Amanda Araújo da Silva
- Neurology and Neurosurgery Unit; Department of Neuropsychiatry; Federal University of Pernambuco; Recife Brazil
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19
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Westergaard ML, Glümer C, Hansen EH, Jensen RH. Prevalence of chronic headache with and without medication overuse: Associations with socioeconomic position and physical and mental health status. Pain 2014; 155:2005-13. [DOI: 10.1016/j.pain.2014.07.002] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 06/27/2014] [Accepted: 07/03/2014] [Indexed: 01/03/2023]
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20
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Affiliation(s)
- Tj Steiner
- Department of Neuroscience, Norwegian University of Science and Technology, Norway
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21
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Stovner LJ, Al Jumah M, Birbeck GL, Gururaj G, Jensen R, Katsarava Z, Queiroz LP, Scher AI, Tekle-Haimanot R, Wang SJ, Steiner TJ. The methodology of population surveys of headache prevalence, burden and cost: principles and recommendations from the Global Campaign against Headache. J Headache Pain 2014; 15:5. [PMID: 24467862 PMCID: PMC3907133 DOI: 10.1186/1129-2377-15-5] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 01/02/2014] [Indexed: 11/10/2022] Open
Abstract
The global burden of headache is very large, but knowledge of it is far from complete and needs still to be gathered. Published population-based studies have used variable methodology, which has influenced findings and made comparisons difficult. Among the initiatives of the Global Campaign against Headache to improve and standardize methods in use for cross-sectional studies, the most important is the production of consensus-based methodological guidelines. This report describes the development of detailed principles and recommendations. For this purpose we brought together an expert consensus group to include experience and competence in headache epidemiology and/or epidemiology in general and drawn from all six WHO world regions. The recommendations presented are for anyone, of whatever background, with interests in designing, performing, understanding or assessing studies that measure or describe the burden of headache in populations. While aimed principally at researchers whose main interests are in the field of headache, they should also be useful, at least in parts, to those who are expert in public health or epidemiology and wish to extend their interest into the field of headache disorders. Most of all, these recommendations seek to encourage collaborations between specialists in headache disorders and epidemiologists. The focus is on migraine, tension-type headache and medication-overuse headache, but they are not intended to be exclusive to these. The burdens arising from secondary headaches are, in the majority of cases, more correctly attributed to the underlying disorders. Nevertheless, the principles outlined here are relevant for epidemiological studies on secondary headaches, provided that adequate definitions can be not only given but also applied in questionnaires or other survey instruments.
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Affiliation(s)
- Lars Jacob Stovner
- Norwegian National Headache Centre, Norwegian University of Science and Technology, and St. Olavs University Hospital, Trondheim, Norway
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mohammed Al Jumah
- King Abdullah International Medical Research Center, King Saud Ben Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, Saudi Arabia
- Prince Mohammed Ben Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia
| | - Gretchen L Birbeck
- Department of Neurology, University of Rochester, Rochester, NY, USA
- Chikankata Hospital, Mazabuka, Zambia
| | - Gopalakrishna Gururaj
- Department of Epidemiology, Centre for Public Health, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Rigmor Jensen
- Danish Headache Centre, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Zaza Katsarava
- Evangelical Hospital, Unna, Germany
- University of Duisburg-Essen, Essen, Germany
| | - Luiz Paulo Queiroz
- Department of Neurology, University Hospital, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Ann I Scher
- Uniformed Services University, Bethesda, MD, USA
| | - Redda Tekle-Haimanot
- School of Medicine, Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Shuu-Jiun Wang
- The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Neurology, Brain Research Center and Institute of Brain Science, National Yang-Ming University of School of Medicine, Taipei, Taiwan
| | - Timothy J Steiner
- Norwegian National Headache Centre, Norwegian University of Science and Technology, and St. Olavs University Hospital, Trondheim, Norway
- Division of Neuroscience, Imperial College London, London, UK
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22
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Steiner TJ, Gururaj G, Andrée C, Katsarava Z, Ayzenberg I, Yu SY, Al Jumah M, Tekle-Haimanot R, Birbeck GL, Herekar A, Linde M, Mbewe E, Manandhar K, Risal A, Jensen R, Queiroz LP, Scher AI, Wang SJ, Stovner LJ. Diagnosis, prevalence estimation and burden measurement in population surveys of headache: presenting the HARDSHIP questionnaire. J Headache Pain 2014; 15:3. [PMID: 24400999 PMCID: PMC3906903 DOI: 10.1186/1129-2377-15-3] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 01/02/2014] [Indexed: 11/10/2022] Open
Abstract
The global burden of headache is very large, but knowledge of it is far from complete and needs still to be gathered. Published population-based studies have used variable methodology, which has influenced findings and made comparisons difficult. The Global Campaign against Headache is undertaking initiatives to improve and standardize methods in use for cross-sectional studies. One requirement is for a survey instrument with proven cross-cultural validity. This report describes the development of such an instrument. Two of the authors developed the initial version, which was used with adaptations in population-based studies in China, Ethiopia, India, Nepal, Pakistan, Russia, Saudi Arabia, Zambia and 10 countries in the European Union. The resultant evolution of this instrument was reviewed by an expert consensus group drawn from all world regions. The final output was the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire, designed for application by trained lay interviewers. HARDSHIP is a modular instrument incorporating demographic enquiry, diagnostic questions based on ICHD-3 beta criteria, and enquiries into each of the following as components of headache-attributed burden: symptom burden; health-care utilization; disability and productive time losses; impact on education, career and earnings; perception of control; interictal burden; overall individual burden; effects on relationships and family dynamics; effects on others, including household partner and children; quality of life; wellbeing; obesity as a comorbidity. HARDSHIP already has demonstrated validity and acceptability in multiple languages and cultures. Modules may be included or not, and others (eg, on additional comorbidities) added, according to the purpose of the study and resources (especially time) available.
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Affiliation(s)
- Timothy J Steiner
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.
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