The long and winding road: the journey taken by headache sufferers in search of help

Aim: To outline the pathways a cohort of first attendees to our headache clinics had taken over the years in search of explanations and treatment for their headaches. To establish a greater awareness of the shortcomings and failures in their medical journey in the hope that better headache management will emerge in primary care. // Background: At first attendance in primary care most headache sufferers will not receive a firm diagnosis. Treatments provided are often ineffective and so many patients embark on a somewhat random self-made journey searching for a remedy. If they reach a Headache Clinic the most common diagnoses are ‘chronic migraine’ and ‘medication overuse headache’. They are either no better or worse than when their headaches first started despite their efforts. // Method: We undertook a prospective questionnaire-based study of over 200 patients on first attendance at each of our headache clinics, three based in District General Hospitals and one in a tertiary referral centre. We documented the patients’ headache characteristics, the ‘burden’ of their headaches, functional handicap and the financial costs incurred seeking help before referral. We also documented what our patients understood about their headache disorder and the treatments previously tried. // Findings: Most patients had not been given a formal diagnosis in primary care and many remained unconvinced of the benign nature of their headache problem and wanted further investigations. A few had sought help from headache charities. Many had unrealistic attitudes to their problem and medication overuse was rife. A few patients had been offered triptans in primary care. Key deficiencies in the primary care management of these patients included failure to provide a formal headache diagnosis, inadequate understanding of the nature and mechanism of headaches and failure to follow a resilient management strategy. We provide a more effective management pathway in primary care

Thresholds for detection of a target against a background grating suggest visual dysfunction in migraine with aura but not migraine without aura.

Square-wave gratings with particular spatial characteristics in visual illusions. Patients with migraine are particularly susceptible to these illusions and report disc. it. Their discomfort tends to be greater when the gratings are illuminated by red light, a tendency 1 known by controls. Gratings that induce illusions have been found to impair the recognition of opt superimposed targets in headache-free control subjects. We measured the impairment of target detection under illuminants of various chromaticities in migraineurs with and without aura and in mat controls. Migraineurs with aura had significantly higher thresholds for target detection than either migraineurs without aura or controls; in addition, the effect of chromaticity was slightly more pronounced in both migraine groups than in the control group. These findings are consistent with a recent suggestion that migraine with aura might give rise to subclinical damage to the primary visual cortex

Características clínicas da enxaqueca sem aura Clinical characteristics of migraine without aura

Um estudo aprofundado das características clínicas da enxaqueca sem aura (ESA) revela alguns dados interessantes. Um questionário foi respondido por 200 pacientes que preenchiam os critérios da Sociedade Internacional de Cefaléia para ESA. O pico do início da enxaqueca foi entre 10 e 19 anos de idade. A cefaléia era restrita a um lado em 19%. Era exclusivamente bilateral em 9%. A maioria (86,2%) dos pacientes que descreveram cefaléias em um único local localizou-a na área fronto-temporal. Cervicalgia estava associada aos ataques de enxaqueca em 70,5% e dor facial em 73,5%. O caráter latejante foi notado por 81%. Todos os pacientes descreveram a cefaléia como moderada a severa. Somente 55% disseram que a dor era agravada por atividades físicas rotineiras. Náusea ocorreu em 91%, foto e fonofobia em 77% e vômitos em 50%. Este olhar detalhado na ESA demonstra a grande complexidade dos seus sintomas.<br>A detailed study of the clinical characteristics of migraine without aura (MOA) reveals some interesting data. A questionnaire was returned by 200 patients who met the International Headache Society criteria for MOA. The peak of onset of migraine was between 10 and 19 years of age. The headache was side-locked in 19%. It was exclusively bilateral in 9%. The majority (86.2%) of the patients who described headaches in only one site located them in the fronto-temporal area. Neck pain was associated with migraine attacks in 70.5% and face pain in 73.5%. A pounding quality was noted by 81%. Every patient described the headache as moderate to severe. Only 55% stated that it was aggravated by routine physical activity. Nausea occurred in 91%, photo and phonophobia in 77%, and vomiting in 50%. This close look at MOA uncovers a great complexity of symptoms