Risk factors for high-altitude headache upon acute high-altitude exposure at 3700 m in young Chinese men: a cohort study.

BackgroundThis prospective and observational study aimed to identify demographic, physiological and psychological risk factors associated with high-altitude headache (HAH) upon acute high-altitude exposure.MethodsEight hundred fifty subjects ascended by plane to 3700 m above Chengdu (500 m) over a period of two hours. Structured Case Report Form (CRF) questionnaires were used to record demographic information, physiological examinations, psychological scale, and symptoms including headache and insomnia a week before ascending and within 24 hours after arrival at 3700 m. Binary logistic regression models were used to analyze the risk factors for HAH.ResultsThe incidence of HAH was 73.3%. Age (p =0.011), physical labor intensity (PLI) (p =0.044), primary headache history (p <0.001), insomnia (p <0.001), arterial oxygen saturation (SaO2) (p =0.001), heart rate (HR) (p =0.002), the Self-Rating Anxiety Scale (SAS) (p <0.001), and the Epworth Sleepiness Scale (ESS) (p <0.001) were significantly different between HAH and non-HAH groups. Logistic regression models identified primary headache history, insomnia, low SaO2, high HR and SAS as independent risk factors for HAH.ConclusionsInsomnia, primary headache history, low SaO2, high HR, and high SAS score are the risk factors for HAH. Our findings will provide novel avenues for the study, prevention and treatment of HAH

The prevalence of primary headache disorders in Ethiopia

BACKGROUND: Knowledge of the epidemiology of primary headache disorders in sub-Saharan Africa (SSA) remains very limited. We performed a population-based survey in rural and urban areas of Ethiopia, using methods similar to those of an earlier study in Zambia and tested in multiple other countries by Lifting The Burden. METHODS: In a cross-sectional survey we visited households unannounced in four regions of Ethiopia: the mostly urban populations in Addis Ababa and its environs and rural populations of selected districts in Oromia, Amhara and South Nations Nationalities and People's Regions States (SNNPRS). We used cluster-randomized sampling: within clusters we randomly selected households, and one adult member (18-65 years old) of each household. The HARDSHIP structured questionnaire, translated into the local languages, was administered face-to-face by trained interviewers. Demographic enquiry was followed by diagnostic questions based on ICHD-II criteria. RESULTS: From 2,528 households approached, 2,385 of 2,391 eligible members (1,064 [44.7%] male, 596 [25.0%] urban) consented to interview (participating proportion 99.8%). Headache in the preceding year was reported by 1,071 participants (44.9% [95% CI: 42.4-46.3]; males 37.7%, females 49.9%), and headache yesterday by 170 (7.1% [6.2-8.2]; males 45 [4.1%], females 125 [9.2%]). Adjusted for gender, age and habitation (urban/rural), 1-year prevalence of migraine was 17.7%, of tension-type headache (TTH) 20.6%, of all headache on ≥15 days/month 3.2%, and of probable medication-overuse headache (pMOH) 0.7%. The adjusted prevalence of headache yesterday was 6.4%. Very few cases (1.6%) were unclassifiable. All headache disorders were more common in females. TTH was less common in urban areas (OR: 0.3; p < 0.0001), but pMOH was very strongly associated (OR: 6.1; p < 0.0001) with urban dwelling. Education was negatively associated with migraine (OR: 0.5-0.7; p < 0.05) but (at university level) positively with pMOH (OR: 2.9; p = 0.067). Income above ETB 500/month showed similar associations: negatively with migraine (OR: 0.8; p = 0.035), positively with pMOH (OR: 2.1; p = 0.164). CONCLUSIONS: Findings for migraine and TTH in Ethiopia were quite similar to those from Zambia, another SSA country; pMOH was much less prevalent but, as in Zambia, essentially an urban problem. Primary headache disorders are at least as prevalent in SSA as in high-income western countries

neurostimulation for refractory primary chronic headache disorders: a review

Headache is the commonest symptom seen in both primary and secondary care. Vast majority are primary i.e. for which no underlying cause has been detected. Tension Headaches, Migraine and Cluster Headaches are the most common primary headache disorders in the population. Although most of the primary headache disorders can be satisfactorily treated with both acute and preventive medications, those that are refractory to conventional treatment pose a great challenge to the headache physician. Moreover some patients are not able to use traditional treatment due to intolerance and co-morbidities. Neurostimulation is a treatment modality that has been used in other neurological disorders such as movement disorders, multiple sclerosis and chronic neuropathic pain and there has been emerging evidence to its usefulness in primary headache disorders. These range from being invasive treatments like deep brain stimulation to minimally invasive one like occipital nerve stimulators. Non-invasive neurostimulation is gradually emerging as a potential non-pharmaceutical option in managing primary headache disorders. The article reviews the evidence of Neurostimulation in primary headache disorders with a view to ascertain its efficacy and safety

A cross-sectional study of pain severity in patients suffering from different types of primary headache in the hospital setting

Background: Primary headache disorders including migraine and tension-type headache (TTH) are of great importance to global public health due to its high prevalence, but very few studies have been conducted to know its prevalence and pain severity of different types of primary headache. Aim of this study was to investigate the subtypes and pain severity of different types of primary headache in hospital setting.Methods: This study is a cross-sectional study with 200 sample size. Includes patients with Primary headache in department of Psychiatry, MGMMC, Indore. Patient aged between 18-65 years, both gender. Diagnosis of headache was done clinically in accordance with International Classification of Headache disorders (ICHD- 3). Semi-structured headache questionnaire, Comparative pain scale were used for assessment of samples.Results: Among 200 patients, Tension type headache was 73.5%, Migraine was 22%, Mixed headache was in 4.5% patients. Majority of migraine and mixed headache cases had severe pain at 93.2% & 55.6% respectively. Majority of TTH cases had moderate pain in 42.2% patients.Conclusions: Study has shown assessments of severity of pain, can be used to assess the impact of Primary headache on patient’s quality of life

Medication-overuse headache : a widely recognized entity amidst ongoing debate

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

Motor skills in children with primary headache: A pilot case-control study

Background: Headache is the most common painful manifestation in the developmental age, often accompanied by severe disability such as scholastic absenteeism, low quality of academic performance and compromised emotional functioning. The aim of the study is to evaluate praxic abilities in a population of children without aural migraine. Materials and methods: The test population consists of 10 subjects without migraine without aura (MwA), (8 Males) (mean age 8.40, SD ± 1.17) and 11 healthy children (7 Males) (mean age 8.27; SD ± 1.10; p = 0.800). All subjects underwent evaluation of motor coordination skills through the Battery for Children Movement Assessment (M-ABC). Results: The two groups (10 MwA vs 11 Controls) were similar for age (8.40 ± 1.17 vs 8.27 ± 1.10; p = 0.800), sex (p = 0.730), and BMI (p = 0.204). The migraine subjects show an average worse performance than the Movement ABC; specifically, migraineurs show significantly higher total score values (31.00 ± 23.65 vs 4.72 ± 2.61; p = 0.001), manual dexterity (12.10 ± 11.20 vs 2.04 ± 2.65; p = 0.009) and balance (14.85 ± 10.08 vs. 1.04 ± 1.05; p &lt;0.001). The mean percentile of migraine performance is significantly reduced compared to controls (9.00 ± 3.82 vs 51.00 ± 24.34, p &lt;0.001) (Table 1). Conclusion: Migraine can alter many cognitive and executive functions such as motor skills in developmental age

Neuromodulators for Primary Headache Disorders: A Review

Primary headache disorders are among the most common and disabling globally. Pharmacological treatments are often insufficient, poorly tolerated, have side effects and the majority of patients are unable to complete their treatment. Understanding the neural pain pathways of these disorders has led to the development of alternative therapies. Electrical nerve stimulation is a form of pain modulation with few side effects for the treatment of primary headache disorders. Different neuromodulation approaches, both invasive and non-invasive, have rapidly led to new approaches for the treatment of patients suffering from headache, particularly those who have failed traditional pharmacotherapy. Non-invasive treatment methods are safe, practical and well-tolerated compared to alternatives. This paper details recent evidence-based advances in neuromodulators for primary headache disorders such as migraine and trigeminal autonomic cephalalgias (in particular, cluster headache) including non-invasive commercial devices used for migraine and cluster headache. The target neural structures, their advantages and disadvantages and their application in headache treatment are discussed. Examples of using neuromodulation to manage primary headache disorders are discussed. Both invasive stimulations e.g. of occipital and vagus nerves, the sphenopalatine ganglion, deep brain and spinal cord, and non-invasive, e.g. stimulation of the frontal, cervical and auricular vagus nerves, transcranial magnetic and transcranial direct current stimulation, are detailed

Interictal Cognitive Performance in Children and Adolescents With Primary Headache:A Narrative Review

Primary headache is a very common and disabling disease. The burden of pain and recurrent attacks may lead to a poor quality of life, anxiety and depression. An increased risk of low functioning and curricular performances in young patients with primary headache has been described. The mechanisms underlying the relationship between migraine and poor school achievement may be various and could be a reflection of weak cognitive skills. Data concerning the cognitive functioning in the free pain interval in pediatric age are under-investigated and results are far from conclusive. The present review article suggests that, though considered a benign disease, pediatric migraine may be associated to altered neuropsychological functioning in the interictal phase. Although children and adolescents with migraine generally have a normal intelligence, they may show a not homogeneous cognitive profile, characterized by possible difficulties in verbal skills, in particular comprehension abilities. Pediatric primary headache may present altered neuropsychological functioning involving attentional resources, processing speed and memory, particularly verbal memory. Given the impact that this disease can have on school performance and the tendency to persist from childhood to adulthood, a cognitive screening in young patients affected by primary headache is pivotal. Additional neuropsychological research using more homogenous methods is needed

Diagnosis of primary headache in children younger than 6 years: A clinical challenge

Background: Criteria defined by the International headache Society are commonly used for the diagnosis of the different headache types in both adults and children. However, some authors have stressed some limits of these criteria when applied to preschool age. Objective: Our study aimed to describe the characteristics of primary headaches in children younger than 6 years and investigate how often the International Classification of Headache Disorders (ICHD) criteria allow a definitive diagnosis. Methods: This retrospective study analysed the clinical feature of 368 children younger than 6 years with primary headache. Results: We found that in our patients the percentage of undefined diagnosis was high when either the ICHD-II or the ICHD-III criteria were used. More than 70% of our children showed a duration of their attacks shorter than 1 hour. The absence of photophobia/phonophobia and nausea/vomiting significantly correlate with tension-type headache (TTH) and probable TTH. The number of first-degree relatives with migraine was positively correlated to the diagnosis of migraine in the patients (p&lt;0.001). Conclusions: Our study showed that the ICHD-III criteria are difficult to use in children younger than 6 years. The problem is not solved by the reduction of the lowest duration limit for the diagnosis of migraine to 1 hour, as was done in the ICHD-II

Headache and alexithymia in children and adolescents: what Is the connection?

Background: Headache is one of the most common complaints in children and adolescents and comorbidity rates are very high and the major associated diseases are depression, anxiety, atopic disorders, sleep, and behavioral disorders. In recent years, it has been highlighted that difficulties regulating emotions such as alexithymia have also been associated with diagnosis of somatization. Methods: We carried out a mini review analyzing the relation between alexithymia and primary headache (e.g., migraine and tension type headache) in children and adolescents by synthesizing the relevant studies in the literature on PubMed, PsycINFO, and Google Scholar. Search terms were "alexithymia" combined with the "primary headache," "migraine," "tension type headache," "children," and "adolescents." Results: All analyzed studies found higher levels of alexithymia in children and adolescents with headache than control groups but there are different opinions about the relationship between headache and alexithymia. For example, some studies suggest that the association between headache and alexithymia in children may be due to an incomplete development of emotive competency or a general immature cognitive development, instead other studies found a correlation between headache symptoms, insecure attachment, and alexithymia. There seems to be also differences between children with migraine compared to those with tension type headache (TTH). Conclusion: There are some studies on adults suffering from headache or migraine and alexithymia, but there is only a moderate amount of research on pediatric age with different opinions and theories about this relationship. Further studies on children and adolescents are necessary to effectively understand this relationship and to help children to reduce headache and improve emotional consciousness