A migraine attack is an extraordinarily complex brain event that takes place over hours to days. This review focuses on recent human studies that shed light on the evolution of a migraine attack. It begins with a constellation of premonitory symptoms that are associated with activation of the hypothalamus and may involve the neurotransmitter dopamine. Even in the premonitory phase, patients experience sensitivity to sensory stimuli, indicating that central sensitization is a primary phenomenon. The migraine attack progresses to a phase that in some patients includes aura, which involves changes in cortical function, blood flow, and neurovascular coupling. The aura phase overlaps with the headache phase, which is associated with further changes in blood flow and function of the brainstem, thalamus, hypothalamus, and cortex. Serotonin receptors, nitric oxide, calcitonin gene-related peptide, pituitary adenylate cyclase-activating polypeptide, and prostanoids are demonstrated specific chemical mediators of migraine based on therapeutic and triggered migraine studies. A number of migraine symptoms persist beyond resolution of headache into a postdromal phase, accompanied by persistent blood flow changes in several brain regions. Although these phases of migraine have substantial temporal, neurochemical, and anatomical overlap, each represents an important window onto the pathophysiology of migraine as well as a target for therapeutic intervention. A comprehensive approach to migraine requires an understanding of the entire range of mechanisms and resultant symptoms that occur throughout the evolution of an attack.
Showing posts with label headache. Show all posts
Showing posts with label headache. Show all posts
Thursday, January 3, 2013
Tuesday, October 30, 2012
Ultrasound Imaging of Embedded Shrapnel Facilitates Diagnosis and Management of Myofascial Pain Syndrome
Abstract
Trigger points can result from a variety of inciting events including muscle overuse, trauma, mechanical overload, and psychological stress. When the myofascial trigger points occur in cervical musculature, they have been known to cause headaches. Ultrasound imaging is being increasingly used for the diagnosis and interventional management of various painful conditions.
A veteran was referred to the pain clinic for management of his severe headache following a gunshot wound to the neck with shrapnel embedded in the neck muscles a few years prior to presentation. He had no other comorbid conditions. Physical examination revealed a taut band in the neck. An ultrasound imaging of the neck over the taut band revealed the deformed shrapnel located within the levator scapulae muscle along with an associated trigger point in the same muscle. Ultrasound guided trigger point injection, followed by physical therapy resolved his symptoms.
This is a unique report of embedded shrapnel and coexisting myofascial pain syndrome revealed by ultrasound imaging. The association between shrapnel and myofascial pain syndrome requires further investigation.
Friday, September 21, 2012
Association Between Headache and Serum 25-Hydroxyvitamin D; the Tromsø Study: Tromsø 6
Background.— High prevalence of headache has been associated with high latitude, thus suggesting a relation with vitamin D. However, there are so far no reports on the association between serum 25-hydroxyvitamin D (25[OH]D) and headache.
Objective.— To investigate the association between headache and serum 25(OH)D in a general population.
Methods.— Cross-sectional study based on questionnaires from 11,614 persons who participated in the sixth survey of the Tromsø Study (Tromsø 6) carried out in 2007-2008. The data were stratified according to smoking status and analyzed with regard to migraine and non-migraine headache. Adjustments were done for age, body mass index (BMI), gender, season, chronic diseases, education, physical exercise, and alcohol consumption.
Results.— Headache of non-migraine type was associated with low levels of serum 25(OH)D with an odds ratio (OR) of 1.20 (1.04-1.39) in the lowest quartile as compared to the highest serum 25(OH)D quartile. No significant association was found between migraine and serum 25(OH)D.
Conclusion.— Non-migraine headache was associated with low levels of serum 25(OH)D. Although adjustment were done for possible confounders, this finding may still reflect lifestyle rather than causality, and further studies are needed to investigate this. No association was found between serum 25(OH)D and migraine.
Monday, September 10, 2012
Improvement in Headaches With Continuous Positive Airway Pressure for Obstructive Sleep Apnea: A Retrospective Analysis
Objective.— We aimed to identify clinical features in patients with severe headaches that predicted obstructive sleep apnea (OSA) and determine clinical and sleep study characteristics that predicted headache improvement with continuous positive airway pressure (CPAP).
Background.— Many patients with headaches complain of sleep symptoms and have OSA. There is often improvement of headaches with CPAP treatment.
Methods.— We conducted a retrospective chart review of all patients referred to adult neurology clinic for headaches and sent for polysomnography between January 2008 and December 2009. Follow-up ranged from 18 to 42 months.
Results.— Eighty-two headache patients (70 females, 12 males) were studied. Mean age was 45 ± 13 years (females 45 ± 13, males 43 ± 11) and mean body mass index was 32 ± 9. Headache types included 17% chronic migraine without aura, 22% episodic migraine without aura, 32% migraine with aura, 21% tension-type headache, 6% chronic post-traumatic headache, 11% medication overuse headache, and 7% other types. All patients were receiving standard treatment for their headaches by their neurologist. Fifty-two patients (63%) had OSA. Increasing age, female gender, and chronic migraine without aura were predictive of OSA. Of the patients with OSA, 33 (63%) used CPAP and 27 (82%) were adherent to CPAP. Headache improvement was reported by 40 patients (49%) due to either standard medical therapy or CPAP. Patients with OSA who were CPAP adherent (21/27) were more likely to have improvement in headaches than patients intolerant of CPAP (2/6), those that did not try CPAP (8/19), and those who did not have OSA (16/30) (P = .045). Of the 33 patients who used CPAP, 13 reported improvement in headaches specifically due to CPAP therapy and 10 additional patients noted benefit in sleep symptoms. The presence of witnessed apneas (P = .045) and male gender (P = .021) predicted improvement in headaches due to CPAP.
Conclusions.— Headache patients should be evaluated for the presence of OSA. Treating OSA improves headaches in some patients.
Tuesday, June 19, 2012
CGRP and NO in the Trigeminal System: Mechanisms and Role in Headache Generation
DOI: 10.1111/j.1526-4610.2012.02212.x
DOI: 10.1111/j.1526-4610.2012.02212.x
Abstract
Calcitonin gene-related peptide (CGRP) and metabolic products of nitric oxide (NO) are increased in jugular venous plasma during migraine attacks and other primary headaches. Patients suffering from primary headaches are particularly sensitive to CGRP and NO donors responding with delayed headaches to an infusion of either of these substances. Accordingly, both CGRP and NO are considered as key mediators in migraine, and clinical trials have shown that inhibitors of CGRP receptors and NO synthase are effective in treating migraine. There is an implicit understanding that CGRP and NO systems interact, and here we review the body of pre-clinical work on these systems focusing on the trigeminovascular system in migraine.
NO derives from various cell types via three isoforms of NO synthase whereas CGRP is produced from a subset of trigeminal afferents. In rodents, NO donors cause activity alterations on different levels of the trigeminal system including enhancement of CGRP release, which in turn results in arterial vasodilatation and possibly mast cell degranulation in the meninges. The activity of spinal trigeminal neurons, which is a sensitive integrative measure for trigeminal activity, is partly under the control of CGRP and NO. Both mediators facilitate nociceptive transmission, possibly via presynaptic mechanisms. These functions are supported by immunolocalization of CGRP receptor components on three trigeminovascular levels: cranial dura mater, trigeminal ganglion and spinal trigeminal nucleus.
Current data support a relationship of CGRP and NO actions on all levels of the trigeminovascular system and emphasize central CGRP receptors as possible therapeutic targets.
© 2012 American Headache Society
Thursday, August 25, 2011
Headache during airplane travel (“airplane headache”): first case in Greece
The Journal of Headache and Pain
Official Journal of the "European Headache Federation" and of "Lifting The Burden - The Global Campaign against Headache"
Evangelia Kararizou1
, Evangelos Anagnostou1, George P. Paraskevas1, Sofia D. Vassilopoulou1, Dimitrios Naoumis2, Grigoris Kararizos2 and Konstantinos Spengos1
Official Journal of the "European Headache Federation" and of "Lifting The Burden - The Global Campaign against Headache"
Evangelia Kararizou1
, Evangelos Anagnostou1, George P. Paraskevas1, Sofia D. Vassilopoulou1, Dimitrios Naoumis2, Grigoris Kararizos2 and Konstantinos Spengos1| (1) | Department of Neurology, Athens National University, Eginition Hospital, 72-74 Vas.Sofias av., 11528 Athens, Greece |
| (2) | Neurological Department, 251 Air Force Hospital, Athens, Greece |
| Evangelia Kararizou Email: ekarariz@med.uoa.gr |
Received: 21 February 2011 Accepted: 22 March 2011 Published online: 6 April 2011
Abstract
http://www.springerlink.com/content/t86630777t603224/fulltext.htmlHeadache related to airplane flights is rare. We describe a 37-year-old female patient with multiple intense, jabbing headache episodes over the last 3 years that occur exclusively during airplane flights. The pain manifests during take-off and landing, and is located always in the left retro-orbital and frontotemporal area. It is occasionally accompanied by dizziness, but no additional symptoms occur. Pain intensity diminishes and disappears after 15–20 min. Apart from occasional dizziness, no other symptoms occur. The patient has a history of tension-type headache and polycystic ovaries. Blood tests and imaging revealed no abnormalities. Here, we present the first case in Greece. We review the current literature on this rare syndrome and discuss on possible pathophysiology and the investigation of possible co-factors such as anxiety and depression.
Free Full Text (Open Access):
Thursday, June 9, 2011
Pneumatized superior turbinate as a cause of headache.
Head Face Med. 2007 Jan 9;3:3.
Homsioglou E, Balatsouras DG, Alexopoulos G, Kaberos A, Katotomichelakis M, Danielides V.
Source
Department of Otolaryngology, Medical School, Democritus University of Thrace. Dragana, Alexandroupolis, Greece. homsioglou@hol.gr
Abstract
BACKGROUND:
A pneumatized superior turbinate is a rare cause of headache. Nasal endoscopy alone, does not provide us with adequate information for this inaccessible area of the superior nasal cavity. A coronal computed tomography (CT) must be obtained to confirm the diagnosis.
CASE PRESENTATION:
We present a 40-year-old female with migraine-type headache and nasal obstruction. Nasal endoscopy revealed a mild septal deviation, a right middle concha bullosa and a paradoxically curved middle turbinate on the left side. Coronal CT-scan showed also the presence of a superior concha bullosa on the left, which was in close contact with the nasal septum. The patient underwent septoplasty and bilateral endoscopic sinus surgery, including partial removal of both the pneumatized middle turbinates in conjunction with gentle lateralization and resection of the lower half of the left superior turbinate. Prompt relief from headache and nasal symptoms was obtained.
CONCLUSION:
Pneumatized superior concha causing migrainous headache is a rare finding. Endoscopic surgery may provide permanent relief of symptoms.
Polyp in concha bullosa: a case report and review of the literature.
HEAD & FACE MEDICINE
http://www.head-face-med.com/content/2/1/11
Source
Baskent University Faculty of Medicine, Department of Otorhinolaryngology, Ankara, Turkey. alpernabierkan@yahoo.com
http://www.head-face-med.com/content/2/1/11
Source
Baskent University Faculty of Medicine, Department of Otorhinolaryngology, Ankara, Turkey. alpernabierkan@yahoo.com
Abstract
Polyp originating within a concha bullosa is uncommon; we report only the third such case in the English literature. A 45-year-old man presented with nasal obstruction and headache. Examination of the nose revealed right septal deviation and a hypertrophic left middle concha. Computed tomography confirmed right septal deviation and identified left concha bullosa with thickening of the mucosa covering this lesion. The lateral lamella of the affected turbinate was removed and a mass was excised. Histopathologic examination of the excised mass revealed polypoid hyperplasia. The rare finding of polyp in concha bullosa is discussed with a review of the literature. In any case of concha bullosa, computed tomography images should be carefully evaluated before surgery to check for other pathologies that might have arisen within the lesion.
[Coronal computed tomography image shows right septal deviation (yellow arrow), left concha bullosa (thick white arrow), thickening of the mucosa covering the concha bullosa, and bilateral maxillary sinusitis (vertical black arrow). Right: Intraoperative views of the polyp in the left concha bu...]
Saturday, January 8, 2011
Treatment of migraine with occipital nerve blocks using only corticosteroids.
Headache. 2011 Jan;51(1):155-9.
doi: 10.1111/j.1526-4610.2010.01801.x. Epub 2010 Nov 10.
Tobin J, Flitman S.
From 21st Century Neurology, Phoenix, AZ, USA.
Abstract
(Headache 2011;51:155-162) The indications for using steroids when performing occipital nerve blocks (ONBs) are not completely clear. We report a patient with chronic migraines who was allergic to local anesthetics, for whom ONBs using only corticosteroid proved useful. To our knowledge, this is only published case describing the effects of ONBs using only corticosteroid, without local anesthetic.
© 2010 American Headache Society.Thursday, December 9, 2010
Greater Occipital Nerve Neuralgia Caused by Pathological Arterial Contact: Treatment by Surgical Decompression
Headache: The Journal of Head and Face Pain; Article first published online: 16 NOV 2010
DOI: 10.1111/j.1526-4610.2010.01802.x
Occipital nerve neuralgia is a rare cause of severe headache, and may be difficult to treat. We report the case of a patient with occipital nerve neuralgia caused by pathological contact of the nerve with the occipital artery. The pain was refractory to medical treatment. Surgical decompression yielded complete remission.
Saturday, November 13, 2010
Allergy and Immunotherapy: Are They Related to Migraine Headache?
Headache. 2010 Nov 4.
doi: 10.1111/j.1526-4610.2010.01792.x. [Epub ahead of print]
Martin VT, Taylor F, Gebhardt B, Tomaszewski M, Ellison JS, Martin GV, Levin L, Al-Shaikh E, Nicolas J, Bernstein JA.
From the Department of Internal Medicine, Division of Allergy and Immunology, University of Cincinnati College of Medicine, Cincinnati, OH, USA (V.T. Martin); Department of Neurology, Park Nicollet Clinic, Minneapolis, MN, USA (F. Taylor); Department of Family Practice, Saint Vincent Hospital, Erie, PA, USA (B. Gebhardt); Department of Family Practice, University of Cincinnati College of Medicine, Cincinnati, OH, USA (M.Tomaszewski); University of Cincinnati College of Medicine, Cincinnati, OH, USA (J.S. Ellison and G.V. Martin); Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH, USA (L. Levin and E. Al-Shaikh); Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, OH, USA (J. Nicolas); Department of Internal Medicine, Division of General Internal Medicine, University of Cincinnati, Cincinnati, OH, USA; Bernstein Allergy Group, Inc., Cincinnati, OH, USA (J.A. Bernstein).
Abstract
Introduction.- Several studies have reported that migraine headaches are more common in patients with allergic rhinitis and that immunotherapy decreases the frequency of headache in atopic headache sufferers.
Objective.- To determine if the degree of allergic sensitization and the administration of immunotherapy are associated with the prevalence, frequency, and disability of migraine headache in patients with allergic rhinitis.
Methods.- Consecutive patients between the ages of 18-65 presenting to an allergy practice that received a diagnosis of an allergic rhinitis subtype (eg, allergic or mixed rhinitis) were enrolled in this study. All participants underwent allergy testing as well as a structured verbal headache diagnostic interview to ascertain the clinical characteristics of each headache type. Those reporting headaches were later assigned a headache diagnosis by a headache specialist blinded to the rhinitis diagnosis based on 2004 International Classification Headache Disorders-2 (ICHD-2) diagnostic criteria. Migraine prevalence was defined as the percentage of patients with a diagnosis of migraine headache (ICHD-2 diagnoses 1.1-1.5). Migraine frequency represented the number of days per month with migraine headache self-reported during the headache interview and migraine disability was the number of days with disability obtained from the Migraine Disability Assessment questionnaire. Generalized linear models were used to analyze the migraine prevalence, frequency, and disability with the degree of allergic sensitization (percentage of positive allergy tests) and administration of immunotherapy as covariates. Patients were categorized into high (> 45% positiveallergy tests) and low (≤45% positive allergy tests) atopic groups based on the number of allergy tests that were positive for the frequency and disability analyses. Results.- A total of 536 patients (60% female, mean age 40.9 years) participated in the study. The prevalence of migraine was not associated with the degree of allergic sensitization, but there was a significant age/immunotherapy interaction (P < .02). Migraine headaches were less prevalent in the immunotherapy group than the nonimmunotherapy at ages <40 years and more prevalent in the immunotherapy group at ages ≥40 years of age. In subjects ≤45 years of age, increasing percentages of allergic sensitization were associated with a decreased frequency and disability of migraine headache in the low atopic group (risk ratios [RRs] of 0.80 [95% CI; 0.65, 0.99] and 0.81[95% CI; 0.68, 0.97]) while increasing percentages were associated with an increased frequency (not disability) in the high atopic group (RR = 1.60; [95% CI; 1.11, 2.29]). In subjects ≤45 years of age, immunotherapy was associated with decreased migraine frequency and disability (RRs of 0.48 [95% CI; 0.28, 0.83] and 0.55 [95% CI; 0.35, 0.87]). In those >45 years of age, there was no effect of degree of allergic sensitization or immunotherapy on the frequency and disability of migraine headache.
Conclusions.- Our study suggests that the association of allergy with migraine headaches depends upon age, degree of allergic sensitization, administration of immunotherapy, and the type of headache outcome measure that are studied. Lower "degrees of atopy" are associated with less frequent and disabling migraine headaches in younger subjects while higher degrees were associated with more frequent migraines. The administration of immunotherapy is associated with a decreased prevalence, frequency, and disability of migraine headache in younger subjects.
© 2010 American Headache Society.PMID: 21054364 [PubMed - as supplied by publisher]
Wednesday, April 21, 2010
Cervicogenic Headache: Evidence That the Neck is a Pain Generator
Headache: The Journal of Head and Face Pain
Volume 50 Issue 4, Pages 699 - 705
Published Online: 13 Apr 2010
CURRENT REVIEW: CLINICAL SCIENCECopyright Copyright © 2010 American Headache Society
ABSTRACT
This review was developed as part of a debate, and takes the "pro" stance that abnormalities of structures in the neck can be a significant source of headache. The argument for this is developed from a review of the medical literature, and is made in 5 steps.
It is clear that the cervical region contains many pain-sensitive structures, and that these are prone to injury. The anatomical and physiological mechanisms are in place to allow referral of pain to the head including frontal head regions and even the orbit in patients with pain originating from many of these neck structures.
Clinical studies have shown that pain from cervical spine structures can in fact be referred to the head.
Finally, clinical treatment trials involving patients with proven painful disorders of upper cervical zygapophysial joints have shown significant headache relief with treatment directed at cervical pain generators.
In conclusion, painful disorders of the neck can give rise to headache, and the challenge is to identify these patients and treat them successfully.
Wednesday, April 7, 2010
When and How to Investigate the Patient with Headache
 |
ABSTRACTThe common complaint of headache usually has a benign cause, most often a primary headache syndrome. The history and neurologic and general physical examinations usually permit a definitive diagnosis. When in doubt, diagnostic testing is indicated. Certain historical and examination findings increase the likelihood of a secondary headache disorder and the need for diagnostic testing. These include (1) recent head or neck injury; (2) a new, worse, worsening, or abrupt onset headache; (3) headache brought on by Valsalva maneuver or cough; (4) headache brought on by exertion; (5) headache associated with sexual activity; (6) pregnancy; (7) headache in the patient over the age of ~50; (8) neurologic findings and/or symptoms; (9) systemic signs and/or symptoms; (10) secondary risk factors, such as cancer or human immunodeficiency virus (HIV) infection. Less worrisome are headaches that wake the patient from sleep at night, always occur on the same side, or show a prominent effect of change in posture on the patient's pain. Diagnostic studies include neuroimaging, cerebrospinal fluid (CSF) examination, and blood tests, which are selected depending on the patient's history and findings. For most patients, the diagnostic test of choice is a magnetic resonance imaging (MRI) brain scan. Computed tomography (CT) of the brain is usually obtained in the setting of trauma or the abrupt onset of headache. CSF examination is useful in diagnosing subarachnoid bleeding, infection, and high and low CSF pressure syndromes. | |||||||||||||||||
Wednesday, March 24, 2010
Wednesday, February 24, 2010
Sleep and Headache
Current Treatment Options in Neurology 1092-8480 (Print) 1534-3138 (Online)Jeanetta C. Rains1 and J. Steven Poceta2
(1) Center for Sleep Evaluation, Elliot Hospital, One Elliot Way, Manchester, NH 03103, USA
(2) Scripps Clinic Sleep Center and Division of Nematology, 10666 North Torrey Pines Road, La Jolla, CA 92037, USA
Published online: 14 February 2010
Opinion statement Headache has been linked to a wide range of sleep disorders that may impact headache management. There are no evidence-based guidelines, but the authors believe that literature supports the following clinical recommendations: 1. Diagnose headache according to standardized criteria. Specific diagnoses are associated with increased risk for specific sleep and psychiatric disorders.
2. Collect sleep history in relation to headache patterns. Screening questionnaires and prediction equations are cost-effective.
3. Rule out sleep apnea headache in patients with awakening headache or higher-risk headache diagnoses (cluster, hypnic, chronic migraine, and chronic tension-type headache); patients with signs and symptoms of obstructive sleep apnea warrant polysomnography and treatment according to sleep medicine practice guidelines. There is no evidence for suspending conventional headache treatment in suspected or confirmed cases of sleep apnea. Treatment of sleep apnea with CPAP may improve or resolve headache in a subset of patients. The impact on sleep apnea headache of other treatments for sleep apnea (eg, oral appliances, surgery, weight loss) is largely untested. At a minimum, sedative-hypnotic drugs should be avoided in suspected apneics until the sleep apnea is treated.
4. Among patients with migraine and tension-type headache, insomnia is the most common sleep complaint, reported by one half to two thirds of clinic patients. Patients who suffer from chronic migraine or tension-type headache may benefit from behavioral sleep modification. Pharmacologic treatment may be considered on a case-by-case basis, with hypnotics, anxiolytics, or sedating antidepressants used to manage insomnia, tailoring treatment to the symptom pattern.
5. Individuals with chronic headache are at increased risk for psychiatric disorders. Assessment for depression and anxiety may be warranted when either insomnia or hypersomnia is present. Psychiatric symptoms affect the choice of sedating versus alerting versus neutral pharmacologic agents for headache.
6. All headache patients, particularly those with episodic migraine and tension-type headaches, may benefit from inclusion of sleep variables in trigger management.
(1) Center for Sleep Evaluation, Elliot Hospital, One Elliot Way, Manchester, NH 03103, USA
(2) Scripps Clinic Sleep Center and Division of Nematology, 10666 North Torrey Pines Road, La Jolla, CA 92037, USA
Published online: 14 February 2010
Opinion statement Headache has been linked to a wide range of sleep disorders that may impact headache management. There are no evidence-based guidelines, but the authors believe that literature supports the following clinical recommendations: 1. Diagnose headache according to standardized criteria. Specific diagnoses are associated with increased risk for specific sleep and psychiatric disorders.
2. Collect sleep history in relation to headache patterns. Screening questionnaires and prediction equations are cost-effective.
3. Rule out sleep apnea headache in patients with awakening headache or higher-risk headache diagnoses (cluster, hypnic, chronic migraine, and chronic tension-type headache); patients with signs and symptoms of obstructive sleep apnea warrant polysomnography and treatment according to sleep medicine practice guidelines. There is no evidence for suspending conventional headache treatment in suspected or confirmed cases of sleep apnea. Treatment of sleep apnea with CPAP may improve or resolve headache in a subset of patients. The impact on sleep apnea headache of other treatments for sleep apnea (eg, oral appliances, surgery, weight loss) is largely untested. At a minimum, sedative-hypnotic drugs should be avoided in suspected apneics until the sleep apnea is treated.
4. Among patients with migraine and tension-type headache, insomnia is the most common sleep complaint, reported by one half to two thirds of clinic patients. Patients who suffer from chronic migraine or tension-type headache may benefit from behavioral sleep modification. Pharmacologic treatment may be considered on a case-by-case basis, with hypnotics, anxiolytics, or sedating antidepressants used to manage insomnia, tailoring treatment to the symptom pattern.
5. Individuals with chronic headache are at increased risk for psychiatric disorders. Assessment for depression and anxiety may be warranted when either insomnia or hypersomnia is present. Psychiatric symptoms affect the choice of sedating versus alerting versus neutral pharmacologic agents for headache.
6. All headache patients, particularly those with episodic migraine and tension-type headaches, may benefit from inclusion of sleep variables in trigger management.
Wednesday, January 27, 2010
The Prevalence of Neck Pain in Migraine
Headache 2010;••:••-••
Anne H. Calhoun, MD; Sutapa Ford, PhD; Cori Millen, DO; Alan G. Finkel, MD; Young Truong, PhD; Yonghong Nie, MS
From the Carolina Headache Institute, Chapel Hill, NC, USA (A.H. Calhoun, S. Ford, and A.G. Finkel); University of North Carolina, Department of Psychiatry, Chapel Hill, NC, USA (A.H. Calhoun, S. Ford, and A.G. Finkel); University of North Carolina, Department of Physical Medicine and Rehabilitation, Chapel Hill, NC, USA (S. Ford); Blue Sky Neurology, Denver, CO, USA (C. Millen); University of North Carolina, Department of Biostatistics, Chapel Hill, NC, USA (Y. Truong and Y. Nie).
Correspondence to A.H. Calhoun, Carolina Headache Institute, 103 Market Street, Chapel Hill, NC 27516, USA.
Financial support: This investigator-initiated study was funded by GlaxoSmithKline.
Conflict of Interest: Dr. Calhoun is a consultant for Merck. Dr. Finkel is on Merck speaker bureau; Dr. Calhoun receives research support and is a consultant for Teva Pharmaceuticals; Drs. Ford, Millen-Schnurr, Truong, and Ms. Nie have no conflicts to report.
Copyright © 2010 American Headache Society
ABSTRACT
Objective.—To determine the prevalence of neck pain at the time of migraine treatment relative to the prevalence of nausea, a defining associated symptom of migraine.
Methods.—This is a prospective, observational cross-sectional study of 113 migraineurs, ranging in attack frequency from episodic to chronic migraine. Subjects were examined by headache medicine specialists to confirm the diagnosis of migraine and exclude both cervicogenic headache and fibromyalgia. Details of all migraines were recorded over the course of at least 1 month and until 6 qualifying migraines had been treated. For each attack, subjects recorded the presence or absence of nausea as well as the intensity of headache and neck pain (graded as none, mild, moderate, or severe).
Results.—Subjects recorded 2411 headache days, 786 of which were migraines. The majority of migraines were treated in the moderate pain stage. Regardless of the intensity of headache pain at time of treatment, neck pain was a more frequent accompaniment of migraine than was nausea (P < .0001). Prevalence of neck pain correlated with chronicity of headache as attacks moved from episodic to chronic daily headache.
Conclusions.—In this representative cross-section of migraineurs, neck pain was more commonly associated with migraine than was nausea, a defining characteristic of the disorder. Awareness of neck pain as a common associated feature of migraine may improve diagnostic accuracy and have a beneficial impact on time to treatment.
--------------------------------------------------------------------------------
Accepted for publication December 3, 2009.
DIGITAL OBJECT IDENTIFIER (DOI)
10.1111/j.1526-4610.2009.01608.x About DOI
Anne H. Calhoun, MD; Sutapa Ford, PhD; Cori Millen, DO; Alan G. Finkel, MD; Young Truong, PhD; Yonghong Nie, MS
From the Carolina Headache Institute, Chapel Hill, NC, USA (A.H. Calhoun, S. Ford, and A.G. Finkel); University of North Carolina, Department of Psychiatry, Chapel Hill, NC, USA (A.H. Calhoun, S. Ford, and A.G. Finkel); University of North Carolina, Department of Physical Medicine and Rehabilitation, Chapel Hill, NC, USA (S. Ford); Blue Sky Neurology, Denver, CO, USA (C. Millen); University of North Carolina, Department of Biostatistics, Chapel Hill, NC, USA (Y. Truong and Y. Nie).
Correspondence to A.H. Calhoun, Carolina Headache Institute, 103 Market Street, Chapel Hill, NC 27516, USA.
Financial support: This investigator-initiated study was funded by GlaxoSmithKline.
Conflict of Interest: Dr. Calhoun is a consultant for Merck. Dr. Finkel is on Merck speaker bureau; Dr. Calhoun receives research support and is a consultant for Teva Pharmaceuticals; Drs. Ford, Millen-Schnurr, Truong, and Ms. Nie have no conflicts to report.
Copyright © 2010 American Headache Society
ABSTRACT
Objective.—To determine the prevalence of neck pain at the time of migraine treatment relative to the prevalence of nausea, a defining associated symptom of migraine.
Methods.—This is a prospective, observational cross-sectional study of 113 migraineurs, ranging in attack frequency from episodic to chronic migraine. Subjects were examined by headache medicine specialists to confirm the diagnosis of migraine and exclude both cervicogenic headache and fibromyalgia. Details of all migraines were recorded over the course of at least 1 month and until 6 qualifying migraines had been treated. For each attack, subjects recorded the presence or absence of nausea as well as the intensity of headache and neck pain (graded as none, mild, moderate, or severe).
Results.—Subjects recorded 2411 headache days, 786 of which were migraines. The majority of migraines were treated in the moderate pain stage. Regardless of the intensity of headache pain at time of treatment, neck pain was a more frequent accompaniment of migraine than was nausea (P < .0001). Prevalence of neck pain correlated with chronicity of headache as attacks moved from episodic to chronic daily headache.
Conclusions.—In this representative cross-section of migraineurs, neck pain was more commonly associated with migraine than was nausea, a defining characteristic of the disorder. Awareness of neck pain as a common associated feature of migraine may improve diagnostic accuracy and have a beneficial impact on time to treatment.
--------------------------------------------------------------------------------
Accepted for publication December 3, 2009.
DIGITAL OBJECT IDENTIFIER (DOI)
10.1111/j.1526-4610.2009.01608.x About DOI
Wednesday, December 30, 2009
Prophylactic Etoricoxib Is Effective in Preventing Yom Kippur Headache: A Placebo-Controlled Double-Blind and Randomized Trial of Prophylaxis for Ritual Fasting Headache
Headache 21 Dec. 2009Research Submission
Michael J. Drescher, MD, FACEP; Evan A. Alpert, MD; Todd Zalut, MD, FACEP; Rafael Torgovicky, MD, MHA; Zev Wimpfheimer, MD, FACEP
From the Division of Emergency Medicine, Hartford Hospital/University of Connecticut, Hartford, CT, USA (M.J. Drescher); Department of Emergency Medicine, Sheba Medical Center, Tel Hashomer, Israel (E.A. Alpert); Department of Emergency Medicine, Shaare Zedek Medical Center, Jerusalem, Israel (T. Zalut and Z. Wimpfheimer); Medical Department, MSD, Israel (R. Torgovicky).
Correspondence to M.J. Drescher, Division of Emergency Medicine, Hartford Hospital, 80 Seymour St., Hartford, CT 06102, USA.
This research was supported by grant number ARX_ISP_IL0802 from MSD Israel.
Conflict of Interest: Dr. Torgovicky is an employee of MSD Israel. All other authors report no conflict of interest.
ABSTRACT
Background.—Religious fasting is associated with headache. This has been documented as "Yom Kippur Headache" and "First-of-Ramadan Headache." Rofecoxib (Vioxx®), a cyclooxygenase-2 (Cox-2) inhibitor with a 17-hour half-life, has been shown to be effective in preventing fasting headache when taken just prior to the 25-hour Yom Kippur fast. Unfortunately for fasters rofecoxib is no longer available. We hypothesized that etoricoxib, another Cox-2 inhibitor with a longer half-life, would also be effective in preventing fasting headache.
Methods.—We performed a double-blind randomized prospective trial of etoricoxib 120 mg vs placebo, taken just prior to the onset of fasting, Yom Kippur 2008. Healthy adults aged 18-65 years were enrolled from the community. Subjects completed a demographic data form and questions regarding headache history and a post-fast survey on headache during the fast. We compared incidence, time of onset and intensity of headache, general ease of fasting, and side effects in control and treatment groups.
Results.—We enrolled 211 patients and 195 completed the post-fast questionnaire (92%). Of those subjects receiving etoricoxib (n = 99), 36 or 36.4% vs 65 or 67.7% of the placebo group (n = 96) developed any headache during the fast (P < .0001). Median severity of headache in the treatment group was significantly lower for the treatment group (3.0 vs 5.0 on a visual analog scale of 10; P = .024). Also, participants in the treatment group reported an easier fast than the placebo group, as compared with previous fasting experience (4.0 vs 3.5 on a scale of 1-5; P < .0001).
Conclusion.—Etoricoxib 120 mg taken prior to a 25-hour ritual fast decreases incidence of and attenuates fasting headache. NCT number is NCTT00752921.
Michael J. Drescher, MD, FACEP; Evan A. Alpert, MD; Todd Zalut, MD, FACEP; Rafael Torgovicky, MD, MHA; Zev Wimpfheimer, MD, FACEP
From the Division of Emergency Medicine, Hartford Hospital/University of Connecticut, Hartford, CT, USA (M.J. Drescher); Department of Emergency Medicine, Sheba Medical Center, Tel Hashomer, Israel (E.A. Alpert); Department of Emergency Medicine, Shaare Zedek Medical Center, Jerusalem, Israel (T. Zalut and Z. Wimpfheimer); Medical Department, MSD, Israel (R. Torgovicky).
Correspondence to M.J. Drescher, Division of Emergency Medicine, Hartford Hospital, 80 Seymour St., Hartford, CT 06102, USA.
This research was supported by grant number ARX_ISP_IL0802 from MSD Israel.
Conflict of Interest: Dr. Torgovicky is an employee of MSD Israel. All other authors report no conflict of interest.
ABSTRACT
Background.—Religious fasting is associated with headache. This has been documented as "Yom Kippur Headache" and "First-of-Ramadan Headache." Rofecoxib (Vioxx®), a cyclooxygenase-2 (Cox-2) inhibitor with a 17-hour half-life, has been shown to be effective in preventing fasting headache when taken just prior to the 25-hour Yom Kippur fast. Unfortunately for fasters rofecoxib is no longer available. We hypothesized that etoricoxib, another Cox-2 inhibitor with a longer half-life, would also be effective in preventing fasting headache.
Methods.—We performed a double-blind randomized prospective trial of etoricoxib 120 mg vs placebo, taken just prior to the onset of fasting, Yom Kippur 2008. Healthy adults aged 18-65 years were enrolled from the community. Subjects completed a demographic data form and questions regarding headache history and a post-fast survey on headache during the fast. We compared incidence, time of onset and intensity of headache, general ease of fasting, and side effects in control and treatment groups.
Results.—We enrolled 211 patients and 195 completed the post-fast questionnaire (92%). Of those subjects receiving etoricoxib (n = 99), 36 or 36.4% vs 65 or 67.7% of the placebo group (n = 96) developed any headache during the fast (P < .0001). Median severity of headache in the treatment group was significantly lower for the treatment group (3.0 vs 5.0 on a visual analog scale of 10; P = .024). Also, participants in the treatment group reported an easier fast than the placebo group, as compared with previous fasting experience (4.0 vs 3.5 on a scale of 1-5; P < .0001).
Conclusion.—Etoricoxib 120 mg taken prior to a 25-hour ritual fast decreases incidence of and attenuates fasting headache. NCT number is NCTT00752921.
Sleep and headache: a bidirectional relationship
Expert Review of Neurotherapeutics
January 2010, Vol. 10, No. 1, Pages 105-117 , DOI 10.1586/ern.09.135
(doi:10.1586/ern.09.135)
Review
Carlo Lovati†, Domenico D’Amico, Elisa Raimondi, Claudio Mariani and Pierluigi Bertora
†Author for correspondence
Sleep and pain perception are two phylogenetically well-conserved functions, strictly influenced by environmental and psychological factors, and are able to interact reciprocally both in physiological and pathological situations. Sleep and head-pain perception share the involvement of several structures, such as the thalamus, the hypothalamus and brainstem nuclei, including the locus coeruleus and raphe nuclei. There ais clinical evidence indicating that sleep disorders can precede the appearance of certain headaches and that head pain, especially when frequent, can, in turn, affect sleep quality. In the present work the anatomy, physiology and pathology of sleep and head-pain perception will be reviewed with the aim of highlighting the points of contact and possible unifying treatment strategies
January 2010, Vol. 10, No. 1, Pages 105-117 , DOI 10.1586/ern.09.135
(doi:10.1586/ern.09.135)
Review
Carlo Lovati†, Domenico D’Amico, Elisa Raimondi, Claudio Mariani and Pierluigi Bertora
†Author for correspondence
Sleep and pain perception are two phylogenetically well-conserved functions, strictly influenced by environmental and psychological factors, and are able to interact reciprocally both in physiological and pathological situations. Sleep and head-pain perception share the involvement of several structures, such as the thalamus, the hypothalamus and brainstem nuclei, including the locus coeruleus and raphe nuclei. There ais clinical evidence indicating that sleep disorders can precede the appearance of certain headaches and that head pain, especially when frequent, can, in turn, affect sleep quality. In the present work the anatomy, physiology and pathology of sleep and head-pain perception will be reviewed with the aim of highlighting the points of contact and possible unifying treatment strategies
Wednesday, November 11, 2009
Recurrent Neck Pain and Headaches in Preadolescents Associated with Mechanical Dysfunction of the Cervical Spine: A Cross-Sectional Observational Study With 131 Students
Journal of Manipulative and Physiological Therapeutics
Received 29 April 2009; received in revised form 26 June 2009; accepted 27 June 2009.
Abstract
Objective
To identify if there were differences in the cervical biomechanics in preadolescents who had recurrent neck pain and/or headaches and those who did not.
Methods
A controlled comparison study with a convenience sample of 131 students (10-13 years old) was performed. A questionnaire placed students in the no pain group or in the neck pain/headache group. A physical examination was performed by a doctor of chiropractic to establish head posture, active cervical rotation, passive cervical joint functioning, and muscle impairment. The unpaired t test and the χ2 test were used to test for differences between the 2 groups, and data were analyzed using SPSS 15 (SPSS Inc, Chicago, Ill).
Results
Forty percent of the children (n = 52) reported neck pain and/or recurrent headache. Neck pain and/or headache were not associated with forward head posture, impaired functioning in cervical paraspinal muscles, and joint dysfunction in the upper and middle cervical spine in these subjects. However, joint dysfunction in the lower cervical spine was significantly associated with neck pain and/or headache in these preadolescents. Most of the students had nonsymptomatic biomechanical dysfunction of the upper cervical spine. There was a wide variation between parental report and the child's self-report of trauma history and neck pain and/or headache prevalence.
Conclusion
In this study, the physical examination findings between preadolescents with neck pain and/or headaches and those who were symptom free differed significantly in one of the parameters measured. Cervical joint dysfunction was a significant finding among those preadolescents complaining of neck pain and/or headache as compared to those who did not.
Tuesday, November 10, 2009
Does migraine-associated vertigo share a common pathophysiology with Meniere's disease? Study with vestibular-evoked myogenic potential
Cephalalgia
Volume 29 Issue 12, Pages 1259 - 1266
Published Online: 23 Apr 2009
© 2008 International Headache Society
KEYWORDS
ABSTRACT
To clarify if migraine-associated vertigo (MAV) and Meniere's disease (MD) share a common pathophysiology, vestibular-evoked myogenic potentials (VEMP) were measured in 11 patients with MAV, 11 with unilateral MD and eight healthy subjects. As acoustic stimuli, tone bursts (TB; 250, 500, 1000 and 2000 Hz) were presented. In healthy subjects, 500-Hz TB evoked the largest amplitude. To quantify this tendency, 500–1000 VEMP slope was calculated, and 500–1000 VEMP slope was the smallest on the affected side of MD patients. Among the 11 MD patients, five had significantly decreased 500–1000 VEMP asymmetry (shift of the tuning to 1000 Hz). Three of the 11 MAV patients also showed a significantly decreased 500–1000 VEMP slope. This finding suggests that MAV might share a common pathophysiology with MD. In addition to this finding, four of the other eight MAV patients showed prolonged p13 latencies. This suggests that MAV could consist of patients with different lesion sites.
Received 5 November 2008, accepted 5 February 2009
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