bluuebunny/crossref_metadata_2025_split huggingface dataset:
Self‐reported Disability Due to Headache: A Comparison of Clinic Patients and Controls
Authors: Ziegler Dewey K. , Paolo Anthony M. 
Published: March 2003

Objective.‐To compare the self‐reported disability of headache sufferers who seek medical assistance with those who do not seek such help and determine possible relationships between perceived disability and psychological factors.Method.‐Subjects were 51 headache patients and 53 persons without medical assistance for their headache within the past 2 years. All subjects completed a structured interview that gathered headache data, a headache disability scale, and the Minnesota Multiphasic Personality Inventory‐Revised (MMPI‐2).Design.‐A 2 x 2 ANCOVA design was employed. Subject group (patient vs control) was the first factor and headache type (migraine vs mixed) was the second. Covariates were headache intensity and five subscales of the MMPI‐2. Dependent variables were the seven subscales of the headache disability scale. Stepwise discriminant analysis was conducted to determine which factors best classified subjects as patients or controls.Setting.‐University Medical Center headache clinic.Results.‐Clinic patients reported significantly greater disability on their occupation than controls‐a difference emerging after controlling for level of headache pain and personality variables. Patients differed from controls, although not significantly, in the rank order of life activities most affected by headache. Discriminant analysis revealed that self‐reported disability for occupation and the Hysteria scale from the MMPI‐2 best differentiated the groups.
Practice and Economics Cost Considerations in Headache Treatment Part 2: Acute Migraine Treatment
Authors: Von Seggern Randal L. , Adelman James U. 
Published: March 2003

Today's physician has many useful medication options available for acute migraine treatment. There is a wide cost range among these drugs and today’s health care environment demands that cost be factored into the decision process. Effective migraine abortive treatment decreases the costs of repeat dosing and disability. Early use of migraine abortive medication can increase its rapidity of action and effectiveness. Adjunctive medication such as metoclopramide ($0.10) is inexpensive and may improve the effectiveness of the primary abortive medication.Over‐the‐counter medications such as aspirin ($0.02/325 mg), Excadrin· ($0.09/tablet), ibuprofen ($0.04/200 mg), or naproxen sodium ($0.09/220 mg) are inexpensive and effective. “Triple therapy” combining metoclopramide, a nonsteroidal ant‐inflammatory agent, and an ergotamine preparation may improve tolerance and effectiveness of the ergot. Locally compounded dihydroergotamine nasal spray is inexpensive ($0.78/1 mg spray). The cost of using oral sumatriptan can be almost halved by prescribing half of a 50‐mg tablet.Emergency department services are expensive. Huge cost savings occur through self‐controlled administration of oral, rectal, or even intramuscular narcotic medications. Oral narcotic agents such as hydromorphone ($0.42/4 mg) and meperidine ($0.92/200 mg) are generally used in inadequate doses to be effective for severe migraine. Guidelines are given for more effective use of these agents.Sophisticated comparative studies are needed to evaluate, not only the direct costs of medications, but all costs of treatment of an acute migraine attack, as well as Indirect costs to the patient, family, and society.
Repeated Doses of Combined Oral Lysine Acetylsalicylate and Metoclopramide in the Acute Treatment of Migraine
Authors: Hugues F.‐C. , Lacoste J.‐P. , Danchot J. , Joire J.‐E. 
Published: March 2003

The combination of lysine acetylsalicylate and metoclopramide is effective in the treatment of migraine attacks. It was unknown whether repeated doses could improve efficacy.The aim of this open trial was to evaluate the effects of a second, and eventually a third dose of lysine acetylsalicylate and metoclopramide when a first dose of the treatment was ineffective. Patients were asked to take a second dose 2 hours after a first dose when they thought that the first dose was ineffective. They were allowed to take a third dose or their rescue medication 2 hours after the second dose when they judged that the treatment remained ineffective.Two hundred ninety‐two patients were included in the study; 262 of the 292 patients treated 517 attacks.Headache relief (reduction in headache severity from grade 3 or 2 to grade 1 or 0) was observed in 54.8% of attacks after one dose, in 48.1% of attacks after a second dose, and in 40.3% of attacks after a third dose.Complete headache relief without recurrence and without use of a rescue medication was reported in 37% of the total attacks.The patients judged their treatment as good or excellent in 78% of attacks treated with one dose, in 41% of those treated with two doses, and in 19% of those treated with three doses.Tolerance, as judged by the patients, was considered good in 92% of treated attacks. Minor side effects occurred in 6% of attacks after a first dose, in 4.5% of attacks after a second dose, in 1.5% of attacks after a third dose, in 2% after unspecified delay, and in 14% overall.In conclusion, the efficacy of lysine acetylsalicylate and metoclopramide in the treatment of migraine attacks can be improved by repeated doses. It is well tolerated.
Headaches and Face Pains as a Manifestation of Munchausen Syndrome
Authors: Solomon Seymour , Lipton Richard B. 
Published: March 2003

Virtually every psychological or physical symptom may be feigned in order to assume a sick role; the term Munchausen syndrome is applied when the physical features are predominant. Complaints of headache as a manifestation of this condition are rare. We report such a case and review the literature of similar cases.A 34‐year‐old man consulted several headache specialists in different cities. Many different diagnoses were made, consistent with the various histories the patient related. It seems most unlikely that any one individual could experience 14 distinct headache disorders. Dozens of medications were prescribed, and a dozen or more were taken by the patient daily.People with Munchausen syndrome consciously feign physical symptoms and signs because of the apparently senseless need to assume a sick role. This condition is distinguished from malingering in which the symptoms are consciously feigned for personal gain and from somatoform disorder in which development of symptoms for psychological purposes is unconscious.Primary headache disorders, once thought to have a psychological basis, are now recognized as biological disorders. Though psychogenic mechanisms have been largely discredited, rarely, as illustrated by the present case, psychological mechanisms are predominant.
Headache in Patients With Neck‐Shoulder‐Arm Pain of Cervical Radicular Origin
Authors: Persson Liselott C.G. , Carlsson Jane Y. 
Published: March 2003

In a series of 81 patients with chronic cervicobrachialgia, 54 (67%) reported that they also suffered from recurrent headache. Forty‐four (81%) of these patients were classified as having cervical headache, 5 as having migraine, 2 with tension‐type headache, and 3 patients were not classifiable according to the diagnostic system of the International Headache Society (IHS). Patients with headache presented significantly higher tenderness scores and pain intensity in the neck‐shoulder‐arm region than patients without headaches.Twenty‐three (52%) of the 44 patients with cervical headache reported that their headache had improved after treatments directed towards their cervicobrachialgia.The IHS classification system of cervical headache is discussed.
Precipitating Factors of Headache. A Prospective Study in a National Control‐Matched Survey in Migraineurs and Nonmigraineurs
Authors: Chabriat H. , Danchot J. , Michel P , Joire J.E. , Henry P 
Published: March 2003

Prospective studies of precipitating factors in migraine are rare. Mig Access is a national control‐matched survey conducted to evaluate the access of migraineurs to health care in France. This study allowed us to screen prospectively some precipitating factors of headache in migraineurs and in nonmigraineurs.Three hundred eighty‐five migraineurs (group 1) and 313 nonmigraineurs (group 2) kept a diary for a 3‐month period (a total of 35 805 days in group 1 and 29 109 days in group 2). Precipitating factors were reported for each headache period. Headache intensity was self‐assessed during each headache period using a visual analog scale of 0 to 100.Headache was reported on 4274 days (12%) in group 1 and on 602 days (2%) in group 2. Headache intensity was greater in group 1 (39 ± 20 versus 32 ± 19, P<.05). The most frequent precipitating factors (reported at least once by more than 10% of subjects [range 18% to 80%] in both groups) were fatigue and/or sleep, stress, food and/or drinks, menstruation, heat/cold/weather, and infections in both groups. All these factors except infections were reported to cause headache more frequently in migraineurs than in nonmigraineurs. Mean intensity of headache related to fatigue and/or sleep, stress, food and/or drinks, hot/cold weather, and menstruation varied from 37 to 43 in migraineurs and from 29 to 35 in nonmigraineurs. Headache with the highest mean intensity was due to infections in the two groups (47 ± 20 in group 1,45 ± 23 in group 2).Our results support that endogenous factors are the most frequent triggers of headache in migraineurs. The most frequent precipitating factors of headache appear identical in migraineurs and in nonmigraineurs. Our results suggest that similar triggers could precipitate headache of different type in these two populations.
Predictability of Exogenous Hormone Effect on Subgroups of Migraineurs
Authors: Mueller Loretta 
Published: March 2003

Objective.–To evaluate whether self‐reported past migraine response to reproductive life events (menses, pregnancy, menopause) alters the likelihood of worsening of migraine with exogenous hormone use.Methods.–A retrospective study was conducted on 451 female patients at the University Headache Center who had a diagnosis of migraine with or without aura.Results.–The majority of migraineurs recalled no change in headaches with oral contraceptive use or hormone replacement therapy (67.2% and 77%, respectively). Worsening of migraines with oral contraceptive use was associated with a menstrual trigger, worsening during pregnancy, and a diagnosis of migraine without aura. Worsening with hormone replacement therapy was associated with worsening during prior oral contraceptive use, improvement during pregnancy, worsening during menopause, and a diagnosis of migraine without aura.Conclusions.–Prospective studies are needed to confirm these associations.
Acute Headache in Children and Adolescents Presenting to the Emergency Department
Authors: Lewis Donald W. , Qureshi Faiqa 
Published: March 2003

Objectives.–Our goals were (1) to investigate the causes of acute headache in childhood from the emergency department perspective and (2) to search for clinical clues that might distinguish headache associated with serious underlying disease.Background.–The clinical presentation of headache in children and adolescents can be separated into 5 temporal patterns: acute, acute‐recurrent, chronic progressive, chronic nonprogressive, and mixed. Few data exist regarding acute headache in children.Methods.–Consecutive children who presented to our emergency department with the abrupt onset of severe headache were prospectively evaluated. The headache character, location, severity, and associated symptoms, as well as underlying causes, were recorded using a standardized survey.Results.–One hundred fifty children, aged from 2 to 18 years, 87 boys and 63 girls, were enrolled over a 10‐month period. Upper respiratory tract infection with fever (viral upper respiratory tract infection 39%, sinusitis 9%, streptococcal pharyngitis 9%) was the most frequently identified cause of acute headache (57%). Other causes included migraine (18%), viral meningitis (9%), posterior fossa tumors (2.6%), ventriculoperitoneal shunt malfunction (2%), epileptic seizure (postictal headache) (1.3%), concussion (postconcussive headache) (1.3%), intracranial hemorrhage (1.3%), and undetermined (7%). Two clinical features were found to have statistically significant associations with serious underlying disease: occipital location of headache and an inability of the patient to describe the quality of the head pain. All children with surgically remediable conditions had clear and objective neurological signs.Conclusions.–In children and adolescents, the abrupt onset of severe headache is most frequently caused by upper respiratory tract infection with fever, sinusitis, or migraine. Special attention is warranted if the acute headache is occipital in location and if the affected patient is unable to describe the quality of the pain. Serious underlying processes such as brain tumor or intracranial hemorrhage are uncommon and, when present, are accompanied by multiple neurological signs (ataxia, hemiparesis, papilledema).
Recurrent Headache, Coping, and Quality of Life in Children: A Review
Authors: Bandell‐Hoekstra Inez , Abu‐Saad Huda Huijer , Passchier Jan , Knipschild Paul 
Published: March 2003

Objectives.–To clarify the concepts of coping with pain and quality of life (QoL) and to present a literature review of the strategies that children with recurrent headaches use to cope with their pain, the impact of recurrent headaches on children's QoL, and the influence of personal and situational variables on headache, coping, and QoL in children.Methods.–The literature search encompassed published articles that were found by means of a CD‐ROM search of MEDLINE (1966 to December 1998) and PsycLIT (1974 to December 1998) and the snowball method.Results.–In pediatric headache research, only three studies have been found in which children report the use of various coping strategies, and only two studies considered QoL. Demographic factors and psychological variables such as depression, anger, and anxiety influence headache prevalence. The impact of headache‐related variables such as headache type, severity, perceived cause, and prior experience on QoL has only been studied in adults.Conclusions.–More research on coping and QoL is needed in pediatric headache. The conceptual model that is presented in this article may serve as a guide.
Periaqueductal Gray Matter Dysfunction in Migraine: Cause or the Burden of Illness?
Authors: Welch K.M.A. , Nagesh Vijaya , Aurora Sheena K. , Gelman Neil 
Published: March 2003

Objective.—The periaqueductal gray matter (PAG) is at the center of a powerful descending antinociceptive neuronal network. We studied iron homeostasis in the PAG as an indicator of function in patients with episodic migraine (EM) between attacks and patients with chronic daily headache (CDH) during headache. High‐resolution magnetic resonance techniques were used to map the transverse relaxation rates R2, R2*, and R2′ in the PAG, red nucleus (RN), and substantia nigra (SN). R2′ is a measure of non‐heme iron in tissues.Methods.—Seventeen patients diagnosed with EM with and without aura, 17 patients diagnosed with CDH and medication overuse, and 17 normal adults (N) were imaged with a 3.0‐tesla magnetic resonance imaging system. For each subject, mean values of the relaxation rates, R2 (1/T2), R2* (1/T2*), and R2′ (R2* − R2) were obtained for the PAG, RN, and SN. R2, R2*, and R2′ values of the EM, CDH, and N groups were compared using analysis of variance, Student t test, and correlation analysis.Results.—In the PAG, there was a significant increase in mean R2′ and R2* values in both the EM and CDH groups (P<.05) compared with the N group, but no significant difference in these values was demonstrated between the EM and CDH groups, or between those with migraine with or without aura in the EM group. Positive correlations were found for duration of illness with R2′ in the EM and CDH groups. A decrease in mean R2′ and R2* values also was observed in the RN and SN of the CDH group compared with the N and EM groups (P<.05), explained best by flow activation due to head pain.Conclusions.—Iron homeostasis in the PAG was selectively, persistently, and progressively impaired in the EM and CDH groups, possibly caused by repeated migraine attacks. These results support and emphasize the role of the PAG as a possible “generator” of migraine attacks, potentially by dysfunctional control of the trigeminovascular nociceptive system.
Differentiating the Efficacy of 5‐HT1B/1D Agonists
Authors: Sheftell Fred D. , Fox Anthony W. , Weeks Randall E. , Tepper Stewart J. 
Published: March 2003

Objective.—To examine, for a set of published clinical trials of serotonin (5‐HT1B/1D) agonists as acute treatments for migraine, whether transformation of efficacy data into therapeutic gain (TG) or number needed to treat (NNT) is useful.Background.—Pivotal clinical trials of 5‐HT1B/1D agonists in migraine use a primary end point of change in pain score from 3 or 2 to 1 or 0. Placebo response rates among such studies are variable. Meta‐analytic comparisons of 5‐HT1B/1D agonists often employ TG and NNT as efficacy measures.Methods.—Data from US product labeling or published sources were converted into TG (TG = active response rate [%] − placebo response rate [%]) and NNT (NNT = 1/TG). Pivotal clinical trial data were compared before and after transformation.Results.—Therapeutic gain ranged from 17.5% to 51%. The transformation of TG into NNT yielded no clinically significant difference in efficacy estimate for the range of 17.5% to 47% (N = 29 clinical trials). However, NNT and TG had a nonlinear relationship for some secondary end points. When the relationship between the standard primary and secondary end points was compared, the correlation of TG with clinical disability (Pearson coefficient R = 0.93) was stronger than for NNT. Placebo response rates correlated more strongly with NNT (R = 0.66) than active response rates (R = 0.42; N = 29 clinical trials), although both TG and NNT were sensitive to placebo response rate.Conclusions.—Transforming efficacy rates into TG or NNT adds no new information to placebo‐controlled trials. The variables, TG and NNT, should not be used to compare members of this class of drugs. Migraine therapies can only be compared using well‐designed head‐to‐head studies and not by meta‐analysis. Broader measures of efficacy should be used to describe and compare 5‐HT1B/1D efficacy.
Headaches Associated With Refractive Errors: Myth or Reality?
Authors: Gil‐Gouveia R. , Martins I.P. 
Published: March 2003

Introduction.—Headache and refractive errors are very common conditions in the general population, and those with headache often attribute their pain to a visual problem. The International Headache Society (IHS) criteria for the classification of headache includes an entity of headache associated with refractive errors (HARE), but indicates that its importance is widely overestimated.Objectives.—To compare overall headache frequency and HARE frequency in healthy subjects with uncorrected or miscorrected refractive errors and a control group.Methods.—We interviewed 105 individuals with uncorrected refractive errors and a control group of 71 subjects (with properly corrected or without refractive errors) regarding their headache history. We compared the occurrence of headache and its diagnosis in both groups and assessed its relation to their habits of visual effort and type of refractive errors.Results.—Headache frequency was similar in both subjects and controls. Headache associated with refractive errors was the only headache type significantly more common in subjects with refractive errors than in controls (6.7% versus 0%). It was associated with hyperopia and was unrelated to visual effort or to the severity of visual error. With adequate correction, 72.5% of the subjects with headache and refractive error reported improvement in their headaches, and 38% had complete remission of headache. Regardless of the type of headache present, headache frequency was significantly reduced in these subjects (t = 2.34, P = .02).Conclusions.—Headache associated with refractive errors was rarely identified in individuals with refractive errors. In those with chronic headache, proper correction of refractive errors significantly improved headache complaints and did so primarily by decreasing the frequency of headache episodes.
Intravenous Propofol in the Treatment of Refractory Headache
Authors: Mendes Paula M. , Silberstein Stephen D. , Young William B. , Rozen Todd D. , Paolone Mary F. 
Published: March 2003

We analyzed the results of treating patients who had chronic daily headaches that were refractory to standard medications with repetitive low‐dose boluses of intravenous propofol (2,6‐diisopropylphenol).Patients were treated over a 1‐year period at Thomas Jefferson University Hospital. A total of 18 patients were treated a total of 21 times. Over 90% of patients had at least some headache relief after treatment. The headache cycle was broken in eight patients. There were no complications. Intravenous propofol is safe and effective when used under monitored conditions and should be considered for patients who have refractory chronic daily headache and have failed other interventions.
A Review of Mechanisms of Response to Pain Therapy: Why Voodoo Works
Authors: Solomon Seymour 
Published: March 2003

A person's response to pain treatment may be due to factors other than the direct effect of analgesics. Amelioration of pain is often associated with modalities that appear to make no scientific sense.This review outlines the mechanisms of pain amelioration other than that by medication. These mechanisms help to explain why pain relief may follow the administration of allopathic modalities.Pain is modulated, enhanced, or diminished by both cerebral and peripheral mechanisms. Cerebral factors include the placebo response, psychological phenomena, and conscious cognitive activation. In addition to evoking endogenous opioids, these central mechanisms activate antinociceptive pathways beginning in the limbic forebrain and relayed in the periaqueductal gray matter to primary afferent nociceptive sites in the spinal cord dorsal horn (and medullary nucleus caudalis). Obvious peripheral factors that may diminish pain perception are those that decrease afferent stimuli. Paradoxically, stimulation of afferent neurons may also ameliorate pain by activating spinal or supraspinal inhibitory mechanisms. Finally, improvement in pain or other symptoms is often falsely attributed to a therapy when remission occurs because the underlying illness has run its normal course.