From the original material of 300 patients, of whom 37.3% had experienced a post-lumbar puncture headache (PPH), a total of 20 males and 50 females were evaluated with the Minnesota Multiple Personality Inventory (MMPI). The test was administered on average 33 months after the lumbar puncture (range 13–51), at a time when anxiety and depression related to the original investigation for a possible organic neurologic disease were expected to affect the results minimally. In the present material PPH was experienced by 45.7% of the patients, 40% of the males, and 48% of the females. Patients without PPH were used as controls. The selected material was a representative sample of the original material both as to distribution of age, proportion of organic diagnoses, and frequency of PPH. The MMPI disclosed no statistically significant differences between PPH patients and controls regarding personality traits.
In this single-blind, randomized study of post-lumbar-puncture headache (PPH) in 300 neurologic inpatients the significance of body posture after lumbar puncture (LP) was evaluated. Immediate mobilization was compared with bed rest for 6 h (3 h prone followed by 3 h supine posture). Contrary to the widely held belief, this investigation did not show significant differences between recumbent and ambulant patients as to frequency of PPH in the total material (39% versus 35%) or when men (31% versus 29%) and women (48% versus 41%) were evaluated separately. Headache associated with nausea was significantly more frequent in the recumbent than in the ambulant patients both in the total material (23% versus 13%) and in women (35% versus 16%). Thus, immediate mobilization seems to be preferable after LP.
This multinational, multicenter, randomized, double‐blind, placebo‐controlled study in 169 patients investigated the effect of a 7‐day period of preemptive treatment with oral sumatriptan (100 mg tid) on the frequency and severity of cluster headache attacks occurring during an established cluster headache period. Safety and tolerability were also assessed. Cluster headache patients who were not taking prophylactic medication and had experienced seven or more attacks in the preceding observation week, treated a cluster headache attack at home with subcutaneous sumatriptan 6 mg using an autoinjector device. Patients were then randomized to take sumatriptan 100 mg or placebo at 8‐hourly intervals for a 7‐day period. Cluster headaches occurring during this period could be treated 5 minutes after onset with rescue medication (100% oxygen or simple analgesics). Diary cards were used to record details of the cluster headache pattern during the observation and study treatment weeks. Preemptive oral treatment with sumatriptan 100 mg tid for 7 days did not produce a significant reduction in the number or severity of cluster headache attacks occurring during an established cluster headache period. Oral treatment with sumatriptan 100 mg tid over a 7‐day period was not associated with an increased or altered adverse event profile from that previously reported.
Abstract Background At the 10-year follow-up in the IBSEN (Inflammatory Bowel in South-Eastern Norway) study, there was an increased relative risk of permanent work disability for patients with inflammatory bowel disease (IBD), compared with the age-matched background population. Now we aimed to assess the prevalence of work disability benefits among Crohn’s disease (CD) and ulcerative colitis (UC) patients 20 years after diagnosis, using data from the IBSEN study and the Norwegian Registry for social security benefits (FD-Trygd). Methods In the IBSEN study the participants have had planned a scheduled follow-up visit after 1-, 5-, 10- and 20-years. At the 20-year follow-up, they received a questionnaire about temporary and permanent work disability benefits and those who answered at least one of the questions were included in this study. Patients above 67 years of age (i.e. the standard retirement age in Norway) at the time of diagnosis were excluded. From FD-Trygd, we acquired officially registered information about the patients’ work disability status. UC and CD patients were compared using the Pearson’s Chi-squared (χ 2) test for categorical variables and the Mann-Whitney U test for continuous variables. Results A total of 421 patients attended a 20-year follow-up and information from 418 were included for analysis. Out of those, 281 had UC (51.2% women) with a median age at the 20-year follow-up of 54.3 years (range 29.5–85.2) and 137 had CD (49.6% women) with a median age of 47.8 (range 27.4–84.8). At the 20-year follow-up, 38.1% of the IBD patients (UC 34.9% and CD 44.6%, p=0.061) reported that they had applied for and/or received temporary or permanent work disability benefits. In total 20.3% (UC 18.3% and CD 24.4%, p=0.181) reported they had been granted a permanent work disability benefit, while 10.2% reported that this was due to their IBD (UC 8.2% and CD 14.2%, p=0.067). In FD-Trygd, 27.3% of the IBD patients in the IBSEN cohort (UC 26.3%, CD 29.2%, p=0.537) were registered as having been granted permanent work disability benefits during the 20-year period. Conclusion Every fifth patient reported that they had been granted permanent work disability benefits after 20 years with IBD, but this was related to other diseases (or reasons) in half of them. According to FD-Trygd, however, more than one in four patients had been granted permanent work disability benefits in the same time-period. While differences between the UC and CD patients were found to be insignificant in these data, the difference between patient-reported and registry data is important for further socio-economic analyses and should be examined more closely.
This multicentre, double-blind, randomised, crossover study compared the efficacy, safety and tolerability of subcutaneous sumatriptan (6 mg and 12 mg) with placebo in 134 in-patients with cluster headache. Headache improvement to mild or no pain at 5, 10 and 15 min after treatment was recorded. At 10 min, headache relief was reported by 25% placebo), 49% (6 mg) and 63% (12 mg) of patients and at 15 min the results were 35% (placebo), 75% (6 mg) and 80% (12 mg) (p < 0.001 for all comparisons with placebo). The 12 mg dose was not significantly better than the 6 mg dose and was associated with more adverse events. The 6 mg dose is therefore recommended for the acute treatment of cluster headache.
In this study of 300 neurological inpatients aged between 18 and 60 years the incidence of post-lumbar-puncture headache (PPH) was 37.3%. The more severe the headache, the more frequently it was associated with dizziness, nausea, vomiting, and tinnitus. If PPH occurred during the first day after lumbar puncture (LP), it was more severe, and lasted longer than PPH, which started later. The incidence of PPH and associated symptoms decreased with increasing age, and was much higher in females than males. The sex difference was nearly exclusively explained by a marked preponderance of PPH in females below 40 years of age, i.e. women in the fertile age. Furthermore, there was a decreased incidence of PPH and associated symptoms in patients with an initial higher than average cerebrospinal fluid (CSF) pressure (162 mm H2O). All these differences were statistically significant. Particularly high frequencies of PPH were found in young women with an initial CSF pressure lower than mean.
Objectives The aim of this study was to evaluate the angiotensin II receptor antagonist candesartan as prophylactic medication in patients with episodic cluster headache. Methods This study comprised a prospective, placebo-controlled, double-blind, parallel-designed trial performed in seven centres in Scandinavia. Forty (40) patients with episodic cluster headache (ICHD-2) were recruited and randomised over a five-year period to placebo or 16 mg candesartan in the first week, and placebo or 32 mg candesartan in the second and third week. Results The number of cluster headache attacks (primary efficacy variable) during the three-week treatment period was reduced from 14.3 ± 9.2 attacks in week 1 to 5.6 ± 7.0 attacks in week 3 (−61%) in the candesartan group and from 16.8 ± 14.1 attacks in week 1 to 10.5 ± 11.3 attacks in week 3 (−38%) in the placebo group. The difference between the candesartan and placebo group was not significant with the pre-planned non-parametric ranking test, but a post-hoc exact Poisson test, which takes into account the temporal properties of the data, revealed a significant result ( p < 0.0001). Conclusions This was a negative trial. Post-hoc statistics suitable to describe the temporal changes in cluster headache indicate that conduction of future larger studies may be justified.
