Assessing Patients with Episodic Tension-Type Headache, Migraine or Chronic Daily Headache Using the Short Pain Inventory
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The difficulty in distinguishing episodic tension-type headache from migraine headache is widely acknowledged. The misdiagnosis of migraine as tension-type headache has potentially significant consequences because it may preclude patients with disabling headaches from receiving appropriate treatment. This article explores the symptomatologic, epidemiologic, and pathophysiologic relationships among migraine and tension-type headaches with the aim of elucidating ways to improve their diagnosis and treatment. Clinical, epidemiologic, and pharmacologic data converge to suggest that rigid adherence to the IHS criteria in diagnosing migraine and tension-type headache may result in misdiagnosis of some headaches. Many migraine attacks are accompanied by tension headache-like symptoms, such as neck pain. Conversely, IHS-defined tension-type headaches are often accompanied by migraine-like symptoms, such as photophobia or phonophobia and aggravation by activity. The health-care provider caring for patients with headache should be cognizant of these overlaps and their implications for the management of patients with headache.
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SYNOPSIS We determined by radioimmunoassay plasma melatonin levels on blood samples drawn at 11 p.m. in migraine patients and control subjects. Ninety‐three cephalalgic outpatients (75 females, 18 males) were compared to a control group (24 females, 22 males) matched according to age. Patients were divided into subgroups presenting common migraine (n = 38); ophthalmic migraine (n = 12); and tension headache associated with ophthalmic or common migraine (n = 24), and associated depressive status (n = 19). Statistical analysis revealed a decrease in plasma melatonin levels for the entire migraine population, compared to the control one, and a heterogeneity in both controls and patients; this heterogeneity was found mainly in the depressive and tension headache subgroups. When the migraine population‐from which the depressive patients were excluded‐was divided into male and female subgroups, a decrease in plasma melatonin levels was observed only for the female subgroups. Results are discussed with reference to the role of the pineal gland in the synchronization of the organism with the environmental conditions.
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Objective.—The present study examined the relationship between the diagnosis of migraine and self‐reported sexual desire. Background.—There is evidence for a complex relationship between sexual activity and headache, particularly migraine. The current headache diagnostic criteria even distinguish between several types of primary headaches associated with sexual activity. Methods.—Members of the community or students at the Illinois Institute of Technology (N = 68) were administered the Brief Headache Diagnostic Interview and the Sexual Desire Inventory (SDI). Based on the revised diagnostic criteria established by the International Headache Society (ICHD‐II), participants were placed in 1 of the 2 headache diagnostic groups: migraine (n = 23) or tension‐type (n = 36). Results.—Migraine subjects reported higher SDI scores, and rated their own perceived level of desire higher than those suffering from tension‐type headache. The presence of the symptom “headache aggravated by routine physical activity” significantly predicted an elevated SDI score. Conclusions.—Migraine headaches and sexual desire both appear to be at least partially modulated by serotonin (5‐HT). The metabolism of 5‐HT has been shown to covary with the onset of a migraine attack, and migraineurs appear to have chronically low systemic 5‐HT. As sexual desire also has been linked to serotonin levels, the results are consistent with the hypothesis that migraine and sexual desire both may be modulated by similar serotonergic phenomena.
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Abstract:
This study investigated the prevalence rates of migraine and tension-type headaches among the students of Shiraz University of Medical Sciences during the academic year 1996-1997. The study was carried out cross-sectionally on a representative random sample of 310 students selected systematically. A semi structured questionnaire was used to screen headache among the students, applying the international Headache Society Classification. A total of 123 (39.7%) students were screened for headache and examined clinically for a proper diagnosis. As a results 80 (25.8%) students were diagnosed to have migraine, tension-type headache or coexisting migraine and tension-headache. Prevalence rates for tension-headache, migraine, coexisting tension-headache and migraine were 15.5%, 7.4% and 2.6% respectively. Odds ratio of tension-headache in boys was 3.4 times higher than that of girls, (P<0.01), but it was not statistically different for migraine and coexisting migraine and tension-headache. The relationships between the headaches and several factors were examined and significant associations were found between migraine and coexisting migraine and tension-type headache with sleeping pattern of students (P<0.05). The odds ratio of migraine in students who had abnormal sleeping pattern was 2.5 times higher than those with normal sleeping pattern, but for coexisting migraine and tension-headache with regard to sleeping pattern it was estimated to be 7.8 times higher than normal. Both odds ratios were statistically significant (P<0.05). In general, headaches including migraine, tension-type, etc were significantly associated with family history of headache (P<0.001).
Keywords: Epidemiology, Prevalence, Headache, Migraine, Tension-type headache, Student
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The objective of this study was to determine the prevalence of migraine headache in a family practice patient population. In addition, this study evaluated the simultaneous presence of Raynaud's phenomenon (RP) and migraine and examined the influence of sex hormonal status on migraine symptoms.Data from the Continuous Morbidity Registration Project (CMR) of Nijmegen, the Netherlands, were used to identify all patients in the registration who had migraine headache and a comparison group of patients with nonvasospastic tension headache. Questionnaires were used to verify the diagnosis and to determine signs and symptoms of both headaches.There was an average annual prevalence of migraine headache of four per 1,000 men and 16 per 1,000 women. Eighty-five percent of patients diagnosed by family physicians as having migraine were found to fulfill the International Classification of Health Problems in Primary Care (ICHPPC) criteria for migraine headache. Migraine differed from tension headache with regard to the duration of the attacks, concomitant photo- and phonophobia, provoking factors, and the need to use analgesic medications. RP was present in 15% of the migraine group and in 16% of the tension headache group and occurred almost exclusively in women. The headaches were worse during and before menstruation in both groups and improved during pregnancy and menopause in the migraine group to greater extent than in the tension headache group.The use of the ICHPPC criteria for migraine headache is reliable in morbidity surveys in family practice. Although there was an overlap, migraine differed in various aspects from tension headache. Digital vasospasm and the influence of female hormonal changes were present in both headache groups.
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Tension headache
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The principal reasons for a predominantly weekend incidence of migraine attacks are likely to be social or psychological in origin. There may be another factor. This study examines the use, and more importantly the way of use, of caffeine containing substances. We collected data by questionnaire from 151 consecutive Migraine Clinic patients with the diagnosis of migraine or tension type headache. Of the whole group, 21.9% claimed to have weekend attacks, with relatively more males than females. The males amongst these were all migraine patients, but 23% of the women suffered from tension-type headache. Patients with both a high daily caffeine intake and excessively delayed wakening at weekends (each defined as greater than the mean for the whole group) had a 69% risk of weekend headache. This compared with 4% in patients exceeding the mean in one only, and zero in those with moderate habits in both. These results support the idea that weekend attacks are linked to caffeine withdrawal. Sleeping in is not on its own a significant cause. We suggest that this possibility should be considered in clinical management of affected patients.
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Weekend effect
Migraine Disorders
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Two thirds of all children are seen at some time during childhood for severe headache. Most headaches in children and adolescents are tension or migraine headaches (2% to 5% is a conservative migraine prevalence rate in children). Correct diagnosis is based on clinical history, and children and adolescents may have difficulty describing their …
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Migraine Disorders
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SYNOPSIS There are few findings of increased stress responses of the vascular system and the (head) muscles in migraine and tension headache patients. However, several studies ignored the headache state of the patients during the experiment and differences in sex, or used small experimental groups. In this controlled study, physiological parameters in migraine patients, tension headache patients and non‐headache controls were investigated during conditions of stress and rest. Each group was composed of at least 25 subjects. Sex was included as an independent variable, and separate analyses were carried out on patients with pain during the measurements. There were no differences in vascular responding nor in muscular responding to stress between migraine patients, tension headache patients and controls. Male migraine patients showed enhanced activity in some indicators of sympathetic activity. No evidence was found for a discrete border separating the two headache types.
Tension headache
Sympathetic activity
Vascular headache
Emotional stress
Migraine Disorders
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To explore the relationship between plasma endothelin and migraine attack. Methods: The plasma endthelin (ET-1) levels were measured by radioimmunoassay in 54 patients with migraine (classic: 18,common:36) and 20 patients with tension headache. Results:The plasma ET-1 level in patients with migraine attack was higher than that of normal controls or patients with tension headache ( P 0.01) . During intermission, the ET-1 level of patients with classic migraine was higher than that of patients with common migraine (P0.01) ,and the ET-1 level in male patients was higher than in female ones. Conclusion:The data suggest that there are abnormalities of vascular endothelial cell system in patients with migraine. ET-1 may be one of factors causing migraine attack.
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Tension headache
Migraine Disorders
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