Presentation of a New Instrument: The Diagnostic Headache Diary
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Abstract:
A new instrument, the Diagnostic Headache Diary, based on the operational diagnostic criteria of the International Headache Society (IHS), was tested in 61 migraine patients from a headache research clinic using the clinical diagnosis (IHS criteria) for comparison. All patients kept the diary for one to eight months. The clinical and diary diagnosis of migraine with and without aura was the same in, respectively, 72 and 87% of the patients. Nausea, photophobia and phonophobia tended to be more pronounced at the clinical interview. The diary identified 20 more cases of episodic tension-type headache and 15 fewer cases of chronic tension-type headache than the clinical interview. Two blinded observers always made the same IHS diagnoses when interpreting the diagnostic headache diary. A combination of a clinical interview and the diagnostic headache diary gives a qualitatively and quantitatively more precise diagnosis than a clinical interview alone.Keywords:
Phonophobia
Photophobia
Presentation (obstetrics)
Tension headache
Clinical Diagnosis
Background: Migraine is one of the most common neurological disorder and fourth most important factor for debility in human. The presentation of migraine is complex. All patients do not have same features of migraine. Objectives: The purpose of the study was to evaluate demographic and clinical patterns of headache in migraine patients. Methods: A total of 30 migraine patients who were visited in the Headache clinic, Department of Neurology, BSMMU, Dhaka were enrolled for the study. Migraine patients diagnosed according to ICHD-3 (International Classification of Headache Disorders 3rd edition) criteria. Results: Out of 30 patients mean age was 30.63±10.95 years with age range 15-60 years in migraine patients. Female were more common. Positive family history was present in 56.7% patients. Common associated symptoms were photophobia, phonophobia (96.7%) and nausea (83.3%) in migraine patients. Common precipitating factors were stress and sunlight (90%) followed by journey (80%) and insomnia (73.3%). A major portion of migraine was without aura (73.3%) and the ratio of aura to without aura is 1: 2.75. Major portion of migraine patients were complained of 4-6 attacks/ month (46.7%) which was followed by 1-3 attacks/month (36.7%). Most of the migraine patients complained as moderate headache (60%) followed by severe headache (40%). Conclusion: This study concluded that migraine is a disease of younger age group and it affects female more commonly than male, pattern of headache in migraine patients is unique. Bangladesh Journal of Neuroscience 2019; Vol. 35 (2): 63-68
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We investigated the influence of age on the IHS criteria for migraine and tension‐type headache in 437 consecutive children and adolescents and found the following age‐associated statistically significant differences: migraine duration, occurrence of migraine aura, and bilateral location of tension‐type headache were more often fulfilled by adolescents, whereas aggravation of headache by physical activity (in migrainous disorder) and photophobia (in migraine with aura) were more often fulfilled by children, Accordingly, there are only a few, differences concerning the fulfillment of the IHS criteria for migraine and tension‐type headache in children and adolescents. Independent of age, the intensity of headache and the presence or absence of nausea are most important for differentiating the two major types of idiopathic headache. The sensitivity of the IHS criteria for migraine could be increased by reducing the minimum duration of migraine and by allowing the diagnosis of migraine when severe headache is associated with nausea, even though the criteria of location, quality, and aggravation by physical activity are not fulfilled.
Tension (geology)
Migraine Disorders
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Until the 1988 classification of headaches by the International Headache Society, the various headache disorders were poorly defined, and migraine and tension-type headache were often viewed as part of a continuum.1 When the society's strict diagnostic criteria were applied to a general population, however, these were shown to be two distinct disorders.2 There are two main types of migraine.1 The first, migraine without aura (previously called common migraine), is characterized by headache attacks lasting 4 to 72 hours. The headache is usually severe, unilateral, pulsating, aggravated by physical activity, and accompanied by nausea, vomiting, photophobia (hypersensitivity to light), and phonophobia . . .
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Background: Nausea is regarded as an essential element in the diagnosis of migraine. However, some patients with migraine do not experience nausea during their migraine attacks. These patients may show different clinical features that demand different management strategies. The authors evaluated how migraineurs without nausea differ from those with nausea in a headache clinic. Methods: This study enrolled 182 consecutive patients (156 female, 26 male) satisfying the International Classification of Headache Disorders-II criteria of migraine with or without aura from August 2009 to July 2011. Patients who overused medications were excluded. All enrolled patients underwent interviews using a structured questionnaire regarding demographic and clinical features performed by a neurologist specialized in headache disorders. Results: Of the 182 patients with migraine, 21 never experienced nausea during their migraine attacks (11.5%). These 21 patients were older and experienced a lower frequency of vomiting, osmophobia, and pulsating headache quality (p < 0.05). However, they did not differ from patients who usually suffered from nausea in terms of the presence of an aura, gender, body mass index, headache years, headache severity expressed on a visual analogue scale, Headache Impact Test-6 score, presence of family history, photophobia, or phonophobia. Conclusions: Migraineurs without nausea showed a tendency to be older and experience less vomiting and osmophobia, and their headache was usually dull and aching rather than pulsating. These results suggest that migraine-associated symptoms have peculiar characteristics that require elucidation by further studies in terms of their clinical significance and role in migraine pathophysiology.
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Osmophobia has been suggested as an additional symptom of migraine without aura, and a high prevalence of osmophobia of up to 50% has been reported in the literature. We conducted a nosographic study of osmophobia in all migraineurs and tension-type headache patients and a field testing of suggested diagnostic criteria of osmophobia, presented in the appendix of the second edition of The International Classification of Headache Disorders and suggested by Silva-Néto et al. and Wang et al ., in migraine without aura and tension-type headache patients (n = 1934).Each patient received a validated semi-structured interview. All subjects fulfilled the diagnostic criteria of the second edition of The International Classification of Headache Disorders for migraine or tension-type headache. Statistical analyses were performed using statistical software R. The statistical R package "Caret" was used to construct a confusion matrix and retrieve sensitivity, which is defined as the suggested criteria's ability to correctly diagnose migraine without aura patients, and specificity, defined as the suggested criteria's ability to not wrongly diagnose tension-type headache patients.Osmophobia was present in 33.5% of patients with migraine with aura, in 36.0% of patients with migraine without aura, and in 1.2% of patients with tension-type headache. All migraineurs with osmophobia also fulfilled the current criteria for migraine by having nausea or photophobia and phonophobia. The appendix criteria had a sensitivity of 0.96 and a specificity of 0.99 for migraine without aura, and a sensitivity of 0.65 and a specificity of 0.99 for probable migraine without aura. Both the criteria by Silva-Néto et al. and Wang et al. had a sensitivity of 0.98 and a specificity of 0.99 for migraine without aura, and a sensitivity of 0.66 and a specificity of 0.99 for probable migraine without aura.This study demonstrates the remarkable specificity of osmophobia. The criteria by Silva-Néto et al. and Wang et al. both had a higher sensitivity than the appendix criteria for migraine without aura; all three criteria had a low sensitivity for probable migraine without aura. However, neither the appendix criteria nor the criteria by Silva-Néto et al. or Wang et al. added any extra patients that would not have been diagnosed by the current diagnostic criteria for migraine. Osmophobia is a valuable symptom that may be useful to differentiate between migraine without aura and tension-type headache in difficult clinical cases.Our results do not suggest that alterations of the current diagnostic criteria for migraine without aura are needed.
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Background According to the I nternational C lassification of H eadache D isorders diagnostic criteria, the differences between migraine and cluster headache ( CH ) are clear. In addition to headache attack duration and pain characteristics, the symptoms accompanying headache represent the key features in a differential diagnosis of these 2 primary headache disorders. Just a few studies of patients with CH exist examining the presence of nausea, vomiting, photophobia, phonophobia, and aura, the features commonly accompanying migraine headache. The aim of this study was to determine the presence of migraine‐like features ( MF ) in patients with CH and establish the significance of these phenomena related to other clinical features and response to treatment. Methods One hundred and fifty‐five patients with CH were studied, and 24.5% of them experienced at least one of MF during every CH attack. Nausea and vomiting were the most frequently reported MF . The clinical presentation between CH patients with and without MF was not significantly different with the exception of aggravation of pain by effort (20.6% vs 4.1%) and facial sweating (13.2% vs 0.85%), both more frequent in CH patients with MF . Conclusion Inferred from the results of our study, the presence of MF in CH patients had no important influence on the diagnosis and treatment of CH patients. The major differences of these 2 primary headache disorders, attack duration, lateralization, and the nature of associated symptoms, as delineated in the I nternational C lassification of H eadache D isorders, are still useful tools for effective diagnosis.
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Background: Migraine is a primary headache disorder. The study was designed to provide a better understanding of the potential role of triggers in the cause of migraine and their impact on its clinical profile and treatment protocol.Methods: A prospective study was conducted between June 2018 to May 2020 in 323 patients suffering from migraine in out-patient department of neurology. Patients were labelled as migraine on the basis of simplified diagnostic criteria for migraine. A structured questionnaire was used to interview patients about triggers and correlated with various clinical variables.Results: All patients had migraine without aura with males 30 (9.3%) and females 293 (90.7%). Episodic migraine found more than chronic daily headache. Trigger factors were present in 234 (72.4%) and absent in 89 (27.6%) patients. Common triggers were hot climate, emotional stress, lack of sleep and fasting. Common foods to precipitate an attack are tomatoes, cheese and collard greens. Mean duration of headache in patients with trigger factors is 5.67±4.99 years with a significant p value (p<0.02). Mean frequency of headache in trigger positive patients is 15.22±8.28 (days/month). Clinical symptoms significant in trigger positive patients are nausea (p<0.0001) (OR=3.94;95% CI=2.02-7.68),vomiting (p=0.0001) (OR=2.62;95% CI=1.50-4.59), photophobia (p<0.0001) (OR=2.69;95% CI=1.56-4.64), phonophobia (p<0.0001) (OR=5.16; 95% CI=2.54-47), pulsating headache (p=0.006) (OR=2.09; 95% CI=1.22-3.56), unilateral location (p<0.0001) (OR=2.88; 95% CI=1.74-4.77).Conclusions: Triggers are not easily modifiable, and avoiding triggers may not be realistic. Healthy life style like exercise, adequate sleep, stress management and eating regularly may prevent triggers and transformation to chronification over time.
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Objective To characterize non-headache symptoms during the migraine attack phase in migraine patients. Methods We enrolled in the present investigation 71 patients with migraine with and without aura who had sought medical treatment in our department from January 2010 to January 2011. We used a self-made migraine questionnaire to investigate associations of the non-headache symptoms with the sociodemographic factors, subtypes, severities and attacks of the headache in the patients. Results There were no significant differences in the number of non-headache symptoms among patients with different ages, genders, education levels, subtypes, severities, mean attack frequencies per month (P＞0.05). The most frequently reported non-headache symptoms were nausea (87.3％),phonophobia (81.7％) and mood change (69.0％).The incidences ofphonophobia,sleep disorder and osmophobia were significantly higher in patients without aura than in patients with aura (P＜0.05).Conclusion Migraine attacks are often accompanied by a variety of non-headache symptoms of which the most frequently reported ones are nausea,phonophobia and mood change.Patients without aura tend to have more phonophobia,sleep disorder and osmophobia than those with aura.
Key words:
Migraine; Non-headache symptom; Mechanism
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Migraine is a primary neurologic headache, often accompanied by nausea, vomiting, photophobia, phonophobia, or vertigo, and may present with or without aura. It is prevalent in 11.7% of Americans with 17.1% in women, and 5.6% in men. Migraine can be acute or chronic. Treatment of this condition includes beta-blockers, anticonvulsants, calcium channel blockers, tricyclic antidepressants, non-steroidal anti-inflammatory drugs, among others. Migraine surgery is indicated when the condition is refractory to medical management.Chronic migraine is defined by the International Headache Society classification of headache disorders (ICHD-3). It is described as: Headache occurring on ≥15 days/month Duration > 3 months Having features of migraine on ≥8 days/month
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Background: Migraine is a form of primary headache, manifested by the recurrent attacks of pulsating headache, mostly associated with nausea, vomiting, photophobia and phonophobia with or without an aura. It is the second most common cause of headache disorder affecting about 12%. In this females are most prone 15% and males are affecting about 6%. On the basis of the symptoms of Ardhavabhedaka, it can be correlated with Migraine. Aim and objectives: To conduct a randomized clinical trial on Kumkumadi Ghrita Nasya and Siravedhana along with Chandrakanta Rasa in the management of Ardhavbhedaka w.s.r. to Migraine. Material and method: Patients attending the O.P.D. and I.P.D. of N.I.A. having the signs and symptoms of Ardhavbhedaka (Migraine) were screened and the diagnosis was achieved on the basis of careful history taking and clinical examination. 30 clinically diagnosed patients of Ardhavbhedaka were registered for trial and they were divided randomly in two groups. Result: Clinical data shows that in Group A effect of therapy on Ardhavbhedhaka is 74.91% and in Group B it is 63.93%; both the results are statistically highly significant at the level of p < 0.001. Conclusion: It can be concluded that clinically Siravedha, Kumkumadi Ghrita Nasya and Chandrakanta Rasa combine work better to manage the Ardhavabhedaka (Migraine)
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