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The co-occurrence of headache and musculoskeletal symptoms amongst 51 050 adults in Norway
European Journal of Neurology
Abstract
Eur J Neurol. 2002;9:527-533.
We have evaluated the association between headache and musculoskeletal symptoms in a large cross-sectional population-based study. Between 1995 and 1997, all 92 566 adults in Nord-Trondelag County in Norway were invited to participate in a health survey. A total of 51 050 (55%) responded to questions concerning headache and musculoskeletal symptoms. Both migraine and non-migrainous headache were strongly associated with musculoskeletal symptoms. However, frequency of headache had a higher impact than headache diagnosis on this association. Thus, the prevalence of chronic headache (headache>14 days/month) was more than four times higher (OR = 4.6; 95% CI 4.0-5.3) in the group of individuals with musculoskeletal symptoms than in those without. Individuals with neck pain were more likely to suffer from headache as compared with those with musculoskeletal symptoms in other restricted areas. In conclusion, there was a strong association between chronic headache and musculoskeletal symptoms, which may have implications for the choice of treatment.
Comment: This study describes an important association between frequent headache and cervical musculoskeletal pain. Further work to explore the relationship between fibromyalgia and headache may help our understanding and treatment of these common and often disabling conditions. DSM
... Neck pain is common in people with primary headaches, both in population-based studies and in the clinic (6)(7)(8)(9)(10). Neck pain may occur as a premonitory manifestation or during the headache phase (11). ...
... Hagen et al. (9) demonstrated that individuals with neck pain were more likely to have migraine and non-migrainous headache compared with individuals with musculoskeletal pain in other areas. In contrast to our findings, the authors did not demonstrate a difference between prevalence of neck pain between individuals with migraine and non-migrainous headache (9). The relationship between TTH and neck/shoulder pain has been studied in children. ...
... Interestingly, the association of neck pain with episodic headache was stronger than with chronic headache in our study. In contrast to our study, previous population-based studies found that higher headache frequency had a higher association with neck/shoulder pain (9). Our finding could be explained by the relatively small sample size. ...
Background
Neck pain is a frequent complaint among patients with migraine and seems to be correlated with the headache frequency. Neck pain is more common in patients with chronic migraine compared to episodic migraine. However, prevalence of neck pain in patients with migraine varies among studies.
Objective
To estimate the prevalence of neck pain in patients with migraine and non-headache controls in observational studies.
Methods
A systematic literature search on PubMed and Embase was conducted to identify studies reporting prevalence of neck pain in migraine patients. This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data was extracted by two independent investigators and results were pooled using random-effects meta-analysis. The protocol was registered with PROSPERO (CRD42021264898).
Results
The search identified 2490 citations of which 30 contained relevant original population based and clinic-based data. Among these, 24 studies provided data eligible for the analysis. The meta-analysis for clinic-based studies demonstrated that the pooled relative frequency of neck pain was 77.0% (95% CI: 69.0–86.4) in the migraine group and 23.2% (95% CI:18.6–28.5) in the non-headache control group. Neck pain was more frequent in patients with chronic migraine (87.0%, 95% CI: 77.0–93.0) compared to episodic migraine (77.0%, 95% CI: 69.0–84.0). Neck pain was 12 times more prevalent in migraine patients compared to non-headache controls and two times more prevalent in patients with chronic migraine compared to episodic migraine. The calculated heterogeneity (I ² values) ranged from 61.3% to 72.0%.
Conclusion
Neck pain is a frequent complaint among patients with migraine. The heterogeneity among the studies emphasize important aspects to consider in future research of neck pain in migraine to improve our understanding of the driving mechanisms of neck pain in a major group of migraine patients.
... In population-based studies and clinics, neck pain is common in persons with primary headaches, both in population-based studies and in the clinic, including migraine, tension-type headaches, and other primary headaches [7,8]. Studies on the association of neck pain in migraine and tension-type headaches are rarely documented. ...
... In a previous study, neck pain was more commonly associated with patients with primary headaches than patients with non-primary. The incidence ranged from 60-70% reported in a previous study which corroborated with the present study with a fraction of 66.4% among the primary headache patients [8]. Though other research teams have mentioned that neck pain is more commonly associated with TTH than migraine, given its hypothesized muscular etiology. ...
Background. The present study aimed to know the association and causal relationship of neck pain with different primary and mixed-type headache disorders. Material and methods. The primary patients with headaches attending the Department of Neurology OPD throughout one-year were included in the study. The demographic features, detailed history of headaches, and the characteristics of neck pain were entered in the pre-designed proforma. With the collaboration of the Department of Neurology, All India Institute of Medical Sciences, Jodhpur, Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow and the Department of Neurology, IMS and SUM Hospital, Bhubaneswar, India. Results. A total of 601 primary headache patients were included in the study, among which a fraction of 66.4% (n=399) had the problem of neck pain either as a pre-disposing event or as a part of the headache. Females were predominately higher than males with a fraction of 67.6%. Among all the patients a fraction of 21% (n=84) had a migraine, 51% (n=203) had a tension-type headache (TTH) and 28% (n=112) had a mixed-type headache. Though several patients with migraine had neck pain as a part of migraine, neck pain was significantly associated with tension and mixed type headache than migraine headache (p<0.001 vs p=0.35). Among the mixed-quality of headaches; chronic TTH (CTTH) with episodic migraine (EM) was most common (54.5%, n=61), followed by CTTH with chronic migraine (CM) at 33% (n=37). Conclusion. The presence of neck pain in migraine headaches showed an increased association with TTH whereas the reverse may not be true. This is yet to prove whether this is a mere association or a causal relationship.
... Neck pain causes a substantial economic burden, attributable to healthcare and insurance costs, decreased work productivity, and work absenteeism [4]. Furthermore, it is associated with myriad other health problems [5], prominently co-morbid headaches [6][7][8], and decreased health-related quality of life [9]. ...
... 8), followed by those with cervicogenic headache (M = 9.3, SD = 6.3), tension-type headache (M = 9.3, SD = 5.9), and those without headache (M = 9.2, SD = 5.7).The number of reported chiropractic visits did not significantly differ by the chiropractor's gender for patients with cervicogenic headache (t(253) = − 0.32, p = .750), tension-type headache (t(253) = − 1.79, p = .075), ...
Background:
Neck pain is a leading cause of individual and societal burden worldwide, affecting an estimated 1 in 5 people aged 70 years and older. The nature and outcomes of chiropractic care for older adults with neck pain, particularly those with co-morbid headaches, remains poorly understood. Therefore, we sought to ascertain: What proportion of Australian chiropractors' caseload comprises older adults with neck pain (with or without headache); How are these conditions treated; What are the reported outcomes?
Methods:
An online survey examining practitioner and practice characteristics, clinical patient presentations, chiropractic treatment methods and outcomes, and other health service use, was distributed to a random nationally representative sample of 800 Australian chiropractors. Quantitative methods were used to analyze the data.
Results:
Two hundred eighty-eight chiropractors (response rate = 36%) completed the survey between August and November 2017. Approximately one-third (M 28.5%, SD 14.2) of the chiropractors' patients were older adults (i.e. aged ≥65 years), of which 45.5% (SD 20.6) presented with neck pain and 31.3% (SD 20.3) had co-morbid headache. Chiropractors reported to combine a range of physical and manual therapy treatments, exercises and self-management practices in their care of these patients particularly: manipulation of the thoracic spine (82.0%); activator adjustment of the neck (77.3%); and massage of the neck (76.5%). The average number of visits required to resolve headache symptoms was reported to be highest among those with migraine (M 11.2, SD 8.8). The majority of chiropractors (57.3%) reported a moderate response to treatment in reported dizziness amongst older adults with neck pain. Approximately 82% of older adult patients were estimated to use at least one other health service concurrently to chiropractic care to manage their neck pain.
Conclusion:
This is the first known study to investigate chiropractic care of older adults living with neck pain. Chiropractors report using well-established conservative techniques to manage neck pain in older adults. Our findings also indicate that this target group of patients may frequently integrate chiropractic care with other health services in order to manage their neck pain. Further research should provide in-depth investigation of older patients' experience and other patient-reported outcomes of chiropractic treatment.
... At one hand, for migraineurs, the occurrence of headache is due to the activation of the trigeminal afferents innervating the pain-sensitive structures, including cranial vessels, dura matter, etc. 13,14 Some researchers suggested that increased attacks and prolonged inputs from the intracranial process could lead to a sensitization of the second-order neurons in the trigeminocervical nucleus receiving cervical input, which may contribute to the clinical phenomena of cervical hypersensitivity. 15,16 However, considering that EM experience a low frequency of headaches, whether this mechanism plays an important role in the presence of neck pain remains unclear. In addition, to date, whether there are differences in characteristics of migraine between EM with neck pain and without neck pain has not been studied. ...
... It was suggested that the increased migraine attacks may lead to the central sensitization, and neck pain could emerge from the sustained central sensitization. 15,16 However, EM experienced a low frequency of headaches, and the mean frequency of migraine in these patients was less than four attacks per month. Moreover, given the fact that two groups had similar profiles regarding headache, the central sensitization may not account for the presence of neck pain in these EM. ...
Purpose: It has been reported that neck pain is more prevalent in episodic migraineurs (EM) than in the general population. Subjects with episodic migraine exhibited widespread hypersensitivity in cranio-cervical region. Our objectives were to explore the potential factors associated with the presence of neck pain for EM, and whether there were differences in pericranial muscle tenderness between EM with and without neck pain.
Patients and methods: Fifty EM with neck pain (34.76±8.04) and 50 age- and sex-matched EM without neck pain (34.26±9.39) were enrolled. The characteristics of headaches and some lifestyle factors were assessed in two groups. The migraine disability score and neck disability index were also recorded. During migraine-free period, cranio-cervical muscle tenderness scores and mechanical pain threshold were assessed for all patients.
Results: There were no significant differences in pain intensity (p=0.44), migraine disability (p=0.71), duration (p=0.44) or frequency (p=0.85) of headache between EM with and without neck pain. The lifestyle factors including smoking, alcohol, coffee, body mass index≧23kg/m², poor sleeping (<8 h/day) and time spent on TV and computers (>2 h/day) were not associated with the presence of neck pain in this study. Compared with EM without neck pain, those with neck pain had higher neck tenderness (p<0.01) and higher cephalic tenderness scores (p<0.01). Neck Disability Index scores were positively correlated with neck and total muscle tenderness scores.
Conclusion: There was a significant difference in cranio-cervical muscle tenderness scores between EM with and without neck pain. For EM, the factors studied in the current research seemed not associated with the onset of neck pain, and further studies including other factors are needed.
... Primary headaches like tension-type headache (TTH) and migraine are associated with various musculoskeletal factors. TTH is, for example, associated with pericranial tenderness, myofascial trigger points and lower muscle coordination of the upper neck flexors (1)(2)(3)(4). Furthermore, migraine may be triggered by myofascial trigger points or bruxism (1,(5)(6)(7). ...
... TTH is, for example, associated with pericranial tenderness, myofascial trigger points and lower muscle coordination of the upper neck flexors (1)(2)(3)(4). Furthermore, migraine may be triggered by myofascial trigger points or bruxism (1,(5)(6)(7). These primary headaches are not caused by musculoskeletal disfunction but are associated with different musculoskeletal symptoms (8). ...
Aim: To systematically review the available literature on the diagnostic accuracy of questionnaires and measurement instruments for headaches associated with musculoskeletal symptoms.
Design: Articles were eligible for inclusion when the diagnostic accuracy (sensitivity/specificity) was established for measurement instruments for headaches associated with musculoskeletal symptoms in an adult population. The databases searched were PubMed (1966-2018), Cochrane (1898-2018) and Cinahl (1988-2018). Methodological quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2) and COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist for criterion validity. When possible , a meta-analysis was performed. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) recommendations were applied to establish the level of evidence per measurement instrument.
Results: From 3450 articles identified, 31 articles were included in this review. Eleven measurement instruments for migraine were identified, of which the ID-Migraine is recommended with a moderate level of evidence and a pooled sensitivity of 0.87 (95% CI: 0.85-0.89) and specificity of 0.75 (95% CI: 0.72-0.78). Six measurement instruments examined both migraine and tension-type headache and only the Headache Screening Questionnaire-Dutch version has a moderate level of evidence with a sensitivity of 0.69 (95% CI 0.55-0.80) and specificity of 0.90 (95% CI 0.77-0.96) for migraine, and a sensitivity of 0.36 (95% CI 0.21-0.54) and specificity of 0.86 (95% CI 0.74-0.92) for tension-type headache. For cervicogenic headache, only the cervical flexion rotation test was identified and had a very low level of evidence with a pooled sensitivity of 0.83 (95% CI 0.72-0.94) and specificity of 0.82 (95% CI 0.73-0.91).
Discussion: The current review is the first to establish an overview of the diagnostic accuracy of measurement instruments for headaches associated with musculoskeletal factors. However, as most measurement instruments were validated in one study, pooling was not always possible. Risk of bias was a serious problem for most studies, decreasing the level of evidence. More research is needed to enhance the level of evidence for existing measurement instruments for multiple headaches.
... For example, the point commonness differs between 6% and 22% and 1-year predominance between 1.5%. 5 Deferent delayed consequences of observational examinations may be a direct result of contrasting differencing of the topic, for example, the neck locale, NP, and the range of pain. Methodological deference, for instance, non-basically indistinguishable masses tests, deferring 835 response rates, and the general idea of the examinations, may similarly cause inclination and explain the irregularities. ...
The background of this study was to determine the predominance of neck pain in the population and to define the variation between studies. Systematically data was collected from following databases PUBMED, PEDro, CINAHL, CIRRIE, NARIC, followed by reference lists of relevant papers. Papers Included for information were of good quality score. Mean value were calculated for day week, month, year, and lifetime), and considered separately for age, gender, quality score, response rate, sample size, anatomical definitions, geography, and publication year. Seventy two papers are taken. Predominant estimates were not changed by age, quality score, sample size, response rate, and different anatomical definitions of NP. NP is a common symptom in the people. As expected, the predominant increase with longer periods and generally women reported more NP.
... NP is highly prevalent in individuals with primary headaches [36], such as migraine and tensiontype headaches, with moderate evidence suggesting the existence of cervical musculoskeletal impairments [37]. Furthermore, the strong association between chronic headache and musculoskeletal symptoms [38], which we aimed to avoid, further supports this notion. Finally, pregnant women or those who gave birth in the last year are excluded to avoid the confounding effects of pregnancy-related NP. ...
Background: Neck pain (NP) is a significant health problem that can lead to pain persistence. Identifying prognostic factors for pain persistence in an acute NP sample might assist in alleviating prolonged pain and disability. Biopsychosocial and clinical factors appear to be adverse solid prognostic factors. Among them, avoidance and overactivity mediate pain persistence and disability. Stress plays a central role in this context, intricately interlinking with persistent pain. Both pain and stress are intricately interconnected processes, serving as adaptive mechanisms to protect the organism from harm. However, in cases of persistent pain, it can be seen as a form of stress overload, indicating a close relationship and the potential for an allostatic overload of the body and brain. Nevertheless, stress and activity patterns such as avoidance and overactivity have yet to be studied as prognostic factors for pain persistence states over one year in subjects with acute NP.
Methods: This longitudinal inception cohort study recruits subjects with acute NP (<4 weeks since the onset of pain) aged 18-65 years in clinical praxis, hospitals, and universities. Activity patterns (Avoidance-Endurance-Fast Screening (AE-FS)) and stress (Stress and Coping Inventory (SCI)) are collected at four different time points. Additionally, hair cortisol concentrations (HCC) are measured to assess stress levels objectively. An online pain diary is maintained, providing information on the progression of pain over a year.
In the initial phase, the prevalence of baseline activity patterns and HCC levels are determined using a cross-sectional design.
As a subsequent step, the pain course over one year is observed. A linear mixed regression model calculates if activity patterns, stress, and pain are prognostic factors for persistent pain and disability at different time points.
Discussion: To the best of our knowledge, this study represents the first investigation of activity patterns in acute NP and if activity patterns, stress, and pain are prognostic factors for persistent pain and disability in acute NP at different time points over one year.
Trial registration: Registration on www.clinicaltrials.gov published 07/22, identifiers: NCT05468684
Keywords: Neck pain, activity patterns, stress, pain, disability
... Ninety-three percent of migraine patients who were evaluated showed signs of at least three musculoskeletal disorders, according to Luedtke et al. (Luedtke et al., 2018); significant differences between healthy controls and patients with episodic or chronic migraine were found by post-hoc analyses. A noteworthy population-based study from Norway discovered a four-fold increase in the prevalence of chronic headache in individuals with musculoskeletal complaints compared to those without them (Hagen et al., 2002). According to Madsen et al., patients with tension-type headache tended to have considerably reduced shoulder abduction muscular strength compared to controls (Madsen et al., 2016). ...
Objectives: To investigate the upper extremity function, muscle strength, endurance, and proprioception in patients with primary headache compared to healthy controls. Materials and Methods: The study was completed with 37 patients with primary headache (22 patients with tension-type headache and 15 patients with migraine) and 36 healthy controls with matched age and gender. Headache severity was evaluated with the Visual Analog Scale (VAS); upper extremity function with Nine-Hole Peg Test (9-HPT); upper extremity isometric muscle strength of shoulder flexor, extensor, and elbow flexor with a hand-held dynamometer; upper extremity endurance with 6-Minute Pegboard and Ring Test (6PBRT); and upper extremity proprioception with shoulder reposition tests using Dualer IQ TM digital inclinometer. Intergroup differences were examined using the Mann-Whitney U Test, and the Spearman correlation analysis was used to ascertain the relationship between the variables in headache groups. Results: There was a significant difference between the results for the 9-HPT, some upper extremity isometric muscle strength tests, 6PBRT, and shoulder reposition tests between patients with tension-type headache, migraine, and healthy controls (p<0.05). Except for the 9-HPT and 6PBRT (r between-0.518 and-0.645; p<0.05 for all), there was no significant relationship between the results for patients with tension type and migraine (p>0.05). Conclusion: Upper extremity function, some upper extremity muscle strength parameters, endurance, and proprioception were decreased in patients with tension-type headache and migraine compared to healthy controls, and upper extremity function was found to be associated with upper extremity endurance in these patients.
... The exact neurobiologic mechanisms underlying neck pain remain incompletely understood. However, there is compelling evidence suggesting a strong association between neck pain and primary headache disorders, particularly migraine and tension-type headache (TTH) (Al-Khazali et al., 2022;Ashina et al., 2015;Calhoun et al., 2010;Fernandez-de-Las-Penas et al., 2010a;Hagen et al., 2002;Hasvold et al., 1996;Kelman 2005;Plesh et al., 2012). It is important to note that migraine and TTH are widespread disorders and collectively account for more years lived with disability than all other neurologic disorders combined (Ashina et al., 2021b(Ashina et al., , 2021cCollaborators 2018aCollaborators , 2020Deuschl et al., 2020). ...
Introduction:
Neck pain is a prevalent neurologic and musculoskeletal complaint in the general population and is often associated with primary headache disorders such as migraine and tension-type headache (TTH). A considerable proportion, ranging from 73% to 90%, of people with migraine or TTH also experience neck pain, and there is a positive correlation between headache frequency and neck pain. Furthermore, neck pain has been identified as a risk factor for migraine and TTH. Although the exact underlying mechanisms linking neck pain to migraine and TTH remain uncertain, pain sensitivity appears to play an important role. People with migraine or TTH exhibit lower pressure pain thresholds and higher total tenderness scores compared with healthy controls.
Purpose:
This position paper aims to provide an overview of the current evidence on the relationship between neck pain and comorbid migraine or TTH. It will encompass the clinical presentation, epidemiology, pathophysiology, and management of neck pain in the context of migraine and TTH.
Implications:
The relationship between neck pain and comorbid migraine or TTH is incompletely understood. In the absence of robust evidence, the management of neck pain in people with migraine or TTH relies mostly on expert opinion. A multidisciplinary approach is usually preferred, involving pharmacologic and non-pharmacologic strategies. Further research is necessary to fully dissect the linkage between neck pain and comorbid migraine or TTH. This includes the development of validated assessment tools, evaluation of treatment effectiveness, and exploration of genetic, imaging, and biochemical markers that might aid in diagnosis and treatment.
... 2 El dolor de cabeza o cefalea se asocia a trastornos musculoesqueléticos; la probabilidad de tener cefalea en quienes tienen un trastorno musculoesquelético es 4.6 veces más (IC del 95%: 4.0 a 5.3) que quienes no lo tienen, siendo los que padecen de dolor cervical los que tienen mayor probabilidad de sufrir algún tipo de cefalea. 3 La comorbilidad entre cefalea y trastorno cervical ha sido estudiada a fin de establecer si existe una relación directa entre la fisiología y biomecánica cervical, sea como mecanismo mediador de las cefaleas o como efecto de ella. En ese sentido, se han encontrado asociaciones entre los puntos gatillo miofasciales y cefaleas, así como patrones alterados de movilidad y postura cefálica como resultado de las mismas. ...
... Neck pain is common global problem with one year period prevalence rate ranging from 4.8% to 79.5% in the general population depending on applied methodology [1][2][3]. Chronic neck pain is associated with substantial disability [3,4] and is associated with both migraine and tension-type headache (TTH) [1,[5][6][7][8][9][10][11]. TTH followed by migraine are the two most common and disabling primary headache disorders [12,13]. ...
Objectives
We aimed to investigate whether coexistent self-reported neck pain influences cephalic and extracephalic pain sensitivity in individuals with migraine and tension-type headache (TTH) in relation to diagnosis and headache frequency.
Methods
A population of 496 individuals completed a headache interview based on ICHD criteria, providing data collected by self-administered questionnaires, assessments of pericranial total tenderness score (TTS) and pressure pain thresholds (PPT). Stimulus-response (SR) functions for pressure vs. pain were recorded. Presence of neck pain in the past year was assessed by the self-administered questionnaire. We categorized participants by primary headache type. We also categorized participants into 3 groups by headache frequency: chronic (≥15) or episodic (<15 headache days/month) headache and controls. TTS, PPTs and the area under the SR curve were compared between subgroups using Generalized Linear Models with pairwise comparisons controlling for age and sex.
Results
Individuals with chronic followed by episodic headache had higher TTS than controls (overall p≤0.001). The difference between chronic and episodic headache subgroups was significant in the group with neck pain (p≤0.001) but not in the group without neck pain. In individuals with neck pain, mean TTS was higher in coexistent headache (migraine and TTH), 23.2 ± 10.7, and pure TTH, 17.8 ± 10.3, compared to pure migraine, 15.9 ± 10.9 and no headache 11.0 ± 8.3 (overall p<0.001). Temporal and finger PPTs did not statistically differ among the chronic headache, the episodic headache and controls in individuals with and without neck pain. Temporalis and trapezius SR-functions showed that tenderness was increased in individuals with chronic headache to higher degree than in those with episodic headache, and more so in those with neck pain.
Conclusions
Coexistent neck pain is associated with greater pericranial tenderness in individuals with chronic headache and to a lesser degree in those with episodic headache. Sensitization may be a substrate or consequence of neck pain and primary headache, but a longitudinal study would be needed for further clarification.
... However, the incidence of tension headache in our study is comparable to the figures for men in Europe (45%) [40]. While seamen´s work involves strenuous physical activity and is often repetitive [24] it is known to give rise to increase incidence of musculoskeletal pain and associated tension headache [42]. ...
Introduction
The working environment abroad a ship is unique, with constant stimuli such as rolling of the vessel, noise, and vibration. Fishing industry is important for Icelandic economy, still the effect of seasickness-related symptoms on seamen´s health is not fully understood. Thus, the objective of this study is to explore the impact of seasickness-related symptoms, i.e., seasickness, seasickness symptoms and mal de débarquement on seaman´s health, and how their working environment may affect those factors.
Methods
Cross-sectional data was collected from 262 seamen answering questionnaire. Majority of the seamen participated while attending a compulsory course held by the Maritime Safety and Survival Training Centre. The majority of participants were men. A chi-square test was used to detect the difference between variables.
Results
The majority of seamen had experienced seasickness (87.8%) or mal de débarquement (85.8%). Having a history of tension headache (38.1%) and tinnitus (37.9%) was quite common. A total of 30.6% of the participants had been admitted to hospital once or more due to mishaps or accidents on land.
Discussion
Seasickness and seasickness symptoms together with mal de débarquement are common in Icelandic seamen. Working conditions at sea are demanding and seam to affect the seamen´s health both at sea and ashore, making further research needed.
... These include head pain produced with neck movement, location of head pain moving from posterior to anterior, and provocation of typical headache by digital pressure on neck muscles [12]. However, these features may not be unique to CGH [13]. ...
Background:
The relative value of clinical tests toward identifying cervicogenic headache (CGH) remains under investigated. Whilst certain physical examination findings have been associated with CGH, consensus on which findings provide the strongest association remains elusive.
Objectives:
To determine which cervical musculoskeletal assessment procedures used in CGH are positively associated with CGH.
Design:
Single blind observational study.
Methods:
Four selected musculoskeletal assessment procedures of the cervical spine, craniocervical flexion test, cervical flexion-rotation test, cervical retraction range of motion and reproduction and resolution of familiar head pain with upper cervical spine sustained joint mobilization, were applied to 20 headache and 20 controls. Inclusion criteria for the headache group met the International Headache Society criteria for CGH except positive diagnostic blocks.
Results:
Upper cervical spine sustained joint mobilization testing associated with reproduction and resolution of familiar head pain was strongly associated with CGH (Odds Ratio = 36, p < 0.01). This was 78% sensitive and 90% specific in identifying CGH. Other physical tests were not statistically associated with CGH.
Conclusions:
Reproduction and resolution of familiar head pain with upper cervical spine sustained joint mobilization is effective in differentiating those with CGH from control participants. Other cervical measures did not clearly identify CGH in this study.
... Contrary to mTMD, which is considered a generalized functional disorder, jTMD is considered more of a localized condition (Furquim et al., 2015). Consequently, studies reporting an association between TMD-related pain and primary headaches have mainly focused on the muscular pain component of the TMDrelated pain (Burnett et al., 2000;Hagen et al., 2002;Leistad et al., 2006;Ebinger, 2006;Blaschek et al., 2012;Watson and Drummond, 2012). The localized nature of jTMD renders it less related to primary headaches, for which generalized mechanisms, such as central sensitization, seem important (Yunus, 2008). ...
This dissertation aimed to study the possible associations of two clinically
assessed signs of TMD-related pain (muscle-related TMD pain [mTMD] and
temporomandibular joint-related TMD pain [jTMD]) with the presence of primary
headaches (migraine and tension-type headaches [TTH]) through cross-sectional
(Study I) and longitudinal (Studies II & III) study designs.
The population of Study I consisted of the Health 2000 Survey participants who
underwent a clinical TMD examination and answered questions related to the
presence and frequency of migraine, as well as the presence of headache
medication consumption, during an interview (n = 5,876). The population of the
Studies II and III was taken from both the Health 2000 Survey (baseline) and the
Health 2011 Survey (follow-up) including participants undergoing clinical TMD
examination at baseline and answering questions about the presence of migraine
and TTH at follow-up (n = 530).
Based on the multivariate, cross-sectional regression analyses, mTMD, but not
jTMD was associated with the presence of migraine (Study I). The results of Study I
also showed that migraine with TMD-related pain was associated with higher
migraine frequency and the presence of headache medication consumption.
Based on the frequentist logistic regression analyses (Study II), no association
between mTMD or jTMD at baseline and the presence of migraine at follow-up was
8
observed (Study II). However, participants with mTMD at baseline had two-times
higher odds for having TTH at follow-up than participants without mTMD at
baseline. Moreover, jTMD at baseline was weakly and inversely associated with the
presence of TTH at follow-up. Sensitivity analyses revealed that the estimates of
these regression analyses were modestly free from unmeasured confounding
effects. Results of Study III (Bayesian logistic regression) suggested that neither
mTMD nor jTMD at baseline were associated with the presence of migraine at
follow-up. However, mTMD at baseline was associated with the presence of TTH at
follow-up. No consistent association was found between jTMD at baseline and the
presence of TTH at follow-up. Bayesian sensitivity analyses revealed that the
estimates of these regression models were stable, demonstrating sufficient validity
and consistency of the effect estimates. The results were quite consistent across
different statistical methodologies, although slightly more precise with the
Bayesian approach.
These results indicate that diverse mechanisms may exist behind the
associations between TMD-related painful conditions and different types of
primary headaches.
Keywords: Epidemiology; Pain; Temporomandibular disorders; Migraine; Tension type
headache; Bayesian statistics; Directed acyclic graphs; Sensitivity analysis
... 4 Many studies have demonstrated a comorbidity between a history of headache and musculoskeletal disorders, such as cervical pain and TMD. [5][6][7][8][9][10] Epidemiologic studies have shown that TMD symptoms are more common in subjects who report primary headaches-such as episodic tension-type headache, migraine, and chronic daily headachecompared to subjects without headaches. 11 This association is bidirectional, with several studies having shown that the majority of TMD patients report headaches. ...
Aims:
To analyze Axis I and II findings of patients diagnosed as having painful temporomandibular disorder (TMD) with headache attributed to TMD (HAattrTMD) in order to assess whether HAattrTMD is associated with a specific Axis I and II profile suggestive of the central sensitization process.
Methods:
This retrospective study included 220 patients with painful TMD divided into those with (n = 60) and those without (n = 160) HAattrTMD, and the patients were compared for Axis I and II results according to the Diagnostic Criteria for TMD (DC/TMD). A P value < .05 was considered statistically significant.
Results:
A total of 27.3% of the patients received a diagnosis of HAattrTMD. Myofascial pain with referral was significantly more common in the HAattrTMD group (P < .001), while local myalgia was significantly more common in the non-HAattrTMD group (P < .001). Characteristic pain intensity was significantly higher in the HAattrTMD group (P = .003), which also showed significantly higher levels of depression (P = .002), nonspecific physical symptoms (P = .004), graded chronic pain (P = .008), and pain catastrophizing (P = .013). Nonspecific physical symptoms were positively associated with HAattrTMD (odds ratio [OR] = 1.098, 95% CI = 1.006 to 1.200, P = .037). Local myalgia was negatively associated with HAattrTMD (OR = .295, 95% CI = 0.098 to 0.887, P = .030).
Conclusions:
Painful TMD patients who report headache in the temple area and are diagnosed as having local myalgia rather than myofascial pain with referral probably do not have HAattrTMD. The diagnosis of HAattrTMD may point to a central sensitization process and possible current/future chronic TMD conditions.
... [51] In research aiming to assess risk factors and correlate with pain, it was shown that chronic headache is 4 times greater in the group of individuals with musculoskeletal symptoms than in those without. [52] It points out to the need for actions focusing on public health policies [53] that contributes to promoting the quality of life of this population, in the sense of collaborating with the promotion of occupational health. It is known that worker's health is a topic that needs to be widely discussed and that the assistance provided to this population must focus from prevention and promotion actions to actions aimed at the control and treatment of health problems that affect them. ...
Musculoskeletal disorders gradually affect workers in different parts of the world, compromising their occupational health and quality of life. Professionals exposed to these symptoms include the motorcycle taxi driver, whose pain is due to the overuse of the musculoskeletal system and little time to recover it.
To identify the prevalence of musculoskeletal symptoms in motorcycle taxi drivers in the city of Rio Branco, Acre, Brazil, West Amazon.
Cross-sectional study, involving 296 motorcycle taxi drivers in the city of Rio Branco-Acre, Brazil, male, from December 2016 to February 2017. The Nordic Musculoskeletal Questionnaire was used to collect information related to symptoms (pain, discomfort, or numbness) in the last 7 days of work. For the exclusion criteria were, being female; not reside outside the city of Rio Branco, Acre; having less than 3 months of work activity; not be carrying out their work activities at the time of application of the protocol; be limited by clinical or physical issues at the time of application of the protocol. The data obtained in the questionnaire were entered into the Epidata program (Epidata Association, Odense, Denmark) and then transferred to the STATA 10 statistical program (Stata Corp., College Station), for categorization and statistical analysis.
The study population is over 36 years old; most reported having a partner and a higher education level. The average daily working hours of the participants were 12 hours, with the majority working over 12 hours daily. Most of the epidemiological variables factors were associated with musculoskeletal pain when the prevalence and prevalence ratio analyzes were performed. Higher prevalence of musculoskeletal symptoms in the lumbar region is with 17.9%. In the lower limbs, the most affected joint was the ankle (5.7%), followed by the hip (5.07%) and knee (5.07%), respectively. Insomnia was present in 55.35% and self-reported headache in 49.4% of participants.
The musculoskeletal disorders generated by the daily service of motorcycle taxi drivers are directly affecting the quality of life of these professionals.
... At the Head HUNT Study in Norway, adults were asked for any headache and musculoskeletal symptom. They found a twofold increase in the prevalence of musculoskeletal symptoms in the population with headache crisis [30]. In our study, 41.2% of the population showed musculoskeletal symptoms as well. ...
Chronic migraine (CM) with medication overuse (MO) develops in patients with a pre-existing primary headache after a regular overuse of symptomatic medication. In these patients, headache crisis may occur together with other painful pathologies which can increase the frequency and intensity of the pain episodes. Such comorbidities need to be assessed as they influence the clinical evolution of the patients. A cohort of 102 patients (89 women and 13 men) with a diagnosis of chronic migraine (CM) with medication overuse (MO) was retrospectively analysed. Patients enrolled in the study were actively followed up 23 months in the Neurology Service of the University Hospital Virgen del Rocío in Seville, Spain. We observed that most of the patients overused multiple symptomatic drugs (34.3%) and NSAIDs (26.5%). In this cohort, the most effective treatments were topiramate and the combination of multiple prophylactic drugs with an effectiveness of 41.6% and 53.8%, respectively, at the end of the study. We observed the ratio of patients reducing their headache crisis was significantly higher among patients abandoning their medication overuse. Detoxification, or withdrawal of medication overuse, is linked to the reduction of the frequency and intensity of 50% or more of the headache crisis in these patients.
... Other chronic physical disorders might be associated with migraine. The Nord-Trøndelag Health Study [25] noted that subjects with headache reported more musculoskeletal pain than other subjects: however, the opposite is true as well, with postural abnormalities more likely to be present in patients who declare to suffer from headache [26]. ...
... Other chronic physical disorders might be associated with migraine. The Nord-Trøndelag Health Study [25] noted that subjects with headache reported more musculoskeletal pain than other subjects: however, the opposite is true as well, with postural abnormalities more likely to be present in patients who declare to su↵er from headache [26]. ...
... [3][4][5] It generally affects individuals in their most economically productive age, between 20 and 55 years, with a two to three times greater prevalence in women than men. 6,7 Overall, migraine has an impressive socioeconomic impact on society due to the deterioration of patients' quality of life, 8 the increase in medical and psychiatric comorbidities, 9,10 medical costs, and loss of productivity representing one of the leading causes of years lost to disability. [11][12][13][14][15] The financial implications of the disease represent also a societal concern with annual costs estimated to be in excess of $20 billion. ...
Objectives:
Migraine is a chronic neurological disorder characterized by recurrent attacks of headache, mainly affecting the working age population with a great socioeconomic impact. The etiology of migraine is still uncertain, and various individual and/or environmental risk factors have been suggested as triggers of the attacks, including irregularities in the sleep-wake rhythm. In this perspective, it is possible that shift and night work, affecting circadian rhythms, may play a key function in the disease pathogenesis. Therefore, aim of this review was to provide an overview on the possible association between shift works and migraine development or clinical outcomes.
Methods:
A systematic review of literature studies available in Pubmed, Scopus, and ISI Web of Science databases, addressing the possible shift work-migraine relationship was performed.
Results:
Conflicting data emerged from the revised studies. Some results supported a positive association between migraine prevalence and shift works, according to peculiar job tasks, seniority in shift works, specific work schedules, and number of night shifts performed in a month. However, other investigations failed to confirm such findings.
Conclusions:
The limited number of available studies, their cross-sectional nature, the different criteria employed for migraine diagnosis, and the various shift work schedules analyzed, together with exposure to other confounding factors on workplace do not allow to extrapolate definite conclusions on shift work-migraine relationship. From an occupational health perspective, further studies appear necessary to better understand such exposure-disease association and possibly define risk assessment and management strategies to protect the health of susceptible and/or migraine affected workers.
... Individuals with musculoskeletal symptoms have been found have headache higher than in those w without by 4 times. (Hagen et al., 2002 ) Diminished cervical ROM in the sagittal plane has been reported in subjects with CGH ( Hall et al.,2004). Flexion is the most affected ROM in patients with CGH (Huber et al., 2013). ...
To Compare the effects of positional release technique (PRT) and post isometric relaxation (PIR) technique for pain, cervical flexion /extension range of motion (ROM) and functional disability in patients with cervicogenic headache (CGH).30 patients were randomly assigned to 2 groups. Group A underwent PRT and group B underwent PIR. Intervention given for 3 weeks. Pain, neck disability index (NDI) and cervical flexion / extension (ROM) were measured after treatment. Both groups showed significant improvement in VAS and NDI. There was non-significant difference between both groups on pain, NDI and flexion cervical ROM; while there was significant difference between both groups on cervical extension in favor to group A .Both treatments were effective in reducing pain and decreasing NDI. There is no significant difference between PRT and PIR on pain, NDI and C flexion ROM while there was significant difference on cervical extension ROM in favor to group (A)
... [6,9]. При увеличении интенсивности и частоты эпизодов боли в шее нарастает головная боль, источниками которой могут быть верхние шейные синовиальные суставы (атлантоокципитальные, латеральные атлантоаксиальные, дугоотростчатые СII-III), связки, сухожилия, межпозвоночный диск CII-III, мышцы (субокципитальная, нижняя задняя шейная, нижняя паравертебральная шейная, трапециевидная, грудино-ключично-сосцевидная) [9,10]. ...
Objective: to comparatively evaluate the clinical efficiency of cervicocranialgia therapy with dexketoprofen (flamadex) and tolperisone (calmyrex), as well as with their combination. Patients and methods. The investigation enrolled 90 patients aged 30–60 years with cervicocranialgia, who were randomized into three equal groups. Group 1 included 7 men and 23 women who took dexketoprofen; Group 2 consisted of 13 men and 17 women who were prescribed dexketoprofen and tolperisone; Group 3 comprised 18 men and 12 women who used tolperisone. The three patient groups underwent assessment of the intensity of pain on a visual analogue scale and the degree of muscle tone on a 3-point scale and evaluation of the efficiency of therapy and the hemodynamic effect of the drugs in the common carotid and vertebral arteries. Results and discussion. In all the groups, their treatment reversed neck pain, headache, and dizziness, normalized muscle tone, and improved hemodynamics in the carotid and vertebral arteries. The effect was more pronounced in patients receiving combination treatment (Group 2). The therapy showed a high safety and a good tolerability. Conclusion. Dexketoprofen and tolperisone have been demonstrated to be effective and safe in treating cervicocranialgia.
... This may be as important a factor for non-migrainous headache [83], but it is not known how this comorbidity influences QoL in other headache disorders. In addition, it has been found, both in Finnish children [84] and in Norwegian adults [85], that headache is also comorbid with other bodily pain. ...
This chapter sets out a multidimensional definition of quality in the context of headache care, along with a related set of quality indicators currently undergoing evaluation. Both were developed for the purposes, inter alia, of guiding implementation of structured headache services in countries that lack them and improving them elsewhere.
... Nevertheless, we cannot rule out the possibility that the analgesics may have been taken because of other painful, not headache-related symptoms. Especially for chronic headache, strong associations to musculoskeletal symptoms and to fibromyalgia have been reported (59,60). It is still unclear whether these relationships are moderated by age. ...
Background: Reliable population-based data on the prevalence and characteristics of primary headache across the lifespan are essential. However, robust data are lacking.
Methods: We utilized questionnaire data from a random general population sample in Germany, that comprised 2,478 participants aged ≥14 years. A standardized questionnaire addressing headache and headache treatment was filled in during the face-to-face survey.
Results: The 6-month prevalence of self-reported headache in the total sample amounted to 39.0% (known diagnosis of migraine 7.2%; tension-type headache 12.4%; another diagnosis or unknown diagnosis 23.4%). Age-specific prevalence rates were 37.9% (14–34 years), 44.6% (35–54 years), 38.5% (55–74 years), and 26.9% (≥75 years). Compared to age group 14–34, participants aged 35–54 were more (OR = 1.29, 95%-CI 1.05–1.60, p = 0.018) and those aged ≥75 were less (OR = 0.55, 95%-CI 0.40–0.76, p < 0.001) likely to have any headache. Of the participants with headache, 79.5% reported headache on <4 days per month, 15.6% on 4–14 days per month and 4.9% on >14 days per month. The frequency of headache did not differ significantly between age groups in men [χ(3, N = 384)2 = 1.45, p > 0.05], but in women [χ(3, N = 651)2 = 21.57, p < 0.001]: women aged ≥75 years were over-represented in the group reporting 4–14 headache days per month. The analgesic use (days per month) differed significantly between age groups among participants with headache on <4 days per month and on >14 days per month: 1.8 (14–34 years), 2.5 (35–54 years), 3.2 (55–74 years), and 3.4 (≥75 years), respectively 7.9 (14–34 years), 11.4 (35–54 years), 18.4 (55–74 years), and 22.8 (≥75 years).
Conclusions: In general, the prevalence of headache decreases with age. However, older women suffer from more frequent attacks and older participants take analgesics on more days per month than younger participants. This might put them at risk of medication overuse which may lead to medication overuse headache. More research is needed to understand these specifics in headache frequency and treatment behavior in older people.
... The relatively low sensitivity in our study may be related to the similarities between FM and CDH. Patients with CDH frequently reported widespread pain, which resembled the FM condition [34,35]. The high prevalence of widespread pain in CDH might have contributed to the imbalanced sensitivity and specificity of the FiRST questionnaire. ...
Background:
Fibromyalgia is a common chronic pain disorder typically associated with headache disorders, particularly chronic daily headache. However, fibromyalgia is typically underdiagnosed and undertreated. The Fibromyalgia Rapid Screening Tool questionnaire is a brief, self-administered questionnaire composed of six "yes/no" questions for detecting fibromyalgia. The Fibromyalgia Rapid Screening Tool questionnaire has demonstrated high sensitivity and specificity among patients with chronic diffuse pain conditions. This study assessed the validity and reliability of the aforementioned questionnaire for detecting fibromyalgia among patients with chronic daily headache.
Methods:
Consecutive first-visit headache patients with primary chronic daily headache (≥15 days/month for three or more months) at the outpatient clinics of four university hospitals were enrolled in this study from April 2015 to October 2015, and the validity and reliability of the Fibromyalgia Rapid Screening Tool questionnaire for determining fibromyalgia were evaluated. Fibromyalgia was diagnosed according to the American College of Rheumatology criteria of 2010.
Results:
A total of 171 patients with primary chronic daily headache were recruited, and 100 (58.4%) were determined to have fibromyalgia. Receiver operating characteristic curve analysis revealed that a cutoff score of 5 (corresponding to the number of positive items) provided the highest rate of correct identification of patients (77.2%), with a sensitivity of 70.0% and specificity of 87.3%. The positive and negative predictive values were 88.6% and 67.4%, respectively. The Cronbach's alpha coefficient was 0.684.
Conclusions:
The Fibromyalgia Rapid Screening Tool is a valid and reliable instrument for identifying fibromyalgia among patients with chronic daily headache.
... Many of them have reported an association of muscle pain with primary headaches, including migraine. [28][29][30][31][32][33][34][35][36][37][38] Apart from masticatory myalgia, migraine (during a nonheadache period) has also been reported to be associated with greater cranial and upper cervical muscle activity, 39 manifested, for example, as neck pain. [40][41][42] Another feature common to both mTMD and migraine is their high prevalence in women. ...
Aims:
To study the possible associations of various clinically assessed painful signs of temporomandibular disorders (TMD) with the presence of migraine using a large population-based dataset.
Methods:
The data were taken from the nationally representative Health 2000 Survey (BRIF8901). The sample consisted of 5,876 adults (age range 30 to 97 years, mean ± standard deviation 52.5 ± 14.8), 5,378 nonmigraineurs and 498 migraineurs. The study participants answered questions concerning migraine presence, migraine frequency, and migraine medication consumption during a home interview. They also underwent a clinical TMD examination.
Results:
Based on the multivariate regression models, painful muscular TMD, but not joint-related TMD, was associated with the presence of migraine (odds ratio [OR] = 1.58; 95% confidence interval [CI] = 1.23 to 2.04; P < .01). Migraine with TMD was associated with increased migraine frequency (daily or a few attacks within a week) (OR = 1.93; 95% CI = 1.27 to 2.93; P < .01) and higher migraine medication consumption (OR = 2.37; 95% CI = 1.43 to 3.92; P < .01).
Conclusion:
According to the results of this study, muscle-related TMD pain is associated with the presence of migraine. Additionally, migraine along with painful TMD signs is associated with increased migraine frequency and migraine medication consumption.
... Neck pain commonly accompanies migraine and tension type headache (TTH) (Ashina et al., 2014;Plesh et al., 2012;Calhoun et al., 2010;Hagen et al., 2002), and patients often seek treatment of the neck as part of headache management (Adams et al., 2013;Moore et al., 2017). Evidence supporting such treatment is limited (Côté et al., 2019). ...
Aims:
Neck pain is common in migraine and tension type headache (TTH). This review aimed to examine the evidence for cervical musculoskeletal impairments in these headaches.
Methods:
Databases PubMed (Medline), EMBASE, CINAHL, SCOPUS, and Web of Science were searched from inception to December 2018. Observational studies using a comparator group were included. Risk of bias was assessed using the Appraisal tool for Cross-Sectional Studies. Results were pooled using random effects meta-analysis. Level of evidence for each outcome was assigned based on risk of bias, consistency of results and magnitude of difference between participants with headache and controls. (PROSPERO registration: CRD42018083683).
Results:
Of 48 studies included, the majority were rated moderate risk of bias due to possible confounding influences. In total, 17 cervical outcomes were assessed, with confidence in findings ranging from very low to moderate levels. Compared to controls, participants with TTH had greater forward head posture (FHP) (MD = -6.18°, 95% CI [-8.18°, -4.18°]) and less cervical range of motion (ROM) (greatest difference transverse plane MD = -15.0°, 95% CI [-27.7°, -2.3°]. Participants with migraine demonstrated minimally reduced cervical ROM (greatest difference sagittal plane MD = -5.4°, 95% CI [-9.9°, -0.9°]. No differences presented in head posture, strength, craniocervical flexion test performance or joint position error between migraineurs and controls.
Conclusions:
TTH presented with more findings of cervical musculoskeletal impairments than migraine however levels of confidence in findings were low. Future studies should differentiate episodic from chronic headache, identify coexisting musculoskeletal cervical disorders, and describe neck pain behaviour in headache.
... Individuals with musculoskeletal symptoms have been found have headache higher than in those w without by 4 times. (Hagen et al., 2002 ) Diminished cervical ROM in the sagittal plane has been reported in subjects with CGH ( Hall et al.,2004). Flexion is the most affected ROM in patients with CGH (Huber et al., 2013). ...
To Compare the effects of positional release technique (PRT) and post isometric relaxation (PIR) technique for pain, cervical flexion /extension range of motion (ROM) and functional disability in patients with cervicogenic headache (CGH).30 patients were randomly assigned to 2 groups. Group A underwent PRT and group B underwent PIR. Intervention given for 3 weeks. Pain, neck disability index (NDI) and cervical flexion / extension (ROM) were measured after treatment. Both groups showed significant improvement in VAS and NDI. There was non-significant difference between both groups on pain, NDI and flexion cervical ROM; while there was significant difference between both groups on cervical extension in favor to group A .Both treatments were effective in reducing pain and decreasing NDI. There is no significant difference between PRT and PIR on pain, NDI and C flexion ROM while there was significant difference on cervical extension ROM in favor to group (A) .
... In the 2015 Global Burden of Disease study, migraine was reported to be 1 of 8 chronic diseases affecting more than 10% of the world population [1], with higher prevalence among women (17%) than men (6%) [2]. Patients with migraine also have higher lifetime rates of depression, anxiety, panic disorder, sleep disturbances, chronic pain syndromes, musculoskeletal symptoms, ischemic stroke (migraine with aura), and suicide attempts [3][4][5][6][7][8][9]. Despite its prevalence, migraine continues to be underdiagnosed and undertreated. ...
Background
Galcanezumab, a humanized monoclonal antibody that selectively binds to the calcitonin gene-related peptide, has demonstrated in previous Phase 2 and Phase 3 clinical studies (≤6-month of treatment) a reduction in the number of migraine headache days and improved patients’ functioning. This study evaluated the safety and tolerability, as well as the effectiveness of galcanezumab for up to 12 months of treatment in patients with migraine.
Methods
Patients diagnosed with episodic or chronic migraine, 18 to 65 years old, that were not exposed previously to galcanezumab, were randomized to receive galcanezumab 120 mg or 240 mg, administered subcutaneously once monthly for a year. Safety and tolerability were evaluated by frequency of treatment-emergent adverse events (TEAEs), serious adverse events (SAEs), and adverse events (AEs) leading to study discontinuation. Laboratory values, vital signs, electrocardiograms, and suicidality were also analyzed. Additionally, overall change from baseline in the number of monthly migraine headache days, functioning, and disability were assessed.
Results
One hundred thirty five patients were randomized to each galcanezumab dose group. The majority of patients were female (> 80%) and on average were 42 years old with 10.6 migraine headache days per month at baseline. 77.8% of the patients completed the open-label treatment phase, 3.7% of patients experienced an SAE, and 4.8% discontinued due to AEs. TEAEs with a frequency ≥ 10% of patients in either dose group were injection site pain, nasopharyngitis, upper respiratory tract infection, injection site reaction, back pain, and sinusitis. Laboratory values, vital signs, or electrocardiograms did not show anyclinically meaningful differences between galcanezumab dosesOverall mean reduction in monthly migraine headache days over 12 months for the galcanezumab dose groups were 5.6 (120 mg) and 6.5 (240 mg). Level of functioning was improved and headache-related disability was reduced in both dose groups.
Conclusion
Twelve months of treatment with self-administered injections of galcanezumab was safe and associated with a reduction in the number of monthly migraine headache days. Safety and tolerability of the 2 galcanezumab dosing regimens were comparable.
Trial registration
ClinicalTrials.gov as NCT02614287, posted November 15, 2015. These data were previously presented as a poster at the International Headache Congress 2017: PO-01-184, Late-Breaking Abstracts of the 2017 International Headache Congress. (2017). Cephalalgia, 37(1_suppl), 319–374.
... The mechanisms associating tenderness in the pericranial muscles to TTH are, to a large extent, still unknown. 9,24,28 One of the proposed mechanisms is central sensitization, which is the result of a period with prolonged nociceptive inputs from the myofascial tissues. 29 Another potential explanation of the association is based on the convergence of afferent nerves from the upper cervical nerves that innervates the trapezius muscle. ...
Objective:
The purpose of the study was to determine the association between trapezius muscle tenderness and tension-type headache among female office workers.
Methods:
Through a questionnaire survey, 256 female office workers with tension-type headaches reported the level of palpable tenderness ("no," "some," or "severe tenderness") in the trapezius muscle. The number of days with headache ("0-7," "8-14," or ">14"), intensity ("low," "moderate," or "high"), duration of headache ("<8 hours per day," ">8 hours per day," and "all day"), and use of analgesic medications were reported. Odds ratio (OR) for tenderness in the trapezius muscle ("no/some" vs "severe tenderness") as a function of days with headache, intensity of headache, duration of headache, and use of analgesic medications were calculated using a binary logistic regression controlling for age and body mass index.
Results:
After adjustments for confounders, a strong association was found between the level of trapezius muscle tenderness and intensity of headache (moderate intensity, OR 2.45; 95% confidence interval [CI] 1.08-5.54; high intensity, OR 7.51 [95% CI 2.65-21.29]) and days with headache (>14 days, OR 4.75 [95% CI 1.41-15.89]). No association was observed for duration of headache or use of analgesic medications.
Conclusions:
For the participants studied, there was a strong association between trapezius muscle tenderness and the level of intensity and the number of days with a headache among female office workers. No association was seen for duration of headaches or use of analgesic medications.
... The relationship between the majority of chronic pain syndromes and migraine, especially CM, is well known. It is reported that this association is observed twice as frequently in CM and that more than 30% of CM patients have back-neck pain, arthritis and joint pain (46). In explaining the comorbidity of painful syndromes, abnormalities of the pain matrix, which involves the cortical and subcortical areas responsible for pain processing, is held responsible rather than a specific pain locus (47). ...
Chronic migraine (CM) is defined as headache occurring on 15 or more days per month for more than three months, which, on at least 8 days per month, has the features of migraine headache. In the International Classification of Headache Disorders, CM is defined as a separate entity and the presence of drug overuse headache is removed from being an exclusion criterion. CM accounts for more than 10% of all migraine patients and includes the group with the most prominent disease-related disability. Diagnosis is often overlooked and most patients do not receive appropriate treatment. CM is associated with social and economic burdens such as frequent use of health services, drug overuse, and significant disruption to work and school life. Compared with episodic migraine, more frequent comorbid disorders are important in migraine chronicity, treatment, and course. With appropriate treatment in CM, it is possible to increase the quality of life of the patient and to reduce the social economic burden associated with migraine. In this review, the disease burden of CM, accompanying comorbid diseases, and current treatment options are reviewed.
... The International Classification of Headache Disorders (ICHD) considers muscle to be relevant in tension-type headache, but does not address its relevance in migraine (Headache Classification Committee of the International Headache, 2013). There have been many studies since the 1970s examining the role of muscle in migraine as well as in tension-type headache, mostly qualitative (Bakal and Kaganov, 1977;Tfelt-Hansen et al., 1981;Bakke et al., 1982;Clifford et al., 1982;Lous and Olesen, 1982;Ahles et al., 1988;Celentano et al., 1990;Lebbink et al., 1991;Jensen et al., 1993;Blau and MacGregor, 1994;Burnett et al., 2000;Hagen et al., 2002;Ebinger, 2006;Leistad et al., 2006;Fernández-de-las-Peñas et al., 2008;Hung et al., 2008;Oksanen et al., 2008;Blaschek et al., 2012;Watson and Head, 2012;Didier et al., 2015;Landgraf et al., 2015). Their conclusions disagree, but many do conclude there is a link between migraine and muscle activation. ...
Objective:
To compare comprehensive measures of scalp-recorded muscle activity in migraineurs and controls.
Method:
We used whole-of-head high-density scalp electrical recordings, independent component analysis (ICA) and spectral slope of the derived components, to define muscle (electromyogram-containing) components. After projecting muscle components back to scalp, we quantified scalp spectral power in the frequency range, 52-98 Hz, reflecting muscle activation. We compared healthy subjects (n = 65) and migraineurs during a non-headache period (n = 26). We also examined effects due to migraine severity, gender, scalp-region and task (eyes-closed and eyes-open). We could not examine the effect of pre-ictal versus inter-ictal versus post-ictal as this information was not available in the pre-existing dataset.
Results:
There was more power due to muscle activity (mean ± SEM) in migraineurs than controls (respectively, -13.61 ± 0.44 dB versus -14.73 ± 0.24 dB, p = 0.028). Linear regression showed no relationship between headache frequency and muscle activity in any combination of region and task. There was more power during eyes-open than eyes-closed (respectively, -13.42 ± 0.34 dB versus -14.92 ± 0.34 dB, p = 0.002).
Conclusions:
There is an increase in cranial and upper cervical muscle activity in non-ictal migraineurs versus controls. This raises questions of the role of muscle in migraine, and the possible differentiation of non-ictal phases.
Significance:
This provides preliminary evidence to date of possible cranial muscle involvement in migraine.
Background
The present study aimed to assess the burden of neck pain in adults with migraine and tension-type headache (TTH), utilizing the Neck Disability Index (NDI) and Numeric Pain Rating Scale (NPRS).
Methods
A systematic literature search was conducted on PubMed and Embase to identify observational studies assessing NDI and NPRS in populations with migraine or TTH. The screening of articles was independently performed by two investigators (HMA and ZA). Pooled mean estimates were calculated through random-effects meta-analysis. The I2 statistic assessed between-study heterogeneity, and meta-regression further explored heterogeneity factors.
Results
Thirty-three clinic-based studies met the inclusion criteria. For participants with migraine, the pooled mean NDI score was 16.2 (95% confidence interval (CI) = 13.2–19.2, I2 = 99%). Additionally, the mean NDI was 5.5 (95% CI = 4.11–6.8, p < 0.001) scores higher in participants with chronic compared to episodic migraine. The pooled mean NDI score for participants with TTH was 13.7 (95% CI = 4.9–22.4, I2 = 99%). In addition, the meta-analysis revealed a mean NPRS score of 5.7 (95% CI = 5.1–6.2, I2 = 95%) across all participants with migraine.
Conclusions
This systematic review and meta-analysis shows a greater degree of neck pain-related disability in migraine compared to TTH. Nevertheless, the generalizability of these findings is constrained by methodological variations identified in the current literature.
BACKGROUND
Endometriosis is a disease among women of reproductive age, which causes several health problems, such as dysmenorrhea, dyspareunia, and subfertility. In addition, it increases psychological stress and often results in marital disharmony. Similarly, migraine is more frequent among this group of women. Several studies have shown an association between endometriosis and migraine among groups of populations completely different from Bangladesh.
OBJECTIVE
This study aimed to identify the association between endometriosis and migraine among the Bangladeshi population.
STUDY DESIGN
This nonrandomized case-control study was conducted with cases of endometriosis and controls without endometriosis who were confirmed by laparoscopy or laparotomy. Among the study participants, cases of migraine in 1 group of respondents who were already diagnosed as patients of migraine were identified, and the others with complaints of headaches were further confirmed by a medicine specialist. Patients were recruited from the Department of Obstetrics and Gynecology at the Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders General Hospital and Ibrahim Medical College. The study was approved by the ethical review committee of the Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders General Hospital. Multivariate logistic regression was used to identify the association between endometriosis and migraine using odds ratios and 95% confidence intervals.
RESULTS
Of 1496 patients who underwent laparoscopy or laparotomy during the study period, the frequency of endometriosis was found to be 12.7%. A total of 190 patients with confirmed endometriosis cases and an equal number of controls without endometriosis were enrolled, maintaining the age distribution of the controls similar to that of the cases. Compared with controls, the distribution of age, body mass index, education, and marital status of the patients with endometriosis were similar. The average ages of respondents were 30.6 years in both the case and control groups. Regarding occupation, cases included more students than controls (12% vs 0%, respectively). The odds of suffering from dysmenorrhea and dyspareunia among the cases were 3.3 (95% confidence interval, 2.66–4.15; P<.001) and 9.5 (95% confidence interval, 5.3–17.9; P<.001) times higher than that of controls, respectively. In addition, the odds of menstrual irregularity was 60% lower among the cases than among controls (odds ratio, 0.4; 95% confidence interval, 0.24–0.64; P<.001). No significant difference was observed in having primary subfertility and secondary subfertility among the 2 groups of respondents. Univariate regression analysis showed that patients with endometriosis have 6.13 times higher odds (95% confidence interval, 2.50–18.40; P<.001) of having a migraine and 2.00 times higher odds (95% confidence interval, 1.2–3.2; P=.01) of having a headache than controls. Furthermore, the age- and body mass index–adjusted multivariate model showed that patients with endometriosis have 5.4 times higher odds of having migraine than patients without endometriosis (95% confidence interval, 2.11–16.4; P<.001). In addition, the higher the age of reproductive-age women, the higher the odds of having migraine. A 1-year increase in age increases the odds of having migraine by 23% (odds ratio, 1.23; 95% confidence interval, 1.13–1.16; P<.001).
CONCLUSION
Our results support the association between endometriosis and migraine among the Bangladeshi population, which is similar to relevant studies conducted in other geographic locations. The groups of physicians who treat patients suffering from the 2 diseases, endometriosis and migraine, should keep this interrelationship in mind to ensure a better quality of life for the patient.
Objective:
To compare socio-demographic, clinical and psychological characteristics and comorbid mental disorders in patients with chronic migraine (CM) and episodic migraine (EM).
Material and methods:
Eighty patients with migraine (40 with CM (16 men and 24 women, mean age 33.5±6.1 years) and 40 with EM (9 men and 31 women, mean age 31.4±5.7 years) were examined. All patients were interviewed and tested with psychometric methods. Socio-demographic and clinical-psychological characteristics were determined in all patients. The psychiatrist assessed the mental status of patients and diagnosed comorbid mental disorders according to the ICD-10 criteria.
Results:
Symptoms of depression, high levels of trait and state anxiety, and a tendency to emotional inadequacy of response were more common in CM patients than in EM patients (p<0.05). Mental disorders, predominantly of the anxiety-depressive spectrum, were more common in CM patients than EM patients (OR (95% CI)=2.54 (2.03 to 2.98, p<0.001). Seventy-five percent of CM patients had more than one psychiatric diagnosis, almost a quarter of CM patients had schizotypal disorder, which is significantly higher than in EM patients (OR (95% CI)=1.99; 1.03 to 2.42, p<0.001). There were more unmarried, single (without constant partner), unemployed, high-education patients in the CM group than in the EM group. The negative impact of headache on the daily activity of patients was significantly higher in the CM group than in the EM group (p<0.05).
Conclusion:
Mental disorders and psychological features (anxiety, depression symptoms, a tendency to emotional inadequacy of response) are more common in CM patients than in EM patients. The presence of these factors may contribute to the chronification of migraine.
Background/purpose:
Headaches are among the most common complaints requiring medical care, and annual expenditures for this condition are estimated to be 14 billion US dollars. The International Headache Society (IHS) describes cervicogenic headache (CGH) as a secondary type of headache emanating from the cervical spine which may be referred to one or more regions of the head and/or face. Mechanical Diagnosis and Therapy (MDT) is an approach shown to be effective in the management of spinal musculoskeletal disorders; however, there is limited evidence as to its efficacy in the management of CGH. The purpose of this case series was to examine the MDT approach in the assessment, classification, and management of a sample of patients experiencing cervicogenic headache.
Case description:
This study was a prospective case series. Following IRB approval, 15 patients meeting the study inclusion criteria were recruited from a hospital-based outpatient physical therapy clinic. All subjects received a physical therapy examination by a Diploma trained MDT clinician which included but was not limited to patient self-report forms and the testing of repeated end range movements. The Numerical Pain Rating Scale (NPRS), Neck Disability Index (NDI), Headache Disability Index (HDI), Yellow Flag Risk Form (YFRF), Cervical Flexion Rotation Test (CFRT), and the Craniocervical Flexion Test (CCFT) were administered at the initial visit, 5th visit, and 10th visit or discharge, whichever occurred first. The NPRS, NDI, and HDI were re-administered at a 3 month follow up. Following the initial examination, patients were classified into the MDT categories of derangement, dysfunction, postural, or 'other' and then received intervention based on directional preference.
Outcomes:
Fifteen subjects (mean age, 45.9 years; F = 11, M = 4; symptom duration, 44.3 months; average visits, 8.8) received an examination and intervention and completed follow-up outcome measures. Based on MDT classification criteria, all 15 subjects in this case series were classified as derangements. A non-parametric Friedman test of Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation differences among repeated measures was conducted on all outcome measures revealing statistically significant improvements in NPRS (p < .01), NDI(p < .01), and HDI (p < .01) scores at visit 10 and 3 month follow up. The mean change scores exceeded the minimal clinical important difference (MCID) for NPRS (4.2), NDI (7.6), and HDI (28.5). CCFT scores improved significantly from the initial examination to visit 5 (p < .01) and YFRF scores improved significantly between visits 5 and 10 (p < .01).
Discussion/conclusion:
The diagnosis of CGH is difficult to determine based on pathoanatomical assessment. This case series suggests that the patient's response to repeated end range movements may indicate a directional preference for manual procedures and exercises which may be used in management of musculoskeletal conditions such as CGH.
Objective:
The aim: To determine the influence of co-occurring neck pain with cervical myofascial dysfunction on the development of psychoemotional disorders and the number of analgesics taken in patients with episodic migraine.
Patients and methods:
Materials and methods: The study included 92 patients, 24 male and 68 female, mean age 42.5±15.5 years. Three groups were identify based on type headache: 1) both episodic migraine and cervicogenic headache with neck pain; 2) episodic migraine only; 3) neck pain only. Visual analogue scale (VAS) for pain syndrome, Migraine Disability Assessment (MIDAS) score, Headache Impact Test (HIT-6), Neck Disability Index, State-Trait Anxiety Inventory (STAI), Beck's Depression Inventory (BDI) and numbers days with analgesics intake were assessment.
Results:
Results: In patients, who suffered on episodic migraine combine with cervicogenic headache and neck pain number days with headache was more (p=0.000052), intensity attack was higher (p=0.003750) and number days with analgesics intake was greater (p=0.000003), compare with group with migraine only. The depression and anxiety state was more significant in patients with migraine and co-occurring neck pain comparable with migraine alone, but we found no significance differences between groups with migraine with neck pain and neck pain only. We observed significant correlation between STAI and Neck Disability Index (r=-0.5155), Neck Disability Index and HIT-6 (r=-0.4819). No correlation found between VAS for migraine, MIDAS and STAI and BDI.
Conclusion:
Conclusions: Our study demonstrate, that co-occurring neck pain in patients with episodic migraine increasing of numbers days with headache, negatively impacts on mood disorders, daily activity and associated with greater acute analgesics use.
Background:
Tension-type headache (TTH) is the most common form of primary headache.
Objective:
The aim of this study was to document and summarize the advances in the understanding of TTH in terms of pathogenesis and management.
Material and methods:
We reviewed the available literature on the pathogenesis and management of TTH by searches of PubMed between 1969 and October 2020, and references from relevant articles. The search terms "tension-type headache", "episodic tension-type headache", chronic tension-type headache, "pathophysiology", and "treatment" were used.
Results:
TTH occurs in two forms: episodic TTH (ETTH) and chronic TTH (CTTH). Unlike chronic migraine, CTTH has been less thoroughly studied and is a more difficult headache to treat. Frequent ETTH and CTTH are associated with significant disability. The pathogenesis of TTH is multifactorial and varies between the subtypes. Peripheral mechanism (myofascial nociception) and environmental factors are possibly more important in ETTH, whereas genetic and central factors (sensitization and inadequate endogenous pain control) may play a significant role in the chronic variety. The treatment of TTH consists of pharmacologic and non-pharmacologic approaches. Simple analgesics like NSAIDs are the mainstays for acute management of ETTH. CTTH requires a multimodal approach. Preventive drugs like amitriptyline or mirtazapine and non-pharmacologic measures like relaxation and stress management techniques and physical therapies are often combined. Despite these measures, the outcome remains unsatisfactory in many patients.
Conclusion:
There is clearly an urgent need to understand the pathophysiology and improve the management of TTH patients, especially the chronic form.
This article begins by presenting basic information about headaches—the headache classification system that is used for diagnosis, the disorders that are frequently comorbid with headaches, the prevalence of headaches, and the impact of headaches on the individual, their family and society. The article proceeds to discuss the triggers of headaches and to present a Functional Model of Primary Headaches that provides a framework for understanding headaches from a psychological perspective. Research on psychological treatments for headaches is reviewed before discussing directions for future research. Finally, guidance is offered for clinicians on psychological assessment and treatment of headaches.
Background:
Cervicogenic headache (CGH) is a secondary headache with a cervical source that radiates pain to the head or face. Accordingly, one reason of CGH is myofascial trigger points. The purpose of this study was to investigate the effect of one session dry needling (DN) of myofascial trigger points of the sternocleidomastoid (SCM) muscle in patients with CGH.
Materials and methods:
In this before-and-after clinical trial, 16 females aged 18-60 years with a clinical diagnosis of CGH were enrolled. All of the patients received one session DN into the myofascial trigger points of the SCM muscle. Headache index (HI), headache duration, headache frequency, and headache disability index (HDI) were assessed at 2 weeks before and 2 weeks after the intervention. This study was registered in Clinical Trials as IRCT20181109041599N1.
Results:
One session DN into myofascial trigger points of the SCM muscle showed a significant improvement in HI (P < 0.001). Duration and frequency of headache as well as HDI significantly reduced after intervention (P < 0.001).
Conclusion:
One session DN into myofascial trigger points of the SCM muscle was effective on improvement of HI, headache duration, headache frequency, and HDI in patients with CGH.
Objective
Being born preterm is related to adverse health effects later in life. We studied whether preterm birth predicts the risk of migraine.
Methods
In this nationwide register study, we linked data from six administrative registers for all 235,624 children live-born in Finland (January 1987 to September 1990) and recorded in the Finnish Medical Birth Register. n = 228,610 (97.0%) had adequate data and were included. Migraine served as primary outcome variable and was stringently defined as a diagnosis from specialised health care and/or ≥2 reimbursed purchases of triptans. We applied sex- and birth year-stratified Cox proportional hazard regression models to compute hazard ratios and confidence intervals (95% confidence intervals) for the association between preterm categories and migraine. The cohort was followed up until an average age of 25.1 years (range: 23.3–27.0).
Results
Among individuals born extremely preterm (23–27 completed weeks of gestation), the adjusted hazard ratios for migraine was 0.55 (0.25–1.24) when compared with the full-term reference group (39–41 weeks). The corresponding adjusted hazard ratios and 95% confidence intervals for the other preterm categories were: Very preterm (28–31 weeks); 0.95 (0.68–1.31), moderately preterm (32–33 weeks); 0.96 (0.73–1.27), late preterm (34–36 weeks); 1.01 (0.91–1.11), early term (37–38 weeks); 0.98 (0.93–1.03), and post term (42 weeks); 0.98 (0.89–1.08). Migraine was predicted by parental migraine, lower socioeconomic position, maternal hypertensive disorder and maternal smoking during pregnancy.
Conclusion
We found no evidence for a higher risk of migraine among individuals born preterm.
Objective: Determine whether common migraine comorbidities affect the efficacy and safety of lasmiditan, a 5-HT1F receptor agonist approved in the United States for the acute treatment of migraine.
Methods: In SPARTAN and SAMURAI (double-blind Phase 3 clinical trials), patients with migraine were randomized to oral lasmiditan 50 mg (SPARTAN only), 100 mg, 200 mg, or placebo. Lasmiditan increased the proportion of pain-free and most bothersome symptom (MBS)-free patients at 2 hours after dose compared with placebo. Most common treatment-emergent adverse events (TEAEs) were dizziness, paraesthesia, somnolence, fatigue, nausea, muscular weakness, and hypoesthesia. Based upon literature review of common migraine comorbidities, Anxiety, Allergy, Bronchial, Cardiac, Depression, Fatigue, Gastrointestinal, Hormonal, Musculoskeletal/Pain, Neurological, Obesity, Sleep, and Vascular Comorbidity Groups were created. Using pooled results, efficacy and TEAEs were assessed to compare patients with or without a given common migraine comorbidity. To compare treatment groups, p-values were calculated for treatment-by-subgroup interaction, based on logistic regression with treatment-by-comorbidity condition status (Yes/No) as the interaction term; study, treatment group, and comorbidity condition status (Yes/No) were covariates. Differential treatment effect based upon comorbidity status was also examined. Trial registration at clinicaltrials.gov: SAMURAI (NCT02439320) and SPARTAN (NCT02605174).
Results: Across all the Comorbidity Groups, with the potential exception of fatigue, treatment-by-subgroup interaction analyses did not provide evidence of a lasmiditan-driven lasmiditan versus placebo differential treatment effect dependent on Yes versus No comorbidity subgroup for either efficacy or TEAE assessments.
Conclusions: The efficacy and safety of lasmiditan for treatment of individual migraine attacks appear to be independent of comorbid conditions.
Objetivo: El objetivo principal fue establecer la prevalencia de dolor de cuello (DC) y de cefaleas (CEF) en la población del Centro Superior de Estudios Universitarios (CSEU) La Salle y como objetivo secundario relacionar ambos dolores con variables psicosociales. Diseño: Estudio observacional descriptivo de corte transversal. Marco: Tanto la recogida de la muestra como el posterior análisis de datos se llevó a cabo en las instalaciones del CSEU La Salle. Participantes: Un total de 303 sujetos, con los siguientes criterios de inclusión: tener entre 18 y 65 años y pertenecer al alumnado, al personal docente e investigador o al personal administrativo del CSEU La Salle en el momento del estudio. La recogida de datos se realizaba de manera presencial en el CSEU La Salle y tenía una duración aproximada de 20 minutos por cada participante. Variables: Las principales variables demográficas a tener en cuenta fueron la edad y el género; y las principales variables de estudio fueron la discapacidad de cuello mediante el Índice de Discapacidad Cervical (IDC), el impacto de las cefaleas en las actividades de la vida diaria (HIT-6), la calidad de vida (SF-12), la ansiedad y la depresión (HADS). Resultados: La prevalencia de DC en el CSEU La Salle es de 5,61%, mientras que la de CEF es del 11,88%. Se obtuvieron diferencias significativas en las puntuaciones del IDC al comparar el grupo CON con el grupo CEF y en el HIT-6 al comparar el grupo CON con el grupo DC (P <0,01). Se obtuvo una correlación negativa alta entre el HAD-AN y el SF-MEN en los grupos CEF (Rho=-0,77; P=0,00) y DC (Rho=-0,82; P=0,00). Conclusión: La prevalencia en el CSEU La Salle de DC fue de 5,61% y la de CEF de 11,88%
Headache epidemiological studies aiming to detect causes of headaches are quite rare compared with those that measure prevalence and burden. The Nord-Trøndelag Health Survey (Helseundersøkelsen i Nord-Trøndelag: HUNT) is a large health survey of all inhabitants in one county, performed in adults in four waves (HUNT1-4) from 1985 to 2019, and in adolescents (Young-HUNT) from 1995. A wide array of health-related data and risk factors have been collected. Questions about headache (migraine and tension-type headache) have been included since HUNT2 in 1995, allowing estimates of associations between headache and putative risk factors both cross-sectionally (in the same study) and longitudinally (in follow-up studies).
A review of all headache epidemiological studies then available was published in 2007. These papers formed the basis for the prevalence calculations in the Global Burden of Disease 2010.
Objectives:
The aim of this study is to evaluate the efficacy of greater occipital nerve (GON) blockage in patients with migraine and fibromyalgia (FM) comorbidity.
Patients and method:
20 patients who were diagnosed as FM according to 2010 American College of Rheumatology (ACR) diagnostic criteria and migraine according to International Classification of Headache Disorers II criteria and did not recieve any medication or GON block for both disorders were included for the study. GON blocks were repeated every week in the first month and repeated montly for the following 2 months. The frequency and duration of the migraine attacks, pain severity with visual analogue scale (VAS), quality of life (QoL) with revised fibromyalgia impact questionnaire (FIQR) and migraine disability assesment questionnaire (MIDAS) before,1 st month and 3rd months after treatment were recorded and compared.
Results:
95% of 20 patients were female (n = 19) and 5% was male (n = 1). The affected site was left in 60% of the patients (n = 12) and 40% was right (n = 8). There was significant improvement in terms of all evaluation parameters both at 1 st month and 3rd months after treatment compared to the baseline. Likely, all parameters were significantly improved at 3rd month compared to the 1 st month.
Conclusions:
GON blockage reduces pain severity, headache frequency and duration and increases QoL in patients with migraine and FM comorbidity.
Chronic daily headache is a group of disorders that are common and seen frequently in the healthcare setting. Along with the disability associated with frequent headaches, chronic daily headache has comorbid conditions that can increase disability and decrease life satisfaction. Understanding and managing these comorbid conditions are important, not only to improve the quality of care we provide to persons with chronic daily headache but to help reduce disability. This chapter will review common comorbidities seen with chronic daily headache such as mood disorders, musculoskeletal disease, head trauma, epilepsy, stroke, sleep disorders, asthma and allergies, thyroid dysfunction, obesity, and cardiovascular disease. We will also highlight potential reasons for the coexistence of these disorders.
In this study, we will propose a density estimation based data analysis procedure to investigate the co-morbid associations between migraine and the suspected diseases. The primary objective of this study has aimed to develop a novel analysis procedure that can discover insightful knowledge from large medical databases. The entire analysis procedure consists of two stages. During the first stage, a kernel density estimation algorithm named relaxed variable kernel density estimation (RVKDE) is invoked to identify the samples of interest. Then, in the second stage, a density estimation algorithm based on generalized Gaussian components and named G²DE is invoked to provide a summarized description of the distribution. The results obtained by applying the proposed two-staged procedure to analyze co-morbidities of migraine revealed that the proposed procedure could effectively identify a number of clusters of samples with distinctive characteristics. The results further revealed that the distinctive characteristics of the clusters extracted by the proposed procedure were in conformity with the observations reported in recently published articles. Accordingly, it is conceivable that the proposed analysis procedure can be exploited to provide valuable clues of pathogenesis and facilitate development of proper treatment strategies.
The relation between musculoskeletal pain and sickness absence was tested in an adult county population. Maximal explained variance in absence from work due to chronic musculoskeletal pain (sickness absence) was tested in a model in which subjective health was expected to mediate the associations between such pain and dysphoria, respectively, and work efficacy. In turn, work efficacy was expected to mediate the link between subjective health and sickness absence. All the residents in the County of Nord-Trøndelag, Norway, aged 20 and older, were invited to take part in a public health survey during 1995-97 (HUNT-2), and 66,140 (71.2%) participated. Prevalence of musculoskeletal pain, dysphoria, subjective health and work efficacy were assessed, as well as sickness absence last year due to musculoskeletal pain. The model test was performed by use of the LISREL procedure based upon data from 30,158 employees reporting chronic musculoskeletal pain last year. The measurement model fitted the data well: χ ² = 9075, df = 52, p < .0004, Critical N = 1041, RMSEA = 0.038, CFI = 0.99, SRMR = 0.020. The structural model fitted the data equally well, and the best prediction of sickness absence was obtained with lower back pain, upper and lower extremity pain, as well as dysphoria as the primary variables affecting subjective health that, in turn, was the convergent predictor of work efficacy that, finally, best explained the variance in sickness absence (56%). The data supported an indirect sequence of complaint-health-efficacy (CHE-model) as the best predictor of sickness absence due to musculoskeletal pain.
In an attempt to survey the prevalence of musculoskeletal symptoms in the Icelandic population, this study was carried out on a random sample of men and women of the ages 16 to 65 years. The aims were to gather reference material for future use as a basis for comparison with results from different subgroups of the working population. The cohort comprised 855 subjects, 421 men and 434 women. The questionnaires used had been developed by a working group supported by the Nordic Council of Ministers. The participation rate was 73.5 per cent. The highest prevalence of symptoms during previous 12 months was that for symptoms are reported by the men from the neck, shoulders, lower back and head. The prevalence of symptoms in each region differed considerably between age groups. We are not aware of any other study performed with such questionnaires on a representative national sample. In this sample, the prevalence of symptoms was high in both sexes, as compared to those prevalences found in a variety of Swedish populations representing a vide range of occupations and work tasks.
To study the pattern of association of background factors with reported migraine, non-migrainous headache, and neck or shoulder pain.
In a cross-sectional survey the population of the municipality of Tromsø between 20 and 56 years of age was screened for risk factors of different diseases. Everybody attending the screening was given a questionnaire on psychosocial, lifestyle, and health factors. The odds ratios of reporting migraine, non-migrainous headache, and neck or shoulder pain were estimated by logistic regression for several background factors.
A population-based study conducted in the municipality of Tromsø, northern Norway.
In a survey of risk factors for diseases in 1987/86, all the subjects between 20 and 56 years of age in the municipality of Tromsø were invited. The attenders were given a questionnaire about lifestyle, health, and psychosocial factors. Of the 18105 people who were given a questionnaire, 8537 men and 9162 women (97.7%) answered the questions about "non-migrainous headache", 8533 men and 9117 women (97.5%) answered the questions about neck or shoulder pain, and 8024 men and 7690 women (86.8%) the questions about migraine.
"Self estimated health" had the strongest association with all three target conditions although the strength of the association between headache and neck or shoulder pain was far higher than that of migraine. The reporting of headache and neck or shoulder pain was associated with psychosocial factors, in contrast to migraine. The less educated women were prone to both headache and neck or shoulder pain, while there was no association between migraine and length of education. The explored lifestyle factors were not associated with any of the target conditions.
Our findings underscore that migraine is reported by people with psychosocial backgrounds other than those of people who report chronic headache and neck or shoulder pain.
Efforts to understand or to monitor upper-extremity musculoskeletal disorders among workers have usually involved the use of questionnaires. The goal of this study was to assess the test-retest reliability of an upper-extremity discomfort questionnaire among industrial workers.
Test-retest agreement among 148 workers was analyzed using the kappa coefficient for categorical outcomes. Values of kappa greater than 0.75 are considered excellent, values between 0.40 and 0.75 are fair to good, and values of less than 0.40 represent poor agreement beyond chance alone. Test-retest results of continuous measures (eg, visual analogue scale responses) were compared with paired t-tests.
The test-retest reliability of the questionnaire used to elicit demographic information, medical history, exercise participation, and information on musculoskeletal symptoms among industrial workers appears to be good to excellent in most instances.
These results suggest that most results of this discomfort questionnaire are reliable and suitable for use in epidemiologic studies. For reassurance of the robustness of these findings, similar studies should be carried out in other worker populations with this, and other, questionnaire instruments.
We studied the associations between psychosocial variables and sick-leave among patients with musculoskeletal pain. Patients (n = 586) seeking care to relieve their pain at health care and physiotherapy centres, completed a questionnaire about such variables as clinical characteristics (e.g. pain intensity), psychological well-being (e.g. burnout, depression) and coping strategies. The results show that the patients who had been on sick-leave for >30 days (n = 217), were significantly more often divorced, immigrants, blue-collar workers and less educated than the rest of the sample. Compared with the rest of the patients, they rated their pain as significantly more severe, frequent, complex and functionally impairing. They reported using more pain medication and tranquillizers, and having undergone more somatic treatments. These patients also showed higher scores on job strain, more symptoms of burnout, anxiety/depression and posttraumatic stress reactions, and poorer coping capacity. Logistic regression analyses revealed that an index related to perceived disability was a major predictor of sick-leave within the group. After controlling for possible confounders, multivariate regression analyses showed that the strongest predictors of the disability index were symptoms of burnout and posttraumatic stress reactions. The results confirm that emotional distress, coping style and perceived disability are associated with sick-leave, after controlling for pain parameters and sociodemographic variables. The high levels of emotional distress and the poor coping capacity reported by the patients with a long history of absence due to illness suggest that cognitive behavioural interventions ought to be integrated in the treatment of musculoskeletal pain.
A multicenter study was carried out in 10 Italian Headache Centers to investigate the prevalence of psychosocial stress and psychiatric disorders listed by the IHS classification as the “most likely causative factors” of tension-type headache (TTH). Two hundred and seventeen TTH adult outpatients consecutively recruited underwent a structured psychiatric interview (CIDI-c). The assessment of psychosocial stress events was carried out using an ad hoc questionnaire. The psychiatric disorders that we included in the three psychiatric items of the fourth digit of the IHS classification were depressive disorders for the item depression, anxiety disorders for the item anxiety, and somatoform disorders for the item headache as a delusion or an idea. Diagnoses were made according to DSM-lll-R criteria. At least one psychosocial stress event or a psychiatric disorder was detected in 84.8% of the patients. Prevalence of psychiatric comorbidity was 52.5% for anxiety, 36.4% for depression, and 21.7% for headache as a delusion or an idea. Psychosocial stress was found in 29.5% of the patients and did not differ between patients with and without psychiatric comorbidity. Generalized anxiety disorder (83.3%) and dysthymia (45.6%) were the most frequent disorders within their respective psychiatric group. The high prevalence of psychiatric disorders observed in this wide sample of patients emphasizes the need for a systematic investigation of psychiatric comorbidity aimed at a more comprehensive and appropriate clinical management of TTH patients.
This study compared the psychological functioning of 275 individuals requesting outpatient treatment for one of five chronic pain syndromes: tension headaches, backaches, migraine headaches, temporomandibular pain, and gastrointestinal pain syndromes. The measure used to assess psychological functioning was the SCL-90. Results show a continuum of acknowledged psychological distress among the groups, with the least amount reported by temporomandibular joint pain patients, and the greatest degree of psychological disturbance reported by the gastrointestinal pain patients. Between these two groups were the migraine patients, backache patients, and the tension headache patients, ranging in this sequence from the low to the higher end of reported psychological symptoms. Demographic and health utilization data, along with duration of pain and referral mechanisms, are also reported for each of the groups.
The co-occurrence of chronic low back pain and headache was examined in a sample of 227 patients referred to a multidisciplinary pain treatment program. Over 60% of the patients who reported chronic low back pain also reported concomitant headache, although only 24.8% of these patients reported a history of headache prior to the onset of low back pain. Discriminant analysis performed on a random half of the subject sample (n = 119) indicated that chronic low back pain patients with concominant headache dif- fered significantly from pain patients without headache on Minnesota Multi- phasic Personality Inventory (MMPI) scales hypochondriasis (Hs), depression (D), hysteria (Hy), and overall impairment as measured by the Sickness Im- pact Profile. Twenty percent of the variance in the discriminant scores was attributable to the difference between groups. Approximately 65% of the cases were classified correctly based upon the discriminant function scores, which was replicated on the remaining subsample of patients (n = 108). There was no significant difference in behavioral pain treatment outcome between patients with vs. without headache.
(C) Lippincott-Raven Publishers.
This study investigated headache parameters (frequency and intensity) in relation to (the number and severity of) two types of psychosocial stress: major life events (as assessed by a revised Social Readjustment Rating Scale) and minor daily hassles (as assessed by a revised Hassles Scale). Subjects were 261 volunteers reporting headache. Results revealed that both headache frequency and intensity were significantly predicted by daily hassles, in particular, the average severity of these hassles, but there was a negligible relationship between headache parameters and any of the life event measures. Furthermore, a significant relationship emerged between life events and daily hassles themselves. This fits with recent findings that life events (while exerting little direct effect on headache) may trigger a succession of hassles which culminate in headaches. Also, it is not the number of hassles, but the perceived severity of these hassles that best predicts headache frequency and intensity. Finally, though significant as predictors, daily hassles explained a small portion of the variance in headache, thus pointing to the host of other possible biological and psychosocial contributions to headache.
Recent studies have indicated that muscular disorders may be of importance for the development of increased pain sensitivity in patients with chronic tension-type headache. The objective of the present study was to investigate this hypothesis by examining the pain perception in tension-type headache with and without muscular disorders defined as increased tenderness. We examined 28 patients with episodic tension-type headache, 28 patients with chronic tension-type headache, and 30 healthy controls. Pericranial myofascial tenderness was recorded with manual palpation, and pressure pain detection and tolerances in cephalic and extracephalic locations with an electronic pressure algometer. In addition, thermal pain sensitivity and electromyographic activity were recorded. The main result was significantly lower pressure pain detection thresholds and tolerances in all the examined locations in patients with chronic tension-type headache with a muscular disorder compared to those without a muscular disorder. There were no such differences in any of the examined locations when the two subgroups of patients with episodic tension-type headache were compared. Thermal pain sensitivity did not differ between patients with and without a muscular disorder, while electromyographic activity levels were significantly higher in patients with chronic tension-type headache with than in those without a muscular disorder. Our results strongly indicate that prolonged nociceptive stimuli from the pericranial myofascial tissue sensitize the central nervous system and, thereby, lead to an increased general pain sensitivity. Muscular factors may, therefore, be of major importance for the conversion of episodic into chronic tension-type headache. The present study complements the understanding of the important interactions between peripheral and central factors in tension-type headache and may lead to a better prevention and treatment of the most prevalent type of headache.
SYNOPSIS
This study investigated the relationship between minor life events (i.e. daily hassles) and personality patterns from selected scales of MMPI in the persistence of primary headache in 83 patients. Comparisons between headache subgroups indicated that tension-type headache patients are much more likely than those with migraine to have experienced high level of microstress (hassles density),with mixed headache in between. Tension-type headache patients reported higher MMPI scores on scales 1, Hypochondriasis (somatic concern), scale 3, Hysteria (denial) and scale 7, Psychasthenia (anxiety), but not on scale 2 (Depression), than migrainous patients. In addition, individuals with high level of microstress appeared to be more depressed and anxious than low-stress headache patients, scoring significantly higher on MMPI scales 2 (Depression) and 7 (Psychasthenia). As no significant differences due to sex, age, headache history and status, except for the headache density (i.e. severity x frequency) appeared, it is likely that high-stress levels are due, at least in part, to greater density of pain, rather than to discrete headache syndromes.
Our findings support the notion that depressed mood and anxiety may account for a third intervening variable in the relationship between chronic headache and life stress.
In a questionnaire survey we determined the prevalence and intensity of muscular symptoms in a group of chronic headache sufferers as compared with age- and sex-matched controls. The muscular symptoms studied were tightness and soreness of the neck, shoulder, and jaw muscles. Muscle tightness was reported significantly more frequently in the headache than in the control group, but only for the neck muscles (48.6 vs. 29.9%; p less than 0.01). When headache was present, the prevalence of neck muscle tightness in the headache group significantly increased further to 68.8% (p less than 0.001) and that of jaw muscle tightness increased significantly from 17.2 to 29.7% (p less than 0.01). The intensity of muscle tightness was again only significantly different between the headache and the control groups for the neck muscles (p less than 0.01). However, it was significantly higher for all three muscle groups in the headache group when headache was actually present than when headache was absent (p less than 0.001). With regard to the prevalence of muscle soreness, there were no significant differences between the headache and the control groups or within the headache group when headache was absent or present. However, the intensity of muscle soreness was significantly greater for all three muscle groups in the headache group when headache was present than when headache was absent (p less than 0.001). The results indicate significant muscular symptoms in relation to headache, particularly in relation to the neck muscles, with tightness standing out more than soreness.
We present the first prevalence study of specific headache entities using the operational diagnostic criteria of the International Headache Society. One thousand 25-64 year old men and women, who lived in the western part of Copenhagen County were randomly drawn from the Danish National Central Person Registry. All subjects were invited to a general health examination focusing on headache and including: a self-administered questionnaire concerning sociodemographic variables, a structured headache interview and a general physical and neurological examination. The participation rate was 76%. Information about 79% of the non-participants showed a slightly differing headache prevalence which was not quantitatively important. The following results in participants are therefore representative of the total sample. The lifetime prevalences of headache (including anybody with any form of headache), migraine, and tension-type headache were 93, 8 and 69% in men; and 99, 25 and 88% in women. The point prevalence of headache was 11% in men and 22% in women. Prevalence of migraine in the previous year was 6% in men and 15% in women and the corresponding prevalences of tension-type headache were 63 and 86%. Differences according to sex were significant with a male: female ratio of 1:3 in migraine, and 4:5 in tension-type headache. The prevalence of tension-type headache decreased with increasing age, whereas migraine showed no correlation to age within the studied age interval. Headache disorders are extremely prevalent and represent a major health problem, which merits increased attention.
The frequency of precipitation of headache attacks by individual emotional states as well as the awareness of vulnerability to particular emotional precipitants were investigated in 90 consecutive patients with tension-type headache and 50 consecutive migraine subjects at an Outpatient Headache Clinic. There was differential emotional precipitation in tension-type headache and migraine, with patients with tension-type headache reacting more selectively to negative emotional arousal (anger, anxiety) and reporting a graded frequency of attack precipitation by individual emotional states. Migraine subjects reported a more uniform distribution of attacks among different emotional precipitants. The two groups also showed a differential awareness of vulnerability to individual emotional precipitants. A cognitive process screening the emotional precipitants of tension-type headache and migraine attacks is proposed, based on different cognitive schemata functioning either over-effectively or defectively. The significance of cognitive mediation of the precipitation of attacks is further emphasized for a comprehensive management of both tension-type headache and migraine.
SYNOPSIS
The occurrence of headache as a sequela of low back pain was examined in a sample of chronic pain patients. All patients had low back pain without history of head, neck, or upper back injury or headache onset simultaneous with the low back pain, Consistent with prior research, headache was found to be a common concomitant of back pain. In many patients, headache was found to have begun or exacerbated markedly after onset of low back pain. Prevalence of migraine in female patients was significantly higher than the population prevalence for females in the United States; this was not true for male patients. Potential mechanisms for explaining the high prevalence of migraine following low back pain are discussed, including increased muscle tension, psychosocial factors, and analgesic overuse.
SYNOPSIS
In this prospective controlled study, thirty-seven migraine and/or tension headache patients andthirty-seven age and sex matched controls were examined for evidence of muscuIoskeletal dysfunction inthe neck. The examination consisted of clinical range of motion testing of neck rotation, sidebending,flexion and extension while in the sitting position. The headache group had more abnormal physicalfindings than the control group. Although the difference for each particular motion test, taken by itself, wasnot statistically significant, two or more abnormalities in combination was found to reach a .05 confidencelevel of significance. It is proposed therefore that musculoskeletal dysfunction of the neck is a contributingfactor to the etiology of migraine and tension headache.
The aim of the present study was to investigate the stimulus-response function for pressure versus pain in patients with myofascial pain. Forty patients with chronic tension-type headache and 40 healthy controls were examined. Tenderness in 8 pericranial muscles and tendon insertions was evaluated by manual palpation with a standardized evaluated methodology. Thereafter, a highly tender muscle and a largely normal muscle were palpated with 7 different pressure intensities using a palpometer, and the induced pain was recorded by the subjects on a visual analogue scale blinded for the observer. Pericranial myofascial tenderness was considerably higher in patients than in controls (P < 0.00001). The stimulus-response function recorded from normal muscle was well described by a power function. From highly tender muscle, the stimulus-response function was displaced towards lower pressures and, more importantly, it was linear, i.e., qualitatively different from normal muscle. Our results demonstrate for the first time that nociceptive processes are qualitatively altered in patients with chronic myofascial pain and suggest that myofascial pain may be mediated by low-threshold mechanosensitive afferents projecting to sensitized dorsal horn neurons. Further investigations of these mechanisms may lead to an increased understanding and better treatment of these common and often incapacitation pain disorders.
To investigate the perception of pain in tender muscles of patients with fibromyalgia.
Twenty-five women with fibromyalgia and 25 healthy women were examined. Seven different pressure intensities were used to palpate a highly tender muscle and a largely normal muscle. Subjects then recorded their response to induced pain on a visual analog scale. The examiner was blinded to each subject's response.
The stimulus-response function for pressure versus pain recorded for normal muscle was well described by a power function. For highly tender muscle, the stimulus-response function was displaced toward lower pressures and, more importantly, it was linear, i.e., qualitatively different from that of normal muscle.
This study demonstrates that nociception is qualitatively altered in patients with fibromyalgia, which is consistent with recent findings in other patients with tender muscles. The data strongly indicate that fibromyalgic pain, at least in part, is due to aberrant central pain mechanisms.
The main purpose of this study was to assess neck mobility (by Cybex equipment) in different headache disorders and, in particular, cervicogenic headache, and to compare these findings with those in controls. A total of 51 control subjects and 90 headache patients were investigated, where of 28 patients suffered from common migraine (migraine without aura), 34 from tension-type headache (9 episodic and 25 chronic), and 28 patients from cervicogenic headache. One-way ANOVA and post hoc Bonferroni analysis showed significant differences between those with cervicogenic headache and the other groups for rotation (P < 0.001) and flexion/extension (P < 0.001), but not for lateral neck movement (P = NS). There were no significant differences between migraine patients, tension-type headache patients, and controls. In all four groups, there was a significant positive correlation between active and passive neck movement for rotation (P < 0.001), flexion/extension (P < 0.001), and lateral neck movement (P < 0.001). Repeated measures analysis of variance (ANOVA) showed no significant day-to-day differences in 10 control subjects. In the control group (n = 51), there was a significant negative correlation between age and neck movement. For rotation, Pearson's correlation coefficient was; r = -0.71 (P < 0.001), for flexion/extension r = -0.71 (P < 0.001), and for lateral neck movement r = -0.67 (P < 0.001). No significant sex difference was found as for any of the neck movements. Pain at the time of investigation did not seem to influence neck mobility. Cervicogenic headache has been recognized as a pain syndrome by the International Association for the Study of Pain (IASP). Since reduced neck mobility is one of the major criteria for this diagnosis, it emphasizes the need for systematic, objective neck mobility measurements in the individual patient to substantiate the diagnosis. The technique is simple and proved reliable.
The aim of the present study was to examine the ability of pericranial muscle tenderness and the second exteroceptive suppression period to distinguish chronic tension-type headache sufferers, migraine sufferers, and controls in a young adult population utilizing a blind design. The second exteroceptive suppression periods were assessed using the methodology recommended by the European Headache Federation and were scored with an automatec computer software program designed in our laboratory to provide reliable, standardized, and precise quantification of exteroceptive suppression periods and eliminate any influence of experimenter bias that may occur with manual scoring.
Our sample consisted of 45 subjects diagnosed according to IHS criteria: 25 with chronic tension-type headache and 20 with migraine without aura. Twenty-three headache-free controls were recruited. Consistent with our previous findings, abnormalities in pericranial muscle-tenderness, but not in the second exteroceptive suppression period distinguished chronic tension-type headache sufferers from controls. The chronic tension headache sufferers exhibited the highest pericranial muscle tenderness and the control group exhibited the lowest tenderness (p<.001). Pericranial muscle tenderness was quite successful in distinguishing recurrent headache sufferers from controls, but failed to distinguish chronic tension-type headache sufferers from migraineurs. Our findings raise the possibility that pericranial muscle tenderness is present early in the development of chronic tension-type headache and migraine without aura, and thus might contribute to the etiology of headache disorders. Our findings also indicate that a shortened second exteroceptive suppression period is not a reliable marker for chronic tension-type headache in young adults.
A multicenter study was carried out in 10 Italian Headache Centers to investigate the prevalence of psychosocial stress and psychiatric disorders listed by the IHS classification as the "most likely causative factors" of tension-type headache (TTH). Two hundred and seventeen TTH adult outpatients consecutively recruited underwent a structured psychiatric interview (CIDI-c). The assessment of psychosocial stress events was carried out using an ad hoc questionnaire. The psychiatric disorders that we included in the three psychiatric items of the fourth digit of the IHS classification were depressive disorders for the item depression, anxiety disorders for the item anxiety, and somatoform disorders for the item headache as a delusion or an idea. Diagnoses were made according to DSM-III-R criteria. At least one psychosocial stress event or a psychiatric disorder was detected in 84.8% of the patients. Prevalence of psychiatric comorbidity was 52.5% for anxiety, 36.4% for depression, and 21.7% for headache as a delusion or an idea. Psychosocial stress was found in 29.5% of the patients and did not differ between patients with and without psychiatric comorbidity. Generalized anxiety disorder (83.3%) and dysthymia (45.6%) were the most frequent disorders within their respective psychiatric group. The high prevalence of psychiatric disorders observed in this wide sample of patients emphasizes the need for a systematic investigation of psychiatric comorbidity aimed at a more comprehensive and appropriate clinical management of TTH patients.
The goal of the present study was to investigate the clinical profile of patients with primary headache syndromes who also suffer from mood disorders. Four-hundred-and-seventy headache outpatients (170M, 300F) and 150 age- and sex-matched healthy subjects were screened using a specific questionnaire that included the Hamilton rating scales for anxiety and depression. The average scores of the Hamilton rating scales for anxiety and depression were significantly higher in headache sufferers (17.4 and 14.2, respectively) than in healthy people (6.8 and 5.7, respectively). The frequency of headache attacks, the history of headaches, and gender (women more than men) were correlated with the score of the Hamilton rating scale for both anxiety and depression. Sixteen headache patients (3.4%) achieved the DSM-IV criteria for major depression or dysthymia versus one among headache-free subjects (0.6%; OR 5.2). Patients suffering from drug-overuse and migraine with aura showed the higher odds ratios (35 and 17, respectively). These results suggest that those headache patients with long history and high frequency of headaches, or patients suffering from migraine with aura and drug-overuse might benefit from psychiatric evaluation.
The repeatability and validity of a questionnaire for upper limb and neck complaints were assessed in a population of 105 hospital outpatients with a range of upper limb and neck disorders (including cervical spondylosis, adhesive capsulitis, lateral epicondylitis, carpal tunnel syndrome and Raynaud's phenomenon). Subjects were asked to complete a modified Nordic-style upper limb and neck discomfort questionnaire on two occasions closely spaced in time. The repeatability of their responses was assessed by calculating a kappa coefficient (kappa), and the sensitivity and specificity of component items in the questionnaire were determined for specific diagnostic categories of upper limb and neck disorder. Symptom reports for pain in the upper limb and neck, pain interfering with physical activities, neurological symptoms and blanching were all found to be highly repeatable (kappa = 0.63-0.90). A number of regional pain reports proved to be very sensitive in relation to specific upper limb disorders, but, with the exception of reported finger blanching in patients with Raynaud's phenomenon, none proved to have a good specificity (range = 0.33-0.38). We conclude that a modified Nordic-style questionnaire is repeatable and sensitive, and is likely to have a high utility in screening and surveillance. However a complementary examination schedule of adequate specificity and repeatability is essential to establish a clinical diagnosis.
We have assessed the validity and reliability of a self-administered headache questionnaire used in the 'Nord-Trøndelag Health Survey 1995-97 (HUNT)' in Norway, by blindly comparing questionnaire-based headache diagnoses with those made in a clinical interview of a sample of the participants. Restrictive questionnaire-based diagnostic criteria for migraine, assessed according to modified criteria of the International Headache Society, performed excellently in selecting 'definite' migraine patients (100% positive predictive value). The best agreement concerning migraine diagnoses was achieved by using a liberal set of criteria (kappa 0.59). Similar agreement was found evaluating patient status as headache sufferers, and as sufferers from frequent headaches (>6 days per month) (kappa 0.57 and 0.50, respectively). The kappa values of non-migrainous headache and chronic headache (> 14 days per month) were 0.43 and 0.44, respectively. The results suggest that our self-administered questionnaire may be suitable in identifying a population with 'definite' migraine, and the questionnaire is an acceptable instrument in determining the prevalence in Nord-Trøndelag of headache sufferers, migraine, non-migrainous headache, and frequent or chronic headache sufferers.
The aim of the present thesis was to investigate the pathophysiology of chronic tension-type headache with special reference to central mechanisms. Increased tenderness to palpation of pericranial myofascial tissues is the most apparent abnormality in patients with tension-type headache. A new piece of equipment, a so-called palpometer, that makes it possible to control the pressure intensity exerted during palpation, was developed. Thereafter, it was demonstrated that the measurement of tenderness could be compared between two observers if the palpation pressure was controlled, and that the Total Tenderness Scoring system was well suited for the scoring of tenderness during manual palpation. Subsequently, it was found that pressure pain detection and tolerance thresholds were significantly decreased in the finger and tended to be decreased in the temporal region in chronic tension-type headache patients compared with controls. In addition, the electrical pain threshold in the cephalic region was significantly decreased in patients. It was concluded that the central pain sensitivity was increased in the patients probably due to sensitization of supraspinal neurones. The stimulus-response function for palpation pressure vs. pain was found to be qualitatively altered in chronic tension-type headache patients compared with controls. The abnormality was related to the degree of tenderness and not to the diagnosis of tension-type headache. In support of this, the stimulus-response function was found to be qualitatively altered also in patients with fibromyalgia. It was concluded that the qualitatively altered nociception was probably due to central sensitization at the level of the spinal dorsal horn/trigeminal nucleus. Thereafter, the prophylactic effect of amitriptyline, a non-selective serotonin (5-HT) reuptake inhibitor, and of citalopram, a highly selective 5-HT reuptake inhibitor, was examined in patients with chronic tension-type headache. Amitriptyline reduced headache significantly more than placebo, while citalopram had only a slight and insignificant effect. It was concluded that the blockade of 5-HT reuptake could only partly explain the efficacy of amitriptyline in tension-type headache, and that also other actions of amitriptyline, e.g. reduction of central sensitization, were involved. Finally, the plasma 5-HT level, the platelet 5-HT level and the number of platelet 5-HT transporters were found to be normal in chronic tension-type headache. On the basis of the present and previous studies, a pathophysiological model for tension-type headache is presented. According to the model, the main problem in chronic tension-type headache is central sensitization at the level of the spinal dorsal horn/trigeminal nucleus due to prolonged nociceptive inputs from pericranial myofascial tissues. The increased nociceptive input to supraspinal structures may in turn result in supraspinal sensitization. The central neuroplastic changes may affect the regulation of peripheral mechanisms and thereby lead to, for example, increased pericranial muscle activity or release of neurotransmitters in the myofascial tissues. By such mechanisms the central sensitization may be maintained even after the initial eliciting factors have been normalized, resulting in the conversion of episodic into chronic tension-type headache. Future basic and clinical research should aim at identifying the source of peripheral nociception in order to prevent the development of central sensitization and at ways of reducing established sensitization. This may lead to a much needed improvement in the treatment of chronic tension-type headache and other chronic myofascial pain conditions.
The objective of this study was to estimate the 1-year prevalence of the following categories of headache; migraine, non-migrainous headache, frequent headache (>6 days/month), and chronic headache (>14 days/month). Between 1995 and 1997, all 92,566 inhabitants 20 years and older in Nord-Trøndelag county in Norway were invited to a comprehensive health study. Out of 64,560 participants, a total of 51,383 subjects (80%) completed a headache questionnaire. The overall age-adjusted 1-year prevalence of headache was 38% (46% in women and 30% in men). The prevalence of migraine was 12% (16% in women and 8% in men), and for non-migrainous headache 26% (30% in women and 22% in men). For frequent headache (> 6 days per month) and for chronic headache (>14 days per month), the prevalence was 8% and 2%, respectively. Women had a higher prevalence than men in all age groups and for all headache categories. Prevalence peaked in the fourth decade of life for both men and women, except for 'frequent non-migrainous headache', which was nearly constant across all age groups in both genders. In accordance with findings in other western countries, we found that headache suffering, including migraine, was highly prevalent, especially in younger women.
This study explored the prevalence of fibromyalgia, the relationship of anxiety and depression with two major symptoms (pain and fatigue), and the role of co-morbidity. Participants were recruited from the Nord-Trøndelag Health Study (The HUNT Study) in Norway (N = 92,936). They were females given the diagnosis of fibromyalgia by their doctor (N = 1,816), divided into one sample without (N = 977) and another with (N = 839) co-morbidity. Owing to colinearity between anxiety and depression, extreme groups were defined according to high vs. low anxiety and depression scores. About four-fifths of the initial sample were excluded by this approach, which permitted a two x two factorial split-plot ANCOVA for the assessment of the relations of anxiety and depression with pain and fatigue. The overall prevalence was 3.2%, which obscured a highly biased sex difference with 5.2% for females and .9% for males. Results from the sample without co-morbidity (N = 977) supported the idea of independent partial correlations of anxiety and depression with pain and fatigue. A different trend was indicated in the co-morbidity sample (N = 839) where fatigue was only significantly associated with depression, whereas pain was associated with anxiety. The idea of widespread pain was supported consistently only in participants without co-morbidity who scored low on anxiety. Age, incident pain and depression contributed to a discriminant function reflecting the status of co-morbidity.
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.
The presence of postural, myofascial, and mechanical abnormalities in patients with migraine, tension-type headache, or both headache diagnoses was compared to a headache-free control sample. Twenty-four control subjects were obtained from a convenience sampling and each was matched by age and sex to three patients with headache (one with migraine [with or without aura], one with tension-type headache, and one with diagnoses of both migraine and tension-type headache [combined diagnosis]) who had been previously assessed by a physical therapist at a headache clinic. Physical therapy assessment findings were compared among the four groups.
There was a significant difference in the presence of postural abnormalities between the controls and the patients, with posture abnormalities more likely to be present in those with headache. The patients were also significantly more likely to have active trigger points and trigger points in the neck than were the control subjects. There were no significant group differences identified in the mechanical measures, nor were there any significant differences among the three headache categories. Determination of the clinical significance of these musculoskeletal abnormalities in patients with headache will require the development and testing of further standardized assessments as well as physical therapy treatment programs.
Standardised questionnaires for the analysis of musculoskeletal symptoms in an ergonomic or occupational health context are presented. The questions are forced choice variants and may be either self-administered or used in interviews. They concentrate on symptoms most often encountered in an occupational setting. The reliability of the questionnaires has been shown to be acceptable. Specific characteristics of work strain are reflected in the frequency of responses to the questionnaires.
The clinical significance of muscular headaches
- Mithoefer W
Mithoefer W (1917). The clinical significance of muscular headaches. Ohio State Med J 13:716–719.
Validity and reliability of a headache ques-tionnaire in a large population-based study in Norway
- Head-Hunt
Head-HUNT: Validity and reliability of a headache ques-tionnaire in a large population-based study in Norway. Cephalalgia 20:244–251.
- Headache Classification Committee of the international Headache Society
Fibromyalgia and chronic daily headache (Abstract)
- Peres MFP