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Objective: This narrative literature review examines the long‐term impact of postdural puncture headache (PDPH) in postpartum women following an unintended dural puncture (UDP) with a large bore needle commonly used for epidural catheter placement. It seeks to bridge the knowledge gap for the neurologist as to the mounting body of obstetric anesthesia literature on the development of chronic headache after PDPH with this unique needle. Background: Headache is the most common complication of dural puncture, and the risk is greatest in the parturient population. Preexisting risk factors for this population include youth and sex, and after UDP with a large bore needle, almost 70%–80% report a headache. Additionally, there appears to be a significant cohort who experience long‐term, persistent headache after UDP. Methods: We performed a narrative review of literature using PubMed, searching terms that included long‐term follow‐up after UDP with a large bore needle in the postpartum population. Results: In women who had UDP with a large bore needle used for epidural catheter placement at delivery, the rate of chronic debilitating headache is around 30% in the months following delivery and may persist for up to a year or longer. Conclusion: Based on the existing literature, we have mounting evidence that UDP with the large bore needle used to place an epidural catheter should be understood as a high‐risk inciting event for the development of long‐term headaches not simply a high risk of acute PDPH. Additionally, consideration should be given to stratifying the etiology of PDPH, based on needle type, and recognizing the entity of chronic PDPH, thus allowing for improvements in research and diagnosis. [ABSTRACT FROM AUTHOR]

Objectives: The primary outcome of this study was to assess the efficacy and safety of preventive treatment with amitriptyline on headache frequency and severity after mild traumatic brain injury (mTBI). Background: Despite the fact that headache is the most common and persistent physical symptom after TBI, there has been little research on the longitudinal course or pharmacologic treatment of this disorder. Of those who have headache after injury, about 60% continue to complain of headache at 3 months post injury, with higher levels of disability than those without headache. There have been no prospective, randomized, controlled trials of a pharmacologic agent for headache after TBI. Additionally, a brain‐injured population may be more susceptible to side effects of medication. Design: This is a single‐center phase II trial of amitriptyline to prevent persistent headache after an mTBI. Medication dose was gradually increased from 10 to 50 mg daily. Results: Fifty participants were enrolled and 33 who completed the 90‐day assessment were included in the final analysis. In order to detect a possible cognitive impact of the study drug, 24 participants were randomly assigned to start amitriptyline immediately after study enrollment and 26 were assigned to start 30 days after enrollment. Forty‐nine percent (18/37) of those assigned to take medication took none throughout the study period, with less compliance in younger participants with mean ages of 32.7 in those who did not take any medication, 33.4 who were less than 80% compliant, and 42.3 who were compliant (P =.013). Compliance in keeping a daily headache diary was low, with 29/50 participants (58%) meeting daily entry completion, and only 10 participants maintaining 100% diary completion. No differences were found between those who started medication immediately vs at day 30 in headache frequency or severity. Conclusions: While headache is the most common symptom following mTBI, current evidence does not support a specific treatment. No differences were noted in headache frequency compared to our prior study. However, the current sample had significantly lower headache severity (15% vs 36% with pain rating of 6 or above, P =.015) compared to our prior study. Our current study was not able to determine whether there is any benefit for the use of amitriptyline as a headache preventive because of difficulty with study recruitment and compliance. The challenges with recruitment and retention in the mTBI population were instructive, and future research in this area will need to identify strategies to improve recruitment, diary compliance, and medication adherence in this population. [ABSTRACT FROM AUTHOR]

Background: Many children suffering from chronic headache and migraine present with comorbid functional disability, including physical, social, emotional, and academic activities. For children severely impaired by headache, intensive interdisciplinary pain rehabilitation treatment (IIPT) can improve functioning. However, there are limited data evaluating children's response to rehabilitation across several time points. Objective: This study aims to evaluate the trajectory of recovery for children undergoing IIPT for chronic headache, as well as to examine the proposed assumption that physical and psychosocial functioning improves prior to a reported reduction in pain. Methods: A retrospective analysis of patient‐reported outcomes in a clinical database of 135 children admitted to an IIPT program between the years 2008 and 2014 was analyzed. Available data across 5 separate time points (up to 1‐year post‐discharge) were reviewed. Results: One hundred and thirty‐five children of mean age 15.2 (SD = 2.2) and 74% female provided data for review. Linear mixed model demonstrated a statistically significant improvement in pain‐specific measures of functioning, including daily functioning (change estimate = −14.53) emotional functioning (change estimate = −14.63), family functioning (change estimate = −5.78), and school absences (change estimate = −11.47) over a 12‐month period (all P's ≤ .01). A more general measure of quality of life improved during the program, based upon child (change estimate = +10.07) and parent report (change estimate = +15.31); although these gains did not continue to improve post‐discharge. As expected, although children did not report a reduction in pain during rehabilitation (change estimate = +0.07), they did report a significant drop in perceived pain in the 12 months following discharge from the program (change estimate = −2.12, P ≤ .01). Conclusions: Children with chronic headache and migraine who are severely functionally impaired demonstrated linear improvement in pain‐specific patient‐reported outcomes over time; however, there remains a need for improved methodology in analyzing response to IIPT programs. [ABSTRACT FROM AUTHOR]

Objectives To investigate the frequency and impact of fibromyalgia among patients with chronic migraine (CM) and chronic tension-type headache (CTTH). Background Fibromyalgia (FM) is a common comorbidity in patients with chronic headaches. CM and CTTH are the two common types of chronic headaches. Methods We conducted a cross-sectional study in neurology outpatient clinics of four university hospitals and selected first-visit 136 patients with CM and 35 patients with CTTH. FM was assessed based on the 2010 American College of Rheumatology diagnostic criteria. Results The frequency of FM was significantly higher among patients with CM when compared to those with CTTH (91/136 [66.9%] vs 9/35 [25.7%], P < .001). Logistic regression analyses revealed an increased odds ratio (OR) for FM for patients with CM when compared to those with CTTH after adjustment for age, sex, anxiety, depression, and insomnia (OR = 3.6, 95% confidence interval = 1.1-11.4). Furthermore, CM patients with FM had higher scores in FM Impact Questionnaire compared to CTTH patients with FM (51.5 ± 16.3 vs 43.7 ± 18.7, P = .015). Comorbidity of FM was associated with increased frequency of photophobia, phonophobia, anxiety, depression, and insomnia among patients with CM. Such association was not noted among patients with CTTH. Conclusion FM based on 2010 American College of Rheumatology diagnostic criteria was more prevalent among patients with CM than those with CTTH. Some clinical features and comorbidities of CM varied with the presence of FM. [ABSTRACT FROM AUTHOR]

Objective To evaluate the efficacy of an intensive outpatient program designed to improve functioning and reduce psychological impairment in chronic headache patients. Background Chronic headaches, occurring 15 or more days per month, for three or more months, may arise from multiple International Classification of Headache Disorders diagnoses: Chronic Migraine, Chronic Tension Type Headache, New Daily Persistent Headache, Chronic Post Traumatic Headaches, and Medication Overuse Headache. Several interdisciplinary programs that treat patients with chronic headaches have reported decreases in headache frequency. This study sought to evaluate the effect of a 3 week interdisciplinary treatment program for patients with chronic headache disorders on headache severity, functional status, and psychological impairment. Methods Subjects were 379 patients admitted to an outpatient chronic headache treatment program. Assessments of headache severity, psychological status, and functional impairment were completed by 371 (97.8%) of these at the time of admission. At discharge, 340 subjects (89.7%) provided assessment data, and 152 (40.1%) provided data at 1-year follow-up. Results Subjects' mean ratings on a 0-10 scale for their headache pain in the prior week declined, and these improvements were maintained at follow-up. (Estimated marginal means on a 0-10 scale for Average pain: admission 6.1, discharge 3.5, follow-up 3.3; for Least pain: admission 3.2; discharge 1.5; follow-up 1.3; for Worst pain: admission 8.2; discharge 6.4; follow-up 5.7), and similar results were found for current pain (admission 4.7; discharge 2.8; follow-up 2.4): Measures of functional impairment also improved following treatment, and these gains were maintained at 12 month follow up (Estimated marginal mean Headache Impact Test-6 score: admission 66.1, discharge 55.4, follow-up 51.9; Estimated marginal mean Pain Disability Index score: admission 36.2, discharge 14.1, follow-up 11.6). As measured by the Depression, Anxiety and Stress Scale, anxiety and reactivity to stress decreased following treatment, and remained improved at follow-up (Estimated marginal mean score for Anxiety: admission 8.7, discharge 5.2, follow-up 4.4; Estimated marginal mean score for stress: admission 14.9, discharge 7.2, follow-up 7.6). Depression decreased with treatment, but while 1-year follow-up depression scores remained significantly lower than at admission, they were also significantly higher than at discharge (Estimated marginal means: admission 13.3, discharge 4.1, follow-up 6.6). Conclusions The study supports the efficacy of the treatment model. Limitations of the study and suggestions for future research are also discussed. [ABSTRACT FROM AUTHOR]

Background Sexual pain and chronic headaches are both complex conditions with associated high disability. Little research has examined whether there is a relationship between the 2. The aim of this survey-based study was to explore the frequency of sexual pain in a population of women being treated for chronic headache. Peripheral aims included exploring the number of patients receiving treatment for sexual pain and the association between sexual pain and libido, and history of abuse. Methods Patients presenting to an ambulatory chronic headache clinic were administered a short 10-item survey. Results Forty-four percent of patients reported that they had pelvic region or genital pain brought on by sexual activity. Only half of these patients had ever discussed their pelvic pain with a health care provider, and 31% of these patients had not received treatment. Almost all patients would be interested in treatment if available. Seventy-five percent of patients indicated a change in libido. Conclusion Chronic headaches and sexual pain are both conditions that have a significant impact on patients and the health care system, and they do coexist. More research is needed to look at the relationship between these conditions in addition to epidemiology, symptomatology, evaluation, and treatments. [ABSTRACT FROM AUTHOR]

Background Behavioral approaches have been found to be effective in managing chronic headache. Recently, attention has been given to the role of exercise in chronic headache management, although much of the literature addresses it as a monotherapy. The current review assesses the effectiveness of exercise as an adjunct to other behavioral treatments for chronic headache. Objective To evaluate the methodology and outcomes of studies using behavioral headache interventions with an aerobic exercise component. Methods A systematic literature review was conducted on PubMed and Psych Info to identify studies that offered or recommended aerobic exercise as part of a multicomponent treatment for headaches. The search included only those articles that were written in English and published in academic journals. Results Nine studies met inclusion criteria, of which 2 were randomized controlled trials. Despite methodological limitations, results of existing studies suggest that the behavioral headache interventions that include aerobic exercise may be associated with positive outcomes for headache variables. Four single-group studies reported statistically significant improvements in at least 1 headache variable at the end of treatment. Both randomized controlled trials and 1 non-randomized trial reported statistically significant post-treatment improvement in at least 1 headache outcome variable in the intervention group compared with control groups. Conclusions Incorporating exercise into behavioral headache treatments appears to be promising, but as studies to date have not evaluated the individual contribution of exercise, its role in managing headache symptoms is unclear. Further work is needed to evaluate the unique role of exercise in such treatment programs. Recommendations for future research include adhering to published guidelines for clinical trial design and reporting, adhering to existing guidelines for headache research (such as reporting outcome data for multiple headache variables), developing exercise prescriptions based on public health recommendations, and reporting all aspects of exercise prescriptions. [ABSTRACT FROM AUTHOR]

Objectives.- The goal of this study was to measure the effect of biofeedback therapy on pediatric headache and to identify factors associated with response to biofeedback therapy. Background.- In the United States, 17% of children have frequent or severe headaches. Biofeedback therapy (BFT) appears to be an effective treatment for headaches in adults and is often recommended for children with headaches, but there are few data in the pediatric population. It is also not clear which patients are most likely to benefit from biofeedback therapy. Methods.- We examined the records of patients, aged 8 to 18 years old, who were referred to a pediatric BFT clinic for management of headache between 2004 and 2008. We extracted data regarding patient and headache characteristics, medication use, family history, and measures of depression, anxiety, and somatization. Chronic headache was defined as ≥4 headache days/week. Positive response to biofeedback was defined as a 50% reduction in number of headache days/week or hours/week, or ≥3-point decrease in severity (0-10 scale) between first and last visits. We analyzed the responder rate for those with episodic and chronic headaches and performed multivariable analysis to determine what factors were associated with headache response to biofeedback therapy. Results.- We analyzed records from 132 children who attended ≥2 biofeedback sessions. Median headache frequency dropped from 3.5 to 2 headache days/week between the first and last visits. The response rate was 58% overall; 48% for chronic headaches and 73% episodic headaches. In multivariate analysis, ability to raise hand temperature by >3°F at the last visit and use of selective serotonin reuptake inhibitors (SSRIs) were associated with a positive response, and preventive medication use was associated with nonresponse. Anxiety, depression, and somatization were not significantly associated with response to biofeedback therapy. Conclusions.- Biofeedback therapy appears to be an effective treatment for children and adolescents with both episodic and chronic headaches. Further study is warranted to compare biofeedback with other treatments for chronic pediatric headache. Use of SSRIs appears to be associated with a positive response to biofeedback therapy, but the reasons for this relationship are unclear and merit further study. [ABSTRACT FROM AUTHOR]

Aim.- Chronic headache is a disabling disorder that is frequently poorly managed in general clinical practice. Objectives.- To investigate primary (headache frequency in days/month) and secondary (headache-related disability, lost work/school time, anxiety and depression, amount and intake frequency of acute medication) 12-month outcomes of a headache-specific cross-sectional outpatient and inpatient multidisciplinary treatment program using a dedicated computer system for data collection and corresponding between integrated care team in a tertiary headache center and practicing headache specialists. Background.- A need for integrated headache care using comprehensive and standardized assessment for diagnosis of headache, psychiatric comorbidity, and burden of disease exists. There are little published data on long-term efficacy of multidisciplinary treatment programs for chronic headache. Design.- A prospective, observational, 12-month, follow-up study. Subjects and Methods.- Prospectively recruited consecutive patients with frequent difficult-to-treat headaches (n = 201; 63 migraine, 11 tension-type headache, 59 combined migraine/tension-type headache, and 68 medication overuse headache) were enrolled. Outcome measures included prospective headache diaries, a medication survey, Migraine Disability Assessment, 12-item short form health survey, and the Hospital Anxiety and Depression Scale. Results.- The primary outcome of a reduction of ≥50% of headache frequency (days/month) was observed in 62.7%. Mean headache frequency decreased from 14.4 ± 8.2 to 7.6 ± 8.3 days/month, P < .0001. Secondary outcomes improved significantly in the total cohort and all headache subgroups. Predictors for good outcome were younger age, few days lost at work/school, and familiarity with progressive muscle relaxation therapy at baseline. Conclusions.- The present analysis provided support for a cross-sectional multidisciplinary integrated headache-care program. [ABSTRACT FROM AUTHOR]

Mild traumatic brain injury is very common in Western societies, affecting approximately 1.8 million individuals in the USA. Even though between 30% and 90% of patients develop post-traumatic headache, post-traumatic headache remains a very controversial disorder. Particularly when it comes to chronic post-traumatic headache following mild closed head injury and headache attributed to whiplash injury. Some experts are disputing its existence as a genuine disorder. Indistinct disease classification, unresolved pathophysiological mechanism, and the role of accident-related legal issues further fuel this controversy. The complex combination of pain and neuropsychological symptoms needs further research in understanding the underlying pathophysiological mechanisms associated with the acute headache following trauma but more so the mechanisms associated with the development of chronic pain in some patients. Investigators should refrain from oversimplifying these complex mechanisms as hysteric exaggeration of everyday complains and from implying greed as motivation for this potentially very disabling disease. [ABSTRACT FROM AUTHOR]

Post-traumatic headache (PTH) is an important public health issue – head injuries are common, headache is the most common sequelae of head injuries, and PTH can be particularly disabling. Fortunately, for most individuals with PTH, the headache gradually dissipates over a period of several days, weeks, or months either spontaneously or aided by non-pharmacologic and/or pharmacologic management. Regrettably, for a minority of head-injured individuals, the PTH is intractable and disabling despite aggressive and comprehensive treatment. Unfortunately, there are many prejudices against individuals with PTH. Frequently, the presence or absence of litigation and/or the mechanism of head injury (sports-related trauma, slip-and-fall injury, motor vehicle accident, or military service-related injury) biases physicians' views on the legitimacy of the patient's PTH. Accordingly, this review attempts to summarize the state of the art of our understanding of PTH. This clinical review highlights: (a) views on PTH throughout the last few centuries, (b) the ICHD-2 classification of PTH, (c) the epidemiology of head injuries and PTH, (d) the clinical characteristics of PTH, (e) PTH related postconcussive symptoms, (f) pathophysiology of PTH, (g) evaluation of PTH, and (h) management of PTH. [ABSTRACT FROM AUTHOR]

Objective.—The objective of this study is to determine the incidence, character, and outcome of headache in patients with unruptured intracranial aneurysms who had been treated to avoid the risk of rupture. Background.—There are a variety of clinical manifestations associated with unruptured intracranial aneurysms. Among them, chronic headache is the most common presenting and/or accompanying symptom. Methods.—Among the 137 patients with unruptured aneurysms who had been treated, we collected 81 patients excluding 30 on the basis of inclusion criteria. Twenty-six patients were lost to follow-up. We collected data by medical record review and a telephone survey. Included in the information collected was the analysis of presenting symptom, location and size of each aneurysm, location, quality, intensity and duration of headaches, associated symptoms, triggering and alleviating factors, and precipitating events. Results.—Forty-nine patients (60.5%) of 81 had chronic headaches before the diagnosis of unruptured intracranial aneurysm. Forty-four patients (89.8%) answered that their headaches were improved slightly (12 patients) or markedly (32 patients) ( P <.05). The clinical pattern of the headache worsened in only 1 patient and did not change in 4 patients. When the surgical group (40 patients) and the coil embolization group (41 patients) were compared, there was no significant difference observed in outcome ( P >.05). Conclusion.—Either by employing the technique of clipping or by coil embolization, treatment of unruptured intracranial aneurysms resulted in relief of headaches in majority of patients who had headaches pre-operatively. [ABSTRACT FROM AUTHOR]

Objective.—The aim was to evaluate whether preventive treatment with topiramate in patients with episodic migraine reduces the risk of developing chronic forms of headache. Background.—Chronic forms of headache, including chronic migraine or medication overuse headache (MOH), are characterized by 15 or more headache days per month. Acute medication overuse has been shown to be a risk factor for developing chronic headache, but it is not known whether preventive treatment can reduce the risk of developing chronic forms of headache or the development of MOH. Methods.—Pooled data from 3 trials in patients with episodic migraine randomized either to treatment with 100 mg topiramate per day (n = 384) or with placebo (n = 372) were analyzed with regard to the number of headache days during a prospective 4-week baseline period and the individual final 4 weeks of each patient's treatment during the planned 26-week double-blind treatment period. Results.—The number of headache days per month in the topiramate versus the placebo-treated groups was 7.3 ± 3.0 versus 7.3 ± 3.1 during baseline and 4.1 ± 4.2 versus 5.6 ± 4.9 during the final 4 weeks, respectively ( P < .001). At the end of the study, 8 versus 16 patients fulfilled International Headache Society criteria of chronic headache (odds ratio: 2.11, P= .082). Moreover, a significantly lower number of patients receiving topiramate treatment reported an increase in headache days per month by the end of the study when compared to placebo (66 vs 88 patients, respectively; odds ratio: 1.49, P < .05). Finally, the number of days with usage of acute medication was significantly lower in the topiramate arm compared with placebo (3.3 ± 3.7 vs 4.3 ± 3.6, respectively; P < .001). Conclusion.—Preventive treatment with topiramate in patients with episodic migraine may reduce the risk of developing chronic forms of headache. [ABSTRACT FROM AUTHOR]

Psychological stress is generally acknowledged to be a central contributor to primary headache. Stress results from any challenge or threat, either real or perceived, to normal functioning. The stress response is the body's activation of physiological systems, namely the hypothalamic-pituitary-adrenal axis, to protect and restore functioning. Chronic activation of the stress response can lead to wear and tear that eventually can predispose an individual to disease. There are multiple ways that stress and headache are closely related. Stress can (a) be a predisposing factor that contributes to headache disorder onset, (b) accelerate the progression of the headache disorder into a chronic condition, and (c) precipitate and exacerbate individual headache episodes. How stress impacts headache is not often understood. However, stress is assumed to affect primary headache by directly impacting pain production and modulation processes at both the peripheral and central levels. Stress can also independently worsen headache-related disability and quality of life. Finally, the headache experience itself can serve as a stressor that compromises an individual's health and well-being. With the prominent role that stress plays in headache, there are implications for the evaluation of stress and the use of stress reduction strategies at the various stages of headache disorder onset and progression. Future directions can help to develop a better empirical understanding of the pattern of the stress and headache connections and the mechanisms that explain the connections. Further research can also examine the interactive effects of stress and other factors that impact headache disorder onset, course, and adjustment. [ABSTRACT FROM AUTHOR]

Objective.—To investigate the relationships between daily hassles, perfectionism, and the experience of chronic headache among university students. Background.—Headaches are very common among university students. It has been found that a higher number of hassles reported by students is associated with an increase in headache activity. It has also been suggested that individuals higher in perfectionism appraise more situations as hassles, and that this dispositional characteristic may constitute a risk factor for the experience of chronic headaches. Methods.—A total of 291 university students completed three questionnaires: (1) the Headache Assessment Questionnaire that was utilized to obtain information on headache occurrence and its features, (2) the Brief College Student Hassles Scale, and (3) the Multidimensional Perfectionism Scale. Results.—A total of 18 students (6.2%) met the 2004 IHS criteria for chronic headaches, 179 (61.5%) met the criteria for frequent headaches, and 69 (23.7%) met the criteria for infrequent headaches. Students with chronic headaches reported significantly more stress, as measured by daily hassles. They also exhibited higher levels of perfectionism. The number of hassles reported was a significant predictor of headache frequency, intensity, and duration. Analyses also revealed that perfectionism was a significant predictor of headache frequency and intensity. Conclusions.—The present study indicates that there is a relationship between perfectionism and chronic headache in university students, with those higher in perfectionism experiencing more frequent headaches. This investigation confirmed the relationship between daily hassles and chronic headache in this population. The results also suggest that perfectionists may generate their own stress through their tendency to appraise more situations as hassles. This, in turn, may explain their tendency to experience chronic headaches. [ABSTRACT FROM AUTHOR]

Background.—The International Headache Society has defined the diagnostic criteria for headache induced by substance use. Recently, a revision to these criteria has been proposed. Objective.—To consider whether the International Headache Society criteria for headache induced by substance use and the proposed revisions for the classification of daily and near-daily headache with medication abuse permit classification of patients commonly seen in a headache center. Methods.—One hundred fourteen consecutive patients (96 women [84.2%] and 18 men [15.8%]; mean age, 54.2 years [SD, 14]) with headache and chronic overuse of medications, admitted for detoxification to the inpatient unit of a headache center, participated in the study. The initial headache, medications and doses used, duration of daily medication use, and means of medication administration were studied. Results.—Eighty-one patients (71%) had an initial headache of migraine without aura, 13 patients (11.4%) had migraine without aura and coexistent tension-type headache, 11 (9.7%) patients had migraine with and without aura, and 9 patients (7.9%) had episodic tension-type headache. Medications overused by patients included analgesics combined with barbiturates or other nonnarcotic substances in 39.5%, simple analgesics in 38.6%, triptans in 11.4%, and ergotamine in 10.5%. Using the International Headache Society diagnostic criteria, we were able to classify only 28.1% of our patients; the proposed revised criteria for daily and near-daily headaches with medication abuse permitted the classification of 46.4% of patients. Conclusion.—The minimum dose of medication required to induce chronic headache should be revised because a high proportion of patients are not classifiable using either the International Headache Society diagnostic criteria or the revised criteria recently proposed. A more comprehensive definition for the required minimum dose might be used. Triptan abuse can cause chronic headache and should be included in the International Headache Society classification. [ABSTRACT FROM AUTHOR]

Objective.—We assessed the views of physicians interested in headache as to the diagnosis of the most commonly occurring and currently controversial headaches. Background.—The International Headache Society (IHS) classification system has received wide professional endorsement and considerable empirical support, but in the United States, their adoption by clinicians may be proceeding more slowly. Questions remain, including what diagnostic criteria for migraine and tension-type headache clinicians may continue to favor over those outlined by the IHS, to what extent is the “transformed migraine” diagnosis used in clinical practice, and how is analgesic rebound headache diagnosed with regard to the various quantitative measures of analgesic use. Methods.—Members of the American Headache Society rated the importance of IHS and non-IHS diagnostic criteria for migraine and tension-type headache and for analgesic rebound headache. Respondents also described their use of the proposed transformed migraine diagnosis. Results.—Two-thirds (67.3%) of the respondents reported use of the IHS criteria or the IHS criteria in conjunction with clinical judgment. For migraine and tension-type headache, IHS criteria were rated with high importance, but some respondents reported using additional non-IHS diagnostic criteria and de-emphasizing certain IHS criteria. For chronic headache, almost two-thirds (63%) of respondents reported using the transformed migraine diagnosis. For analgesic rebound headache, respondents preferred to make the diagnosis based on medication consumption that is lower than amounts stipulated in the IHS classification system. Conclusions.—There remains a number of physicians interested in headache who do not use the IHS classification system, who modify the IHS criteria in practice, and who use the “transformed migraine” diagnosis for patients with chronic daily headache. [ABSTRACT FROM AUTHOR]

Objective.—To test whether chronic headache (>3 days/week) is more prevalent than episodic headache (<3 days/week) in patients with a previous history of significant head trauma. Method.—We included 903 consecutive patients referred to a specialist center for headache during a period of 2 years. As the main parameter, we selected self-reported history of previous significant head trauma defined as loss of consciousness or hospitalization due to head trauma. Results.—One hundred eighty-nine out of 903 patients with difficult headache referred to a neurologist had a previous history of head trauma (21%). We identified 297 patients with headache 3 days or more per week (33%). Of these patients with chronic headache, 68 (23%) reported previous significant head trauma compared with 121/714 (17%) in other patients with headache (P = .18). Shorter length of education was associated with chronic headache; however, age, sex, or specific headache syndromes such as migraine or tension headache were not related to chronicity. Conclusion.—Although the incidence of previous head trauma was prevalent in this highly selected group of patients with headache, such a history was not a predictor of chronicity. [ABSTRACT FROM AUTHOR]

The article presents several studies concerning headache. One of these studies aim to identify whether glial cells are involved in the mustard-oil induced central sensitization in trigeminal subnucleus caudalis (Vc) nociceptive neurons. Another one reveals the role of p38 mitogen-activated protein kinase (MAPK) (p38 MAPK) in the spinal cord as well as in development of chronic morphine antinociceptive tolerance. A review which illustrates the two roles of microglia and astrocytes is emphasized.

A 35-year-old Chinese woman presented with a 26-year history of persistent headache, relieved only by diuretics. Characteristic CT findings, peripheral eosinophilia, lymphocytic CSF pleocytosis, elevated CSF IgG, positive oligoclonal bands, antibody-positive ELISA, and Western blot results with Taenia solium antigen, and a favorable response to albendazole led to the diagnosis of neurocysticercosis. [ABSTRACT FROM AUTHOR]