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Objective To examine treatment utilization patterns and safety of onabotulinumtoxinA for the prophylactic treatment of chronic migraine in routine clinical practice. Background Clinical trials support onabotulinumtoxinA for the prophylaxis of headache in patients with chronic migraine, but real-world data are limited. Design/methods A prospective, observational, post-authorization study in adult patients with chronic migraine treated with onabotulinumtoxinA. Data were collected at the first study injection and approximately every three months for ≤52 weeks for utilization and ≤64 weeks for safety data, and summarized using descriptive statistics. Results Eighty-five physicians (81% neurologists) at 58 practices in the United Kingdom, Germany, Spain, and Sweden participated and recruited 1160 patients (84.2% female, median age 46.6 years). At baseline, 85.8% of patients had physician diagnoses of chronic migraine/transformed migraine and reported an average of 11.3 (SD = 6.9) severe headache days per 28 days; 50.6% had previously used onabotulinumtoxinA for chronic migraine. A total of 4017 study treatments were observed. The median number of injection sites (n = 31) and total dose (155 U) were consistent across all treatment sessions, with a median 13.7 weeks observed between sessions. At least one treatment-related adverse event was reported by 291 patients (25.1%); the most frequently reported treatment-related adverse event was neck pain (4.4%). Most patients (74.4%) were satisfied/extremely satisfied with onabotulinumtoxinA treatment. Conclusions Patient demographics/characteristics are consistent with published data on the chronic migraine population. Utilization of onabotulinumtoxinA treatment for chronic migraine appears to be consistent with the Summary of Product Characteristics and published PREEMPT injection paradigm. No new safety signals were identified. [ABSTRACT FROM AUTHOR]

Objectives People with migraine and tension-type headache ( TTH) have psychiatric comorbidities. We aimed to test differences in mental health constructs by type and frequency of primary headache and associated pain sensitivity. Materials and methods Data on headache features, neuroticism (Eysenck Personality Questionnaire) and depression (Major Depression Inventory) were obtained from 547 individuals classified into chronic (≥15) or episodic (<15 headache days/month) and into pure migraine (n=43), pure tension type headache ( TTH, n=97), migraine and TTH (n=83) and no headache diagnosis (controls, n=324) groups. A pericranial total tenderness score ( TTS) and pressure pain thresholds ( PPTs) were measured. Differences in mental health constructs were examined by headache frequency and type using generalized linear mixed models adjusting for sociodemographic covariates. Results Depression scores were highest among people with chronic headache, lower in those with episodic headache, and lowest in controls. The chronic and episodic headache groups had higher neuroticism scores than controls. Mental health construct scores were highest for the migraine and TTH group and lowest in the control group. TTS and cephalic PPTs were correlated with neuroticism and depression and were higher in the chronic headache group compared to the no headache group even when adjusted for neuroticism and depression. Conclusions Neuroticism and depression scores are associated with headache frequency (chronic vs episodic) and are highest for migraine and TTH followed by pure TTH then migraine. Mental health constructs were correlated with but did not influence differences in TTS and PPTs between headache groups. [ABSTRACT FROM AUTHOR]

Objectives To investigate predictors for successful treatment outcome after a brief intervention ( BI) for medication-overuse headache ( MOH). Materials and methods This study evaluated predictors of successful withdrawal among patients initially participating in a pragmatic cluster-randomized controlled trial with single crossover in Norwegian general practice (the BIMOH study). BI (early or after crossover) was compared to business as usual ( BAU) for the treatment of MOH. Patients were followed up 3 months after the BI. Results In total, 46 patients had the chance to receive the BI (24 early and 22 after crossover) and were included in the predictor analyses. The mean reduction in headache and medication days/month from baseline for the BI was 6.9 (95% CI: 4.8-9.1) and 10.9 (8.1-13.6). The mean percentage reduction in headache and medication days was 30.5% (21.4-39.7) and 50.4% (39.5-61.3). Only five patients started prophylactic medication. Neither age, gender, co-occurrence of migraine, main type of overused drug at baseline nor Severity of Dependence Scale score at baseline predicted successful withdrawal in the prespecified analyses. Headache days/month and medication use at baseline were significant predictors in exploratory analyses with more headache and medication days predicting worse outcome. Conclusions Brief intervention for MOH is a simple and effective intervention in primary care. As the only identified predictors were frequency of headache and medication use, we conclude that treatment for all MOH patients should be attempted in primary care before referral. A raised awareness of MOH is important, as the condition is highly preventable and treatable. Trial Registration ClinicalTrials.gov identifier: NCT01314768. [ABSTRACT FROM AUTHOR]

Background Knowledge about long-term outcomes after medication withdrawal therapy for chronic headache, including tension type and migraine headache is lacking. Methods We re-examined 56 patients an average of nine years after they participated in a medication withdrawal study with a one-year follow-up. We collected and compared data on headache, use of medication, quality of life, quality of sleep, anxiety, depression, and labor participation one and nine years after the start of withdrawal therapy. Results Headache days per month decreased from 16.7 (14.0-19.3) at one year to 13.3 (10.6-15.9) at nine years (P = 0.007). The proportion of patients meeting the criteria for chronic headache decreased from 27/56 (48%) at one year to 18/56 (32%) at nine years (P = 0.004). Medication overuse was reported in seven (13%) patients at one year and 18 (32%) at nine years (P = 0.013). The majority of patients overusing medication at nine years (10/18) belonged to a group of 14 patients who had a poor early response to withdrawal therapy and had sustained chronic headache after nine years. After excluding patients receiving retirement pensions, the proportion who received disability benefits increased from 21/55 (38%) at one year to 30/49 (61%) at nine years (P = 0.003). Conclusion Improvements after withdrawal therapy for chronic headache last at least nine years, with a parallel increase in the use of disability benefits. However, a high proportion of patients with a poor initial response to withdrawal therapy and sustained chronic headache overuse medication. [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]

The aim of this study was to examine the effect of body awareness therapy (BAT) on pain and body image in patients with tension-type headache and migraine. Twenty eight patients were included in the study. Socio-demographic and clinical features of the patients were recorded. Visual Analogue Scale and Body Image Questionnaire was used in order to evaluate severity of pain and body image, respectively. After initial assessments, the patients received BAT for 6 weeks each being 60 min in 3 sessions every week. Patients were re-evaluated at the end of 6 weeks of intervention. There was no relation between severity of pain and body image, occupation, participation to physical activity, use of analgesic and existence of headache. The results of the study showed that BAT is an alternative treatment method that can be securely used in order to decrease pain in patients with chronic headache and to increase body image. [ABSTRACT FROM PUBLISHER]

Background: headaches account for 10% of all consultations with the general practitioner, and the third leading cause of emergency department visits. The current prevalence of headache can go from 7.4% to 22.7% and may be associated with much comorbidity, and can cause significant disabilities in an individual's quality of life. Methodology: in this paper we carried out a systematic review on 32 observational (nonrandomized) studies using PUBMED. Aim: our aim in the study is to evaluate the prevalence, associated risk factors, pathogenesis, management, and the effect on quality of life caused due to chronic headaches. Conclusion: chronic headache adds to a huge burden in overall health care system, and a very frequent general practice visit. Treatment of this type of headache is very challenging due to its chronicity as well as its risk of conversion into medication onset headache. More researches that can promise better quality of life for individuals that suffer from chronic daily headache must be done. [ABSTRACT FROM AUTHOR]

Background: Posttraumatic headache (PTH) occurs in up to 82% of patients with traumatic brain injury (TBI). Posttraumatic stress disorder (PTSD) occurs in 39% of those with PTH. This study evaluates whether PTSD affects PTH disability. Methods: Eighty-six patients with TBI were prospectively evaluated in a secondary care trauma center. Headache disability was assessed using the Headache Impact Test version 6 and signs indicative of PTSD using the PTSD Check List Civilian version. Results: Increased PTSD-type symptoms were significantly associated with increased headache disability (p<0.001), as were employment status and loss of consciousness (p=0.049 and 0.016, respectively). Age was negatively correlated with headache disability (Spearman's correlation rho=0.361, p=0.001). Conclusion: Increased severity of PTSD-type symptoms is significantly associated with increased headache disability in patients with chronic PTH. Managing PTSD symptoms in patients with chronic PTH may facilitate headache management. [ABSTRACT FROM AUTHOR]

Background and purpose: Withdrawal therapy improves the headache situation for many patients with medication-overuse headache (MOH), but relapses are common. The objective was to assess the long-term effectiveness of a general practitioner conducted brief intervention (BI) for MOH. Methods: Sixty MOH patients initially participating in a blinded cluster-randomized controlled trial evaluating BI versus business as usual (BAU) were followed up for 16 months. Follow-up was open after 6 months. Headache and medication days per month were evaluated in three groups: BI early (BI throughout the study, n = 24), BI late (initial BAU, then cross-over to BI, n = 22) and BAU throughout the study (n = 14). Results: Fifty-five of 60 initially included patients completed the follow-up. The mean change over 16 months' observation in the BI early group was a reduction of 8.4 (5.4-11.4) headache and 13.5 (9.6-17.3) medication days per month. The relapse rate into medication overuse was 8.3%. Patients in the BI late group also improved significantly after a BI. BAU showed no significant improvement. Conclusions: Treatment for MOH in primary care through a BI is a simple intervention with lasting effects and low relapse rate. This approach may be a logical first step in MOH treatment, and referral should generally be reserved for primary care non-responders. [ABSTRACT FROM AUTHOR]

Background: Alexithymia is a term used to describe a disorder where patients have difficulty in expressing their own feelings in words. Aims: The analysis of alexithymia in patients suffering from chronic migraine (CM) or episodic migraine (EM) compared to healthy controls. Methods: Two clinical samples formed by 80 CM patients (21 males and 59 females, mean age: 44.65) and 44 EM patients (8 males and 36 females, mean age: 42.18) were enrolled. A group of 67 healthy subjects served as controls (26 males and 41 females, mean age: 41.21). All subjects were requested to fill in the 20-item version of the Toronto Alexithymia Scale (TAS-20). Results: We found a statistically significant difference between groups in Factor 1 (difficulty in describing feelings),F(2, 191) = 7.96,p < 0.001, and in TAS total,F(2, 191) = 5.37,p = 0.005. Post-hoc analyses revealed that CM patients had higher scores in TAS factor 1 and in TAS total than healthy controls. There were no significant differences between CM and EM patients, even if CM sufferers reported a trend towards higher scores in each TAS factor as well as in TAS total. Conclusions: Alexithymia emerges as a potential characteristic trait of migraine, regardless of disease severity. [ABSTRACT FROM PUBLISHER]

Vascular headache and chronic rhinosinusitis (CRS) are diseases that share similar symptoms and demographics, including headache, facial pain and nasal symptoms. Contribution of chronic sinusitis as a cause of chronic headache is controversial, as there are scarce studies to know incidence of vascular headache in patients with CRS. To evaluate incidence of vascular headache in patients with CRS. Using descriptive study design, group of 100 patients with symptoms of CRS with headache were included in study. Patients underwent surgical management and 3% managed medically. Patients were assessed for associated factors with headache and further evaluated for persistence of headache postoperatively. Inferential statistics was done by Chi square test using SPSS for Windows Software (Version 21.0). Leading symptoms of CRS were headache (100%), nasal obstruction (93%), and nasal discharge (90%). Pre-treatment 25% had exposure to sunlight as aggravating factor and associated nausea vomiting in 30%. Post-treatment, follow-up at 6 months, 20% reported persisting headache, with duration of headache >1 year in 37.5% ( p = 0.01). Those with pre-operative sunlight exposure as aggravating factor, headache persisted in 60% ( p < 0.0001) and those with nausea/vomiting pre-treatment; headache persisted in 56.7% ( p < 0.0001). These results were statistically significant. In CRS patients who had other factors contributing to headache like duration of headache more than 1 year, associated nausea/vomiting, and aggravating factors like exposure to sunlight, headache persisted after medical and surgical treatment of CRS. It signifies that 20% CRS patients with headache were having co existing vascular headache. [ABSTRACT FROM AUTHOR]

In the past few years, research on chronicization of headache has focussed primarily on migraine, even though there are other types of primary headache that over time can turn into chronic forms. Only a minority of migraine sufferers will develop a chronic condition, with attacks that are likely to vary in their clinical features. As a result, in chronic migraine the specific diagnostic criteria for this headache type do not always exhibit the typical features of migraine. Among the factors that play a major role in favouring chronicization are a high frequency of migraine attacks since the beginning, overuse of symptomatic medication and onset of depression or arterial hypertension. Several neurophysiology, biochemistry and functional neuroimaging studies suggest that chronic migraine may be associated with structural, functional and metabolic changes in the brain, especially involving the brainstem. [ABSTRACT FROM AUTHOR]

A 39-year-old man presented with chronic headaches and intermittent blurred vision with previous neuroimaging and blood work that was reportedly normal. He had papilledema and further questioning elicited a history of extensive alcohol use, unexplained weight loss, and night sweats. Magnetic resonance imaging of the brain demonstrated communicating hydrocephalus and leptomeningeal enhancement. The patient underwent ventriculoperitoneal shunt placement and leptomeningeal biopsy, which was initially unrevealing. Cerebrospinal fluid eventually yielded positive titers for coccidioides, a diagnosis that was confirmed by biopsy culture results. [ABSTRACT FROM AUTHOR]

This study aims to characterize the psychological wellbeing of chronic headache (CH) patients, to identify cortical structural abnormalities and any associations of those abnormalities with resting state functional connectivity (rsFC), and to determine whether such rsFC abnormality is specific to CH patients. Compared with healthy controls (CONCH), CH patients suffered from mild depression, sleep disturbances, and relatively poor quality of life. CH patients also exhibited widespread cortical thickness (CT) abnormalities in left premotor (BA6), right primary somatosensory (S1) and right prefrontal (BA10) cortices, as well as in regions of default mode and executive control networks. Using cortical regions with thickness abnormality as seeds, we found cortical region pairs showed strengthened rsFC in CH patients. Using the same seeds, rsFC analysis from chronic low back pain (CLBP) patients and their controls (CONCLBP) identified abnormalities in non-overlapping cortical region pairs. Direct comparison of rsFC between CH and CLBP patients revealed significantly differences in thirteen cortical region pairs, including the four identified in CH and CONCH comparison. Across all three groups (CH, CLBP and CON), the rsFC between left multisensory association area (BA39) and left posterior cingulate cortex (BA23) differed significantly. Eight regions showed CT abnormality in CLBP patients, two of which overlapped with those of CH patients. Our observations support the notion that CH and CLBP pain are pathological conditions, under which the brain develops distinct widespread structural and functional abnormalities. CH and CLBP groups share some similar structural abnormalities, but rsFC abnormalities in several cortical region pairs appear to be pathology-specific. Hum Brain Mapp 38:1815-1832, 2017. © 2017 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Background The Cohen Perceived Stress Scale is being used widely in various countries. The present study evaluated the validity and reliability of the Cohen 10-item Perceived Stress Scale (PSS-10) in assessing tension headache, migraine, and stress-related diseases in Iran. Methods This study is a methodological and cross-sectional descriptive investigation of 100 patients with chronic headache admitted to the pain clinic of Baqiyatallah Educational and Therapeutic Center. Convenience sampling was used for subject selection. PSS psychometric properties were evaluated in two stages. First, the standard scale was translated. Then, the face validity, content, and construct of the translated version were determined. Results The average age of participants was 38 years with a standard deviation (SD) of 13.2. As for stress levels, 12% were within the normal range, 36% had an intermediate level, and 52% had a high level of stress. The face validity and scale content were remarkable, and the KMO coefficient was 0.82. Bartlett’s test yielded 0.327 which was statistically significant (p < 0.0001) representing the quality of the sample. In factor analysis of the scale, the two elements of “coping” and “distress” were determined. A Cronbach’s Alpha coefficient of 0.72 was obtained. This confirmed the remarkable internal consistency and stability of the scale through repeated measure tests (0.93). Conclusion The Persian PSS-10 has good internal consistency and reliability. The availability of a validated Persian PSS-10 would indicate a link between stress and chronic headache. [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]

Purpose Of Review: Chronic headache sufferers are estimated to be around 3% of the population. These patients have a high disease burden. When prophylactic treatments have low efficacy and tolerability, patients are in need of alternative therapeutic strategies and options.Recent Findings: In the last decade, a number of neuromodulation procedures have been introduced as treatment of chronic intractable headache patients when pharmacological treatments fail or are not well tolerated. Neurostimulation of peripheral and central nervous system has been carried out, and now, various non-invasive and invasive stimulation devices are available. Non-invasive neurostimulation options include vagus nerve stimulation, supraorbital stimulation and single-pulse transcranial magnetic stimulation; invasive procedures include occipital nerve stimulation, sphenopalatine ganglion stimulation and hypothalamic deep brain stimulation. In many cases, results supporting their use derive from open-label series and small controlled trial studies. Lack of adequate placebo hampers adequate randomized controlled trials. In this paper, we give an overview on the main neurostimulation procedures in terms of results and putative mechanism of cation. [ABSTRACT FROM AUTHOR]

Background: Although headache is considered a frequently experienced type of pain, the challenges, experiences, and perceptions of people suffering from chronic headaches are poorly understood. The aim of this study was to gain subjective information regarding these aspects in daily life, in order to answer the research question "What is life like with a chronic headache?", Methodology: Semi-structured, in-depth interviews were conducted with 16 patients who suffered from chronic headaches. Five main domains were explored: emotions related to headaches; trauma/stressful events; behavioural changes, relationships, and coping mechanisms., Analysis and Interpretation: Participants reported that pain restricted their lives in many ways, including not being able to work, loss of status, identity, freedom, intimate relationships and friends. The majority believed that psychological and/or physiological trauma was the reason for their headaches. New information that emerged from this study was how common life events not usually considered major traumas, initiated and maintained symptoms. Shame and feelings of stigmatization appeared to be strongly associated with chronic pain, leading to a scenario where thriving, contentment and enjoyment were often lacking., Main Results: This study provided an in-depth understanding of how chronic headache adversely affects the lives of sufferers. Chronic headaches restrict sufferers' lives, resulting in emotional and behavioural changes and a high level of disability. The complexity of chronic headaches in clinical practice is hugely underestimated, and poorly understood by society in general., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Whiplash trauma can result in a range of symptoms, including chronic neck pain, headache, facial pain, upper back pain, and tinnitus, which comprises whiplash-associated disorder (WAD). Intermediate cervical plexus block (iCPB) is a novel intervention that targets the upper cervical nerves and anecdotal reports suggest benefits in WAD., Objectives: We hypothesized that the cervical plexus may have a role in the pathogenesis of WAD and blocking the cervical plexus may provide analgesia., Study Design: Prospective observational trial., Setting: Tertiary pain medicine unit at a university teaching hospital., Methods: Adult patients who presented with refractory chronic neck pain following whiplash were included in a prospective observational trial. The pragmatic trial studied the effectiveness of 2 sequential cervical plexus blocks (iCPB with local anesthetic [iCPB-LA] and iCPB with steroid and LA mixture [iCPB-Steroid]) in refractory chronic neck pain following whiplash. Patients who reported < 50% relief at 12 weeks after iCPB-LA were offered iCPB-Steroid. Primary outcome was "neck pain at its worst in the last 24 hours" at 12 weeks. Secondary outcomes included change in neck disability index, employment status, and mood., Results: After excluding cervical zygapophyseal joint dysfunction, 50 patients underwent the iCPB-LA between June 2020 and August 2022. Five patients reported > 50% relief (durable relief) at 12 weeks and 3 patients were lost to follow-up. Forty-two patients received iCPB-Steroid. iCPB-Steroid was associated with significant reduction in neck pain, neck disability, and improvement in mood at 12 weeks when compared to the block with LA. In addition, iCPB-Steroid was associated with significant reduction in neck pain and disability at 24 weeks. Due to functional improvement, 34 patients (34/50, 78%) were able to maintain employment., Limitations: This is an open-label, observational, single-center study in a limited cohort under a single physician. Cervical facet joint dysfunction was ruled out clinically and radiologically., Conclusions: Cervical plexus may play a central role in the pathogenesis of WAD. iCPB could potentially be a treatment option in this cohort.

Vitamin D Deficiency is a possible factor involved in the etiology of chronic tension-type headache (CTTH). Vitamin D is directly associated with lifestyle and eating habits and affects a large proportion of the general population. The aim of this study was to investigate the role of vitamin D deficiency in CTTH. Patients aged 18 years or older that presented to our Neurology polyclinic with CTTH between December 1, 2017 and March 31, 2018 were reviewed retrospectively. Patients were assigned into three groups based on their Vitamin D levels: (I) deficiency state: <10 ng/mL, (II) insufficiency state: 10-25 ng/mL, and (III) optimal state: 25-70 ng/mL. The groups were compared with regard to age, gender, and Vitamin D levels. The study included a total of 782 patients comprising 32% men and 68% women with a mean age of 34 years. Based on their serum Vitamin D levels, 482 (61.6%) patients were classified into Group I (<10 ng/mL), 211 (27.0%) patients into Group II (10-25 ng/mL), and 89 (11.4%) patients into Group III (>25 ng/mL) and a significant difference was found among the three groups with regard to serum Vitamin D levels (p<0.01). Vitamin D deficiency is an increasingly major health problem due to modern lifestyle. Accordingly, Vitamin D deficiency should be considered in patients presenting with CTTH. [ABSTRACT FROM AUTHOR]

Background Cigarette smoking is common among adults with chronic pain. The primary objective of this study was to determine the period prevalence of smoking in patients with chronic pain. A secondary objective was to determine the prevalence of smoking among patients with commonly occurring pain diagnoses including fibromyalgia, low back pain, and headache. Methods This population study included 5350 patients (1256 smokers, 4094 nonsmokers) admitted to the Mayo Comprehensive Pain Rehabilitation Center from January 1998 through December 2012. Smoking status was determined using a self-report questionnaire. Results During the 15 year study period, the overall prevalence of smoking was 23.5 % (95 % CI 22.4 – 24.6). The prevalence of smoking in 2000, 2005, and 2010 was 24.2, 25.7, and 28.3 % respectively. The overall prevalence of smoking in patients with fibromyalgia, low back pain, and headache was 25.2 % (95 % CI 22.8 – 28.3), 22.8 % (95 % CI 21.3 – 25.9), and 21.2 % (95 % CI 17.9 – 24.7), respectively. In a multiple variable logistic model adjusted for age and sex, opioid use was significantly associated with status as a current smoker. Conclusions The prevalence of smoking in patients with chronic pain has not declined when compared to the general population. The higher prevalence of smoking was consistently observed in commonly occurring pain diagnoses including fibromyalgia, back pain, and headache. Further research is needed to identify the potential factors that contribute to the high prevalence of smoking in this patient population.

Background. A possible link between 3D-movies and headache (HA) has never been a target of specific and systematic investigations. The aim of this study was to investigate the relationship between 3D-cinema and HA and to evaluate possible risk factors of developing HA during or after watching a 3D-movie.Methods. This was a prospective, non-randomised, observational study. Six thousand specifically designed questionnaires were distributed to consecutive cinema visitors. Relative HA risks for 2D- vs 3D-movie visitors, and the effects of background variables were analysed.Results. The questionnaire was filled and returned by 1293 persons. The mean age of responders was 33.0 ± 11.3 years. Individuals who viewed 3D-movies reported HA during or after the movie 1.61 times more often than 2D-movie viewers (11.1% in 3D vs 7.2% in 2D-movies, p=0.017). The risk was higher in women: 2.65 times for 2D (p=0.019) and 1.85 times for 3D-movies (p=0.06), and decreased with age by 4.6% with each year for 2D (p=0.0035) and by 3.2% for 3D-movies (p=0.0098). Among 3D-movie visitors, those with previous HAs were 4.17 times more prone to get a cinema-induced HA (p=0.02). The risk was the highest for persons with migraine (OR=3.37, p=0.001). Conclusions. For the first time it was evidentially shown that 3D-movies can provoke HA. Persons at risk are mostly younger women and/or migraineurs. Based on our results, for those belonging to the aforementioned risk groups it can be mainly recommended to choose passive 3D technology and to view movies from the farthest possible distance.

Objective: To find out the proportion of intracranial abnormalities in patients with chronic headache without neurologic abnormality with the use of computed tomography (CT) and to compare the results with similar studies done previously. Materials and methods: CT images of 56 patients with chronic/recurrent headache and normal neurological findings were reviewed retrospectively. In 38 of 56 patients, both plain and contrast enhanced CT were done. Patients were divided into three groups according to the CT findings: those with no abnormality, those with minor abnormality (that did not alter patient management) and those with clinically significant abnormality. Proportion of patients in each group was found out and results were compared with previous studies with similar study design. Z test was used to evaluate whether the difference in proportions of patients in our study and previous study was statistically significant or not. Results: Of the 56 patients, 50 had normal CT (89.28 %), four had minor abnormality (7.14%) that did not alter patient management and two had significant lesions (3.57%). Contrast enhanced CT did not improve lesion detection. The minor findings detected were sub-ependymal calcifications of Tuberous sclerosis, calcified neurocysticercosis and old lacunar infarctions in external capsule. Clinically significant lesions detected were small ring enhancing lesion (neurocysticercosis or tuberculoma) and pineal cyst. Results of this study were compared with previous study with similar study design. The Z test showed that the difference in proportions in these studies was not statistically significant (p =0.0708 for minor findings and p =0.2033 for significant findings). Conclusion: The proportion of intracranial abnormalities detected by CT in this study was similar to that of previous studies. The use of intravenous contrast material administration did not improve its yield. This corroborates the evidence that the ability of CT scan in detecting significant intracranial pathology is poor in patients with chronic headache without neurologic abnormality. DOI: http://dx.doi.org/10.3126/jonmc.v1i2.7301 Journal of Nobel Medical College (2012), Vol.1 No.2 p.57-63

Hypertrophic pachymeningitis (HP) is a rare disorder of diverse etiology. It presents with headaches, cranial neuropathies and ataxia occurring alone or in combination. Dural biopsy is essential to exclude secondary causes of pachymeningitis. There is paucity of data on biopsied cases of HP. We report three biopsy-proven cases of idiopathic hypertrophic cranial pachymeningitis. All our patients had headaches and multiple cranial neuropathies; ataxia was seen in one patient. One patient had recurrent anterior and posterior cranial neuropathies, while one each had recurrent anterior and posterior cranial neuropathies. Two patients had profound irreversible mono-ocular visual loss. All of them showed prominent pachymeningeal thickening on imaging. Infarcts were seen in one patient, which have rarely been documented. All patients showed biopsy evidence of meningeal thickening and nonspecific chronic inflammation of the dura. The disease may have a remitting and relapsing course, and usually responds to steroids. Clinical improvement was excellent in two patients and modest in one on steroid therapy. All our patients required azathioprine during the course of therapy. Early institution and long-term maintenance of steroid therapy prevents neurologic sequelae. Occurrence of abdominal inflammatory pseudotumor in a patient of HP possibly as part of multifocal fibrosclerosis has not been described earlier.

OBJETIVE: To evaluate the influence of the periodontal disease (PD), a chronic infection, in patients with chronic craniofacial pain complaints. METHOD: Twenty patients with chronic craniofacial pain and PD (CFP group) and 20 patients with PD (PD group) were assessed before and after periodontal treatment (baseline, 30 and 180 days after treatment). The paramenters evaluated were: plaque index, bleeding index, clinical probe insertion, Visual Analogic Scale (VAS) for pain intensity and Numerical Rating Scale (NRS) and Verbal Rating Scale (VRS) for the "chief complaint". RESULTS: After 180 days PD was controlled in both groups (pOBJETIVO: Avaliar a influência da doença periodontal (DP) em pacientes com queixas de dores crônicas crânio-faciais. MÉTODO: Vinte pacientes com dor crônica crânio-facial e DP (CFP group) e 20 pacientes com DP (PD group) foram avaliados antes e depois do tratamento periodontal (baseline, 30 e 180 dias). Avaliações: índice de placa, índice de sangramento gingival, inserção clínica de bolsa, Escala Visual Analógica (VAS) para a dor, Escalas Numérica (NRS) e Verbal (VRS) para as "queixas principais". RESULTADOS: Após 180 dias a DP foi controlada em ambos os grupos (p

Background: Medication overuse headache (MOH) is a secondary headache condition caused by consistently using more medication than necessary to treat headache symptoms. MOH is defined as a headache that occurs for 15 or more days per month in a patient with a pre-existing primary headache, and it develops as a result of regular overuse of symptomatic headache medication for more than three months. Patients with headaches often use simple pain medication for 15 or more days per month (e.g., non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol) and 10 or more days per month of opioids, triptans, and combination analgesics, but when there is no relief from these medications, the headache progression can lead to a cycle of consuming more medication with increased pain, which can lead to MOH., Objective: This study aimed to assess the prevalence and awareness of MOH among the general population of Makkah, Saudi Arabia., Methods: A cross-sectional study was conducted between December 2022 and March 2023 using a self-administered online questionnaire disseminated through social media. Data were collected from females and males 18 years of age and older living in Makkah, Saudi Arabia., Results: Overall, 715 individuals completed the questionnaire, 497 of whom were female (69.5%). The average age of the participants was 32.9 years (±13.3 years). The prevalence of MOH among those who reported having experienced headaches throughout their lifetimes was estimated to be 4.5%. Only 134 people (18.7%) were determined to be aware of MOH., Conclusion: This study demonstrated that the general population of Makkah has a high prevalence of MOH and low levels of MOH awareness., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alharbi et al.)

Background Recent evidence shows that multidisciplinary treatment is effective in chronic pain syndromes, especially in headache disorders. Aim The aim of this review is to summarize current knowledge on integrative care concepts in headache patients regarding the optimal and necessary treatment parts, optimal duration and setting. Methods We present a narrative review reporting current literature and personal experience. Results and conclusion Based on current knowledge, multidisciplinary treatment programs appear to be reasonable and efficient in headache disorders. Sufficient controlled studies regarding the need for individual parts of the integrative care approach are missing as yet. Recommendations are therefore at least partly based on personal experiences. It seems to be unambiguous that patients should be referred to a specialized headache center offering such a program instead of being sent sequentially to various medical specialists. The extent and kind of required therapy (e.g. personal consultation versus group sessions) is not known yet. All patients should learn relaxation training, although it is unclear yet which training is the best for which patient. Physiotherapy with guidance on more activity and individual exercises should be used in all patients. Some patients might benefit from cognitive behavioral therapy. However, therapies often depend more on country-specific health care systems than on clinical needs or scientific data. [ABSTRACT FROM AUTHOR]

Background: Primary headache disorders are among the most common neurological complaints worldwide, and are significant causes of disability. Data are limited on the prevalence of primary headaches among individuals aged 60 years and older in China. The purpose of our study was to investigate the prevalence and characteristics of primary headaches among people aged 60 years and older in a rural area of northern China. Methods: A door-to-door survey was conducted in Ji County of Tianjin Province. A total of 5248 residents aged 60 years and older were visited from 2014 to 2015, unannounced, and basic sociodemographic and headache diagnostic information was collected via a questionnaire. Primary headache was classified tension-type headaches, migraines, chronic headache, and unclassified headache. Results: The 1-year prevalence for primary headaches in Ji county is 10.30 %. The 1-year prevalence of tension-type headaches, migraines, chronic headache, and unclassified headache is 2.02 %, 0.85 %, 3.79 %, and 3.63 %. The 1-year prevalence of primary headache was higher in women than in men. The 1-year prevalence of primary headache was decreased with increasing age. The 1-year prevalence of tension-type headaches and chronic headache were decreased with higher education. Headache in the elderly was mild to moderate and not serious. Conclusions: In a population older than 60 years of age in rural, northern China, we found the 1-year prevalence of primary headache was 10.30 %, of tension-type headaches was 2.02 %, of migraines was 0.85 %, of chronic headache was 3.79 %, and of unclassified headache was 3.63 %. The prevalence of all of these was much lower than those observed in previous studies examining prevalence rates in the general population. The results of our study also indicated that women are more likely to have primary headache than men. We also found that chronic headache was frequent among the elderly. Participants with higher education levels were more predisposed than healthy participants to tension-type headaches. We also found that respondents who did not participate in social activities had a decreased predisposition for primary headache in general, as well as for unclassified headache. Lastly, we found that participants who had heart disease were more likely than healthy participants to experience primary headache, tension-type headache, chronic headache, and unclassified headache. [ABSTRACT FROM AUTHOR]

Background: A possible link between 3D movies and headache (HA) has never been a target of specific and systematic investigations. The aim of this study was to investigate the relationship between 3D cinema and HA and to evaluate possible risk factors of developing HA during or after watching a 3D movie. Methods: This was a prospective, non-randomized, observational study. Six thousand specifically designed questionnaires were distributed to consecutive cinema visitors. Relative HA risks for 2D- vs. 3D-movie visitors and the effects of background variables were analyzed. results: The questionnaire was filled and returned by 1293 persons. The mean age of responders was 33.0 ± 11.3 years. Individuals who viewed 3D movies reported HA during or after the movie 1.61 times more often than 2D-movie viewers (11.1% in 3D vs. 7.2% in 2D movies, p = 0.017). The risk was higher in women: 2.65 times for 2D (p = 0.019) and 1.85 times for 3D movies (p = 0.06), and decreased with age by 4.6% with each year for 2D (p = 0.0035) and by 3.2% for 3D movies (p = 0.0098). Among 3D-movie visitors, those with previous HAs were 4.17 times more prone to get a cinema-induced HA (p = 0.02). The risk was the highest for persons with migraine (OR = 3.37, p = 0.001). conclusion: For the first time, it was evidentially shown that 3D movies can provoke HA. Persons at risk are mostly younger women and/or migraineurs. Based on our results, for those belonging to the aforementioned risk groups, it can be mainly recommended to choose passive 3D technology and to view movies from the farthest possible distance. [ABSTRACT FROM AUTHOR]

Background: Recurrent and especially chronic headaches are associated with psychiatric comorbidities such as depression and anxiety. Only few studies examined the impact of depression and anxiety on episodic (EH) and chronic headache (CH), and data for Austria are missing at all. Therefore, the aim of the present study was to assess the impact of depression and anxiety on burden and management of EH and CH in patients from eight Austrian headache centres. Methods: We included 392 patients (84.1 % female, mean age 40.4 ± 14.0 years) who completed the Eurolight questionnaire. The treating physician recorded details about ever-before prophylactic medications. We used Hospital Anxiety and Depression Scale to assess depression and anxiety and compared patients with anxiety and/or depression to those without. Results: Depression and anxiety were more common in CH than in EH (64 % vs. 41 %, p < 0.0001). Presence compared to absence of depression and anxiety increased the prevalence of poor or very poor quality of life from 0.7 % to 13.1 % in EH and from 3.6 % to 40.3 % in CH ( p = 0.001; p < 0.0001). Depression and anxiety had a statistically significant impact on employment status and on variables related to the burden of headache such as reduced earnings, being less successful in career, or feeling less understood. Neither in EH nor in CH health care use and the ever-before use of prophylactic medication was correlated with anxiety and/or depression. Conclusion: Depression and anxiety have a significant impact on quality of life and increase the burden in patients with EH and CH. Improved multidimensional treatment approaches are necessary to decrease disability on the personal, social and occupational level in these patients. [ABSTRACT FROM AUTHOR]