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The co-occurrence of bruxism, temporomandibular disorders (TMDs), and headache is common in patients. However, there is conflicting evidence regarding whether this association is simply a result of their high prevalence or whether there are indeed causal relationships. This review provides an overview of the current state of research while taking into account the controversies surrounding research methods, particularly in definitions and diagnostic standards. Bruxism—defined as repetitive jaw muscle activity during sleep or wakefulness—is not a painful disorder but may—particularly in co-occurrence with TMD—worsen preexisting headache. It seems important to differentiate between sleep and awake bruxism because of different impact on pathophysiological processes in different primary headache disorders such as migraine and tension-type headache. Temporomandibular disorder is a heterogenous entity with both myofascial and arthrogenous types of pain in addition to nonpainful disorders. Research suggests a correlation between TMD pain and migraine, as well as between awake bruxism and tension-type headache. However, psychosocial factors may act as confounders in these relationships. Determining causality is challenging because of the limited number of experimental and clinical studies conducted on this topic. The main finding is an apparent lack of consensus on the definition and assessment criteria for bruxism. Treatment wise, it is important to differentiate all 3 conditions because treatment of one condition may have an effect on the other 2 without proving causality. For future research, it is crucial to establish greater consistency and applicability in diagnostic procedures and definitions. In addition, more experimental and clinical studies investigating the question of causality are needed. [ABSTRACT FROM AUTHOR]

Key Clinical Message: The use of DN to the muscular trigger points and distal periosteal enthesis of the levator scapulae may be a useful adjunct intervention within a multi‐modal plan of care for the management of work‐related chronic tension‐type headaches associated with LSS. Chronic tension‐type headaches (CTTH) have a lifetime prevalence of 42% and account for more lost workdays than migraine headaches. Dry needling (DN) is being increasingly used by physical therapists in the management of CTTH; however, to date, the supporting evidence is limited. The purpose of this case report was to describe how three sessions of DN targeting myofascial trigger points in the levator scapulae (LS) muscle and its distal enthesis was used to treat a 63‐year‐old male patient who presented with work‐related CTTH associated with levator scapulae syndrome (LSS). The patient was treated for five visits over the course of 2 months. At discharge and 6‐month follow‐up, the patient reported full resolution of symptoms. Self‐report outcomes included the numeric pain rating scale and the Neck Disability Index. The use of DN to the LS muscle and its distal enthesis may be a valuable addition to a multi‐modal plan of care in the treatment of work‐related CTTH associated with LSS. [ABSTRACT FROM AUTHOR]

Objective: The aim of this investigation was to compare the thickness of the deep local muscles in the neck region, as well as local and widespread sensitivity and functionality, between individuals with migraine, Tension-Type Headache (TTH), and healthy controls. To date, we know that the onset of migraine and TTH share similar pathophysiological pathways. Nevertheless, there may be some anatomical and functional differences which would explain why clinicians may obtain variable results when treating both pathological entities with similar or equal approaches. Methods: An observational study was conducted in accordance with STROBE guidelines. The flexor longus colli and multifidus, two neck-stabilizing muscles, were measured using B-mode ultrasound imaging. The upper trapezius, masseter, temporalis, tibialis anterior, and median nerve all underwent bilateral pressure-pain threshold (PPT) assessments. Results: Ninety participants were enrolled in the study. All subjects were equally divided into TTH, migraine and control groups. The PPT values exhibited lower thresholds in patients with TTH than both migraine and healthy participants. Specifically, in the temporal muscle on both sides, patients with TTH exhibited a significantly lower threshold (p < 0.001)than both migraine and healthy participants. Patients with TTH displayed significantly lower thresholds in both upper trapezius muscles (right: p < 0.001; left: p = 0.001). Similar results were obtained for the tibialis anterior PPTs from both sides (p = 0.001 in both). However, both clinical groups exhibited lower thresholds than the healthy subjects (p < 0.001). In multifidus muscle cross-sectional area (CSA), no statistically significant differences were found between migraine patients and healthy subjects, both in relaxation and contraction (right; p > 0.05 and p > 0.05; left: p > 0.05 and p > 0.05). However, patients with TTH exhibited a smaller CSA than both migraine patients and healthy controls in multifidus relaxed and contracted state (right: p < 0.001 in both relaxed and contracted multifidus; left: p = 0.001 and p < 0.001, respectively). Similar results were obtained for the left longus colli muscle in both relaxation and contraction for patients with TTH and migraine compared with healthy subjects (p = 0.001 and p < 0.001, respectively, for muscle relaxation and p < 0.001 for muscle contraction). However, no significant differences were observed between patients with TTH and migraine (p < 0.05 in both relaxation and contraction). In the right longus colli, TTH and migraine patients had a significantly smaller CSA during contraction than healthy subjects (p < 0.001 in both comparisons). In the craniocervical flexion test, both groups of patients with TTH and migraine showed significantly lower values than healthy subjects (p < 0.001 in both comparisons). However, no significant differences were found between patients with TTH and migraineurs (p > 0.05). Conclusion: The findings provide a significant message for clinicians since anatomical and functional impairments were shown in patients with TTH and migraine. This study corroborates a lack of strength and smaller CSA in both clinical groups compared to controls. Therefore, strengthening programs may be addressed successfully for people with these pathological entities. To be more accurate, according to PPTs and CSA lower values in patients with TTH compared to migraine and controls, manual therapy approaches to desensitize craniocervical soft tissues and exercise therapy to increase endurance of deep cervical muscles may become meaningful especially in subjects with TTH. Nevertheless, in order to distinguish precisely between patients with TTH and migraine, different diagnostic strategies may be used in the future to describe these populations in further detail, which will assist health professionals in a more accurate treatment selection. [ABSTRACT FROM AUTHOR]

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Copyright of Osmangazi Journal of Medicine / Osmangazi Tip Dergisi is the property of Eskisehir Osmangazi University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: It was aimed to determine the etiological and clinical features of pediatric patients with headache complaints. Methods: The files of patients who were admitted to the pediatric neurology outpatient clinic with headache were reviewed retrospectively. Patients' age, gender, features of headache, symptoms accompanying headache, available blood tests, brain magnetic resonance (MR) and electroencephalography (EEG) results were recorded. Results: Of the total 470 patients, aged between 3 and 17 years, 291 (61.9%) were female and 179 (39.1%) were male. The mean age of the patients was 12.38±3.45 years. According to age groups, there were 16 (3.4%) patients under the age of 5, 159 (33.8%) between the ages of 6-11, and 295 (62.8%) patients aged 12-17 years. While 289 (61.5%) patients were diagnosed with primary headache, 122 (26.0%) patients were diagnosed with secondary headache, and headaches of 59 (12.5%) patients could not be classified. The most common primary headaches were tension-type headache (TTN) (n=177, 37.7%) and migraine (n=111, 23.6%). The 86 (70.5%) of the patients with secondary headache were diagnosed with sinusitis. Abnormal neurological examination finding was determined in 8 (1.7%) patients. Brain MR was performed in 439 (93.4%) of all patients and abnormal brain MR findings were detected in 52 (11.8%) patients. EEG was performed in 205 (43.6%) of all patients and abnormal EEG findings were detected in 24 (11.7%) patients. Conclusion: According to age groups, headache was most common in the 12-17 age group. The most common causes of headache were TTN and migraine, respectively. The most common secondary headache cause was sinusitis. We think that physical and neurological examination still maintains its priority in determining the causes of headache. [ABSTRACT FROM AUTHOR]

Key Clinical Message The use of DN to the muscular trigger points and distal periosteal enthesis of the levator scapulae may be a useful adjunct intervention within a multi‐modal plan of care for the management of work‐related chronic tension‐type headaches associated with LSS. Abstract Chronic tension‐type headaches (CTTH) have a lifetime prevalence of 42% and account for more lost workdays than migraine headaches. Dry needling (DN) is being increasingly used by physical therapists in the management of CTTH; however, to date, the supporting evidence is limited. The purpose of this case report was to describe how three sessions of DN targeting myofascial trigger points in the levator scapulae (LS) muscle and its distal enthesis was used to treat a 63‐year‐old male patient who presented with work‐related CTTH associated with levator scapulae syndrome (LSS). The patient was treated for five visits over the course of 2 months. At discharge and 6‐month follow‐up, the patient reported full resolution of symptoms. Self‐report outcomes included the numeric pain rating scale and the Neck Disability Index. The use of DN to the LS muscle and its distal enthesis may be a valuable addition to a multi‐modal plan of care in the treatment of work‐related CTTH associated with LSS.

ObjectiveThe aim of this investigation was to compare the thickness of the deep local muscles in the neck region, as well as local and widespread sensitivity and functionality, between individuals with migraine, Tension-Type Headache (TTH), and healthy controls. To date, we know that the onset of migraine and TTH share similar pathophysiological pathways. Nevertheless, there may be some anatomical and functional differences which would explain why clinicians may obtain variable results when treating both pathological entities with similar or equal approaches.MethodsAn observational study was conducted in accordance with STROBE guidelines. The flexor longus colli and multifidus, two neck-stabilizing muscles, were measured using B-mode ultrasound imaging. The upper trapezius, masseter, temporalis, tibialis anterior, and median nerve all underwent bilateral pressure-pain threshold (PPT) assessments.ResultsNinety participants were enrolled in the study. All subjects were equally divided into TTH, migraine and control groups. The PPT values exhibited lower thresholds in patients with TTH than both migraine and healthy participants. Specifically, in the temporal muscle on both sides, patients with TTH exhibited a significantly lower threshold (p 0.05 and p > 0.05; left: p > 0.05 and p > 0.05). However, patients with TTH exhibited a smaller CSA than both migraine patients and healthy controls in multifidus relaxed and contracted state (right: p 0.05).ConclusionThe findings provide a significant message for clinicians since anatomical and functional impairments were shown in patients with TTH and migraine. This study corroborates a lack of strength and smaller CSA in both clinical groups compared to controls. Therefore, strengthening programs may be addressed successfully for people with these pathological entities. To be more accurate, according to PPTs and CSA lower values in patients with TTH compared to migraine and controls, manual therapy approaches to desensitize craniocervical soft tissues and exercise therapy to increase endurance of deep cervical muscles may become meaningful especially in subjects with TTH. Nevertheless, in order to distinguish precisely between patients with TTH and migraine, different diagnostic strategies may be used in the future to describe these populations in further detail, which will assist health professionals in a more accurate treatment selection.

Abstract Background Previous studies in headache patients measured the cerebrovascular reactivity (CVR) in response to photic stimulation but they have yielded contradictory results. The purpose of study was to measure CVR of both migraine and chronic tension headache (TTH) patients in response to photic stimulation. Methods The study included 37 migraineurs and 24 chronic TTH patients compared with 50 age- and sex-matched healthy volunteers. Peak systolic, end diastolic, mean flow velocities and CVR (PSV, EDV, MFV, and CVR) were measured using TCD ultrasonography of the middle, anterior, posterior cerebral and vertebral arteries (MCA, ACA, PCA, and VA) before and after 100 s of 14 Hz photic stimulation. Results A three-way repeated measures ANOVA interaction with main factors of Vessels (MCA, ACA, PCA, VA), Time (pre-post photic) and Groups (migraine, TTH, and control group) revealed significant 3-way interactions for measures of PSV (P = 0.012) and MFV (P = 0.043). In the migraine patients there was significantly higher PSV, EDV, and MFV in the MCA, ACA, and PCA after photic stimulation compared with baseline. The CVR of the MCA was also significantly higher in migraineurs than controls. In the TTH group, there was significantly higher PSV, EDV, and MFV (P = 0.003, 0.012, 0.002 respectively) in the VA after photic stimulation than at baseline. The CVR was significantly higher in the VA of TTH patients than controls. Conclusion Compared with controls after photic stimulation, the higher CVR of the MCA in migraineurs and of the VA in TTH patients could be used as diagnostic tool to differentiate between the two types of headaches.

Headache(TTH). The headache is associated with vestibular impairment (VI) and neck pain, but this association has not been studied in elder population. Objective: To determine the association of common types of headaches with vestibular impairment and neck pain in elderly. Methods: A cross sectional study was conducted from February 2021 to June 2021 at District Headquarters Hospital Narowal using a non-probability convenience sampling technique on n=140 participants. The inclusion criteria include age above 50 years, able to ambulate independently, complaint history of common type of headache. Headache was assessed clinically based on diagnostic criteria. The head impulse test was used to assess the vestibular function. The neck pain presence was asked through close ended question with binary response. The chi-square (x2) test used for association between the variables. Results: The mean age of the participants was 58.17 ± 7.14 years. The tension type headache was seen in n=76 (54.2%), migraine in n=33 (23.5%) and cervicogenic headache in n=31 (22.1%) patients. Vertigo was seen in n=52 (37%) patients and neck pain in n=82 (58%) patients. A significant association of vestibular impairment with migraine (Chi square value= 7.79, p=0.02) and cervicogenic headache (Chi square value= 6.12, p=0.04). While no significant association with tension type headache (Chi square value= 0.97, p=0.04). All type of headache were significantly associated (p

Background: Previous studies in headache patients measured the cerebrovascular reactivity (CVR) in response to photic stimulation but they have yielded contradictory results. The purpose of study was to measure CVR of both migraine and chronic tension headache (TTH) patients in response to photic stimulation. Methods: The study included 37 migraineurs and 24 chronic TTH patients compared with 50 age- and sex-matched healthy volunteers. Peak systolic, end diastolic, mean flow velocities and CVR (PSV, EDV, MFV, and CVR) were measured using TCD ultrasonography of the middle, anterior, posterior cerebral and vertebral arteries (MCA, ACA, PCA, and VA) before and after 100 s of 14 Hz photic stimulation. Results: A three-way repeated measures ANOVA interaction with main factors of Vessels (MCA, ACA, PCA, VA), Time (pre-post photic) and Groups (migraine, TTH, and control group) revealed significant 3-way interactions for measures of PSV (P = 0.012) and MFV (P = 0.043). In the migraine patients there was significantly higher PSV, EDV, and MFV in the MCA, ACA, and PCA after photic stimulation compared with baseline. The CVR of the MCA was also significantly higher in migraineurs than controls. In the TTH group, there was significantly higher PSV, EDV, and MFV (P = 0.003, 0.012, 0.002 respectively) in the VA after photic stimulation than at baseline. The CVR was significantly higher in the VA of TTH patients than controls. Conclusion: Compared with controls after photic stimulation, the higher CVR of the MCA in migraineurs and of the VA in TTH patients could be used as diagnostic tool to differentiate between the two types of headaches. [ABSTRACT FROM AUTHOR]

Background: Headache disorders now represent a major public health problem globally. It is more prevalent in developing countries with the rising trends of headache disorders observed in young adults affecting their quality of life negatively. Very little information is available on the epidemiology of headache disorders in the Jammu Division of the north Indian population. Aim: The aim of the present study was to find out the prevalence of headache and its two major types, i.e., migraine and tension-type headache (TTH), in the population of the Jammu Division. Methods: The present study was conducted in two phases: (Phase I: face-to-face interview and Phase II: E-based sampling) and the sufferers of headaches were incorporated into the study based on the International Classification of Headache Disorder-3 (ICHD-3) criteria for a representative sample. Frequency distribution and mean ± standard deviation were used in descriptive statistics to describe the data sets, while a t-test, chi-square test, multiple logistic regression, and prevalence ratio were used in inferential statistics. Results: In the present study, a total of 3,148 patients were recruited, with an overall prevalence of headache of 53.84%, with a majority of females (38.18%) over males (15.66%). As regards the type of headache, migraine was found to be of the more prevalent (33.25%) type than the TTH (20.58%). Females suffering from migraine showed the highest prevalence (25.28%), in contrast to females suffering from the TTH (12.89%). Sociodemographic variables, such as gender [female; AOR = 2.46, 95% CI (2.12-2.85), p-value < 0.0001] and marital status [married; AOR: 1.46, 95% CI (1.11-1.92) p-value = 0.006], showed a significant association with the headache. Conclusion: The present study shows that the prevalence of headache is high in the Jammu Division of Jammu and Kashmir (J&K) India, with migraine being the highly prevalent type. [ABSTRACT FROM AUTHOR]

The bulk of patients with primary headaches HA (cephalalgias) are observed in primary care. The optimal diagnostic algorithm implies the exclusion of potentially dangerous causes of HA and secondary cephalalgias requiring specific treatment. Verification of the form of primary HA is carried out clinically, does not require additional diagnostic methods and is based on the use of the criteria of the International Classification of Headache Disorders. Among all cephalalgias in general clinical practice, the vast majority of cases are represented by four forms: migraine, tension type headache, cluster headache, and medication overuse headache. The complex application of modern methods of pharmacological and non-pharmacological treatment with the use of preventive strategies ensures high efficiency in the management of patients with HA.

BackgroundHeadache disorders now represent a major public health problem globally. It is more prevalent in developing countries with the rising trends of headache disorders observed in young adults affecting their quality of life negatively. Very little information is available on the epidemiology of headache disorders in the Jammu Division of the north Indian population.AimThe aim of the present study was to find out the prevalence of headache and its two major types, i.e., migraine and tension-type headache (TTH), in the population of the Jammu Division.MethodsThe present study was conducted in two phases: (Phase I: face-to-face interview and Phase II: E-based sampling) and the sufferers of headaches were incorporated into the study based on the International Classification of Headache Disorder-3 (ICHD-3) criteria for a representative sample. Frequency distribution and mean ± standard deviation were used in descriptive statistics to describe the data sets, while a t-test, chi-square test, multiple logistic regression, and prevalence ratio were used in inferential statistics.ResultsIn the present study, a total of 3,148 patients were recruited, with an overall prevalence of headache of 53.84%, with a majority of females (38.18%) over males (15.66%). As regards the type of headache, migraine was found to be of the more prevalent (33.25%) type than the TTH (20.58%). Females suffering from migraine showed the highest prevalence (25.28%), in contrast to females suffering from the TTH (12.89%). Sociodemographic variables, such as gender [female; AOR = 2.46, 95% CI (2.12–2.85), p-value < 0.0001] and marital status [married; AOR: 1.46, 95% CI (1.11–1.92) p-value = 0.006], showed a significant association with the headache.ConclusionThe present study shows that the prevalence of headache is high in the Jammu Division of Jammu and Kashmir (J&K) India, with migraine being the highly prevalent type.

Background and Objectives: Tension type headache is one of the costliest primary headaches which can cause a significant impact on an individual's life. Healthcare professionals are exposed to multiple trigger factors which give rise to an increase in headache frequency, most notable reasons being sleep disturbances, stress and untimely food habits. With this background, we conducted this study of detailed clinical profile and trigger factors among the 2050 subjects (MBBS students: 909, BDS students: 323, nursing students: 268, postgraduates students and staff: 550) in our medical institute.Materials and Methods: Subjects were given questionnaires on headache and were instructed to give the details of their clinical symptoms along with relevant questions on trigger factors. The assessment tools used were the Visual Analogue Scale (VAS) and Migraine Disability Assessment Scale (MIDAS).Results: Out of 2050 subjects, 464 patients suffered from tension type headache. Overall prevalence of tension type headache was 22.6%. Prevalence was higher in females (57.9%) as compared to males (42.1%). Headache experienced by majority of the student population was unilateral (31.4%), pulsating type (51.6%) and of moderate intensity (77.1%). Common associated symptoms were nausea associated with other factors (40%) and photophobia and phonophobia (18.6%). Stress (72.1%) and decreased sleep (49.4%) were the most common triggering factors. Practice of self-medication was reported by 80.2% of subjects.Conclusion: Our study noted a high frequency of trigger factors in medical professionals, the most common triggering factors being stress and disturbed sleep. To our knowledge this is the first large study to evaluate headache and specifically tension type headache among medical professionals. [ABSTRACT FROM AUTHOR]

Purpose: The retinochoroidal evaluation in tension type headache (TTH) was aimed in this study. Materials and Methods: This case-controlled study conducted in Ordu University Training and Research Hospital included 92 patients, 62 of whom with TTH. Group 1 included 30 (32.6%) TTH patients with photophobia, Group 2 included 32 (34.8%) TTH patients without photophobia and Group 3 included 30 (32.6%) healthy control (HC) subjects. All patients underwent complete neurological and ophthalmological examinations including optical coherence tomography (OCT). Results: Subfoveal choroidal thickness (SCT) value was measured significantly higher, whereas average ganglion cell-innerplexiform layer (GCIPL) thickness, GCIPL in the superior and superonasal sectors were measured significantly lower in Group 1 compared to Group 3. Comparing Group 1 and 2, SCT was significantly thicker and GCIPL thickness in the superonasal sector was significantly thinner in Group 1. When total patients with TTH taken into consideration, TTH patients demonstrated a thicker SCT and thinner GCIPL thickness in the superior and superonasal sector than the controls. Discussion: TTH seems to demonstrate thicker SCT and thinner GCIPL in selected sectors, with the photophobia accentuating these effects. [ABSTRACT FROM AUTHOR]

Objective: We conducted a systematic review and dose–response meta‐analysis to investigate the association between body mass index (BMI) and primary headache disorder subtypes and to clarify the shape of this relationship. Methods: PubMed and Scopus were searched from inception to September 2020. Observational studies reporting the risk estimates of primary headache disorders across categories of BMI were included. We restricted our systematic search to articles published in English. Meta‐analyses, reviews, letters to editor, case reports/case series, and abstracts with inadequate data were excluded. We used the Joanna Briggs Institute's critical appraisal tool to assess the quality of the studies included in the meta‐analyses. One author extracted data from each study by using prespecified data extraction forms. Results: In total, 41 observational studies investigating the association between BMI and different primary headache disorders with 154,044 cases and 792,500 participants were included. Among subtypes of headache disorders, the risk of migraine significantly increased in subjects who were either underweight or had obesity compared to those with normal BMI (odds ratio [OR] = 1.21, 95% confidence interval [CI]: 1.09–1.34, I2 = 6.2%; OR = 1.28, 95% CI: 1.15–1.43, I2 = 89.7%, respectively). However, there was limited evidence to support the association between BMI and the risk of other subtypes of primary headache disorders. A nonlinear association was found between BMI and migraine (p nonlinearity <0.0001), and the lowest risk was observed in BMI around 20 and increased at BMI values >29. Conclusion: This meta‐analysis suggests through a nonlinear association an increased risk of migraine among individuals who are either underweight or obese. These results support the recommendation that headache disorders' prevention will benefit from weight control. [ABSTRACT FROM AUTHOR]

Background: Clinical presentation is the key to the diagnosis of patients with migraine and tension-type headache, but features may overlap when both become chronic. Psychophysical parameters may distinguish both conditions. We aimed to compare psychophysical aspects of patients with chronic migraine, chronic tension-type headache and headache-free controls, and to determine whether these can predict headache frequency.Methods: An examiner blinded to the diagnosis assessed 100 participants (chronic migraine (n = 38), chronic tension-type headache (n = 31) and controls (n = 31)). Assessed variables included painful area, pressure pain thresholds, temporal summation, cervical range of motion, neck posture, headache and neck impact, quality of life, and kinesiophobia. Comparison between groups was performed with one-way ANOVA and multiple linear regression was used to assess the headache frequency predictors.Results: We found differences of both headache groups compared to controls (p < 0.01), but not between headache groups. Neck disability was a significant predictor of headache frequency for chronic tension-type headache (adjusted R2 = 0.14; β = 0.43; p = 0.03) and chronic migraine (adjusted R2 = 0.18; β = 0.51; p < 0.01).Conclusions: Chronic tension-type headache and chronic migraine showed similar psychophysical results, but were significantly worse when compared to controls. The psychophysical examination did not discriminate between headache types. The variable best explaining headache frequency for both headache types was neck disability. [ABSTRACT FROM AUTHOR]

Pendahuluan: Tension Type Headache (TTH) dapat dipengaruhi banyak faktor, beberapa di antaranya adalah stres dan kadar hormon kortisol. Beberapa penelitian telah menganalisa hubungan nyeri kepala terhadap kortisol, dan stres. Namun, jarang ada penelitian yang menghubungkan ketiganya. Tujuan: Membuktikan adanya hubungan antara intensitas nyeri kepala, stres psikologis dan kadar kortisol serum pada penderita TTH. Metode: Jenis penelitian adalah analitik observasional dengan rancangan cross sectional dengan uji korelasi. Hasil: Pada penelitian ini didapatkan 42 subyek penelitian. Dari pengolahan data, didapatkan p= 0,594. Yang berarti tidak ada korelasi signifikan antara intensitas nyeri kepala dengan stres psikologis. Sementara itu, pada intentistas nyeri kepala dengan kadar kortisol didapatkan korelasi signifikan dengan p= 0,04. Pada stres dan kadar kortisol tidak ditemukan korelasi signifikan dengan p= 0,154. Kesimpulan: Ada hubungan yang signifikan antara intensitas nyeri kepala dengan kadar kortisol serum. Sebaliknya, pada intensitas nyeri kepala dengan stres psikologis dan stres psikologis dengan kadar kortisol serum, tidak memiliki hubungan yang signifikan.

Patients with primary headaches are prone to frequent uncontrolled use of analgesics, leading to medication-overuse headache (MOH). One of the most accessible and effective strategies for its prevention is informing patients about the potential danger of its development. For this, training programs («schools») are conducted.Objective: to evaluate the effectiveness of educational programs in management of patients with MOH and its prevention.Patients and methods. We included 120 patients (12 men and 108 women, mean age: men – 46.3±3.54 years, women – 41.3±9.5 years) with primary headache and MOH. The follow-up period was 12 months. First, patients were divided into two groups depending on the clinical diagnosis: group I (n=44) – patients with chronic primary headaches without MOH, group II (n=76) – patients with chronic primary headaches and MOH. Then, patients in each group were randomized into subgroups depending on the prescribed therapy. All participants underwent repeated clinical examinations and questionnaires assessment at 1-, 3- and 12-months follow-ups. In addition, all patients kept a headache diary. An educational «school» developed for this study was held in those subgroups where educational programs were specified.Results and discussion. We observed a significant decrease in mean Headache-Attributed Lost Time (HALT) and Headache Impact Test (HIT-6) scores (р

Melatonin is a hormone secreted 80% by epiphysis and 20% by extrapineal structures. It performs several functions including chronobiotic, antioxidant, oncostatic, immune modulating, normothermal, and anxiolytic functions. There are numorouse studies demonstrating melatonin efficacy in relation to chronic pain syndromes. The present paper reviews the studies on melatonin use in various forms of headaches, and chronic back pain. The paper discusses the possible mechanisms of analgesia. Circadian rhythm normalization results in sleep improvement, which is disordered in chronic pain syndromes, hence there is evidence of melatonin-independent analgesic effect involving melatonin receptors. [ABSTRACT FROM AUTHOR]

Abstract Background Migraine, tension type headache (TTH), and hypothyroidism are clinical problems that affect patient daily activities and quality of life. Objectives The purpose of this study was to investigate the potential association between hypothyroidism in patients with migraine and TTH. Patients and methods Two hundred and twelve patients with migraine and TTH and one hundred control subjects underwent clinical evaluation, assessment of thyroid hormones, and thyroid ultrasound. Results Subclinical and overt hypothyroidism were significantly higher in patients with migraine and TTH (P = 0.001) than control subjects. Patients with migraine and TTH showed significantly more abnormal thyroid gland morphology than healthy control (P = 0.027). Hypothyroidism is significantly expressed in chronic TTH more than TTH with infrequent or frequent TTH (P = 0.009). Conclusions Patients having migraine and TTH more prone to develop hypothyroidism when compared with control group. Also patients with chronic TTH are susceptible to develop hypothyroidism (either subclinical or overt) when compared with patients having frequent or infrequent TTH.

Abstract Background Pharmacological treatment of patients with tension-type headache (TTH) includes symptomatic (acute) and prophylactic (preventive) medication. No previous study has investigated variables associated to symptomatic medication intake in TTH. Our aim was to assess the association of clinical, psychological and neurophysiological outcomes with the use and timing of the use of symptomatic medication in TTH. Methods A longitudinal observational study was conducted. One hundred and sixty-eight (n = 168) patients with TTH participated. Pain features of the headache (intensity, frequency, duration), burden of headache (Headache Disability Inventory), sleep quality (Pittsburgh Sleep Quality Index), anxiety/depression (Hospital Anxiety and Depression Scale), trait/state anxiety levels (State-Trait Anxiety Inventory), and bilateral pressure pain thresholds on the temporalis, C5-C6 joint, second metacarpal and tibialis anterior were assessed. Symptomatic medication intake was also collected for a 6-months follow-up period. Differences between patients using or not using symptomatic medication, depending on self-perceived effectiveness, and time (early during an attack, i.e., the first 5 min, or when headache attack is intense) when the symptomatic medication was taken were calculated. Results One hundred and thirty-six (n = 136, 80%) reported symptomatic medication intake for headache (73% NSAIDs). Sixteen (12%) reported no pain relief, 81 (59%) experienced moderate relief and 39 (29%) total pain relief. Fifty-eight (43%) took ‘early medication’ whereas 78 (57%) took ‘late medication’. Patients taking symptomatic medication in general showed lower headache frequency and lower depressive levels than those patients not taking medication. Symptomatic medication was more effective in patients with lower headache history, frequency, and duration, and lower emotional burden. No differences in pressure pain sensitivity were found depending on the self-perceived effectiveness of medication. Patients taking ‘late symptomatic’ medication exhibited more widespread pressure pain sensitivity than those taking ‘early medication’. Conclusions This study found that the effectiveness of symptomatic medication was associated with better headache parameters (history, frequency, or duration) and lower emotional burden. Further, consuming early symptomatic medication at the beginning of a headache attack (the first 5 min) could limit widespread pressure pain sensitivity.

Abstract Background In the ongoing Global Campaign endeavour to improve knowledge and awareness of headache prevalence worldwide, Mongolia is a country of interest. It sits between Russia and China, in which prevalence is, respectively, much higher and much lower than the estimated global mean. We conducted a population-based study in Mongolia both to add to knowledge and to inform local health policy. Methods Using standardized methodology with cluster random sampling, we selected Mongolian adults (aged 18–65 years) from five regions reflecting the country’s diversities. They were interviewed by trained researchers, cold-calling at their homes, using the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) structured questionnaire following pilot-testing. ICHD-3 beta diagnostic criteria were applied. Results N = 2043 (mean age 38.0 [±13.4] years, 40% urban-dwelling and 60% rural), with a non-participation proportion of 1.7%. Males were somewhat underrepresented, for which corrections were made. The crude 1-year prevalence of any headache was 66.1% (95% CI: 64.0–68.2%), with a strong female preponderance (OR: 2.2; p

Susanne Hwiid Klausen,1 Gitte Rønde,1 Birte Tornøe,2 Lene Bjerregaard3 1Department of Pediatrics, Zealand University Hospital, Roskilde, Denmark; 2Department of Health Sciences, Lund University, Lund, Sweden; 3Open Patient Data Explorative Network (OPEN), University of Southern Denmark (SDU), Odense, DenmarkCorrespondence: Susanne Hwiid KlausenDepartment of Pediatrics, Zealand University Hospital, Køgevej 10, Roskilde 4000, DenmarkTel +45 24416410Email susannehwiid@hotmail.comPurpose: Children and adolescents with primary headache are at risk of persistent somatic symptoms and reduced quality of life (Qol) due to pain and pain-related behaviors, such as avoiding school and activities. Sleep is essential to health, and children and adolescents with primary headaches have more sleep complaints than do healthy controls. A treatment approach that addresses multifactorial causes is likely important. Nonpharmacological interventions seem promising. However, knowledge about effective strategies is limited. The objective of this review is to assess the effect of nonpharmacological interventions in randomized controlled trials (RCTs) among children and adolescents with primary headache in order to identify useful strategies.Patients and methods: Outcome measures are pain, sleep, Qol, and coping versus no intervention or control intervention. Medline, CINAHL, EMBASE, and PsycINFO were searched for eligible trials. ClinicalTrials.gov. was searched for ongoing trials. Initial searches yielded 2588 publications. After initial screening and subsequent full-text review and quality assessment, 13 RCTs reported in 15 articles were selected for review. All reviewers independently assessed study quality using the CONSORT criteria for nonpharmacological interventions.Results: Cognitive behavioral therapy (CBT), including education on pain-related topics, sleep, coping, and stress management, is an effective strategy for reducing headache and pain within groups over time. Fifteen studies assessed pain, 3 studies assessed sleep, 6 studies assessed Qol, and 11 studies assessed coping.Conclusion: Strategies identified as useful were parts of CBT interventions. However, it was not possible to identify a single effective intervention addressing pain, sleep, Qol, and coping in children and adolescents with headache, primarily because sleep was infrequently addressed. Various aspects of Qol and coping strategies were assessed, rendering comparison difficult. Strategies for future interventions should include descriptions of theory-driven CBT interventions, depending on clinical setting and based on local resources, to promote a solid evidence base for nonpharmacological interventions.Keywords: tension-type headache, migraine, pain, sleep, quality of life, coping

Headache is consistently one of the most common complaints reported by patients in the medical setting worldwide. Headache can be a symptom of another condition or illness, secondary to the disruption of homeostasis, or can be a primary disorder with inherent variability and patterns. Headache disorders, whether primary or secondary, can cause significant disability and loss of quality of life for those affected. As such, it is important for primary care providers to feel confident evaluating and treating patients with headache, especially given the limited access to Headache Medicine subspecialists., Competing Interests: Disclosure None., (Published by Elsevier Inc.)

This study aimed to investigate the associations between psychopathological characteristics of children and adolescents with primary headache, as measured by the Strengths and Difficulties Questionnaire (SDQ), and treatment outcomes. A cohort study was conducted on 124 pediatric patients with primary headache. At the first consultation, the SDQ was completed by the parents. The analysis of treatment efficacy was conducted on 90 patients with a follow-up period of at least one year. Treatment responders were defined as those who showed 50% reduction in the headache frequency. First, an analysis of the SDQ total scores and five subscales, among the migraine and tension-type headache groups, was conducted for 124 participants. Second, the association between the SDQ scores and treatment outcomes in the groups with periods of improvement of less than three months and three months or more were analyzed in 90 patients. Migraine patients displayed more difficulties than strengths in terms of the total score (p =.004) and in the emotional symptoms subscale (p =.012) compared with tension-type headache patients. Migraine patients who required more than three months to show improvement displayed more peer problems (p =.020), while tension-type headache patients who required more than three months to show improvement displayed fewer conduct problems (p =.007). Evaluation of patient characteristics using the SDQ at first consultation can predict the treatment outcome. Moreover, it can help provide appropriate initial treatment and improve outcome of primary headache in children. [ABSTRACT FROM AUTHOR]

La prévalence de la céphalée de tension (CT) est supérieure à celle de la migraine ; elle est ainsi un motif de consultation fréquent et ne doit pas être méconnue. La CT est une entité hétérogène, d'origine multifactorielle, ainsi les critères diagnostiques définis par l' International Classification of Headache Disorders (ICHD) sont peu spécifiques permettant surtout de l'opposer à la migraine et les explorations sont parfois nécessaires pour exclure une céphalée secondaire. On distingue les CT épisodiques peu fréquentes et fréquentes et les CT chroniques. En fonction de la fréquence des céphalées, les études suggèrent des mécanismes physiopathologiques probablement différents. On retiendra essentiellement une activation des structures myofaciales périphériques et un phénomène de sensibilisation centrale. La prise en charge repose sur le traitement de la céphalée par les AINS, et un traitement de fond pour les CT fréquentes et chroniques. Les patients souffrant de CT chronique justifient d'une prise en charge multidisciplinaire pour prévenir le risque de chronicisation et d'abus d'antalgiques. Tension type headache (TTH) has a higher prevalence than migraine; thus it is a frequent reason for consultation and it must not be denied. The diagnostic criteria of TTH defined by the International Classification of Headache Disorders (ICHD) are non-specific, especially allowing to contrast with migraine, because tension type headache is a heterogeneous entity of multifactorial origin. So, explorations are sometimes necessary to exclude a secondary headache. A distinction is made between infrequent and frequent episodic TTH and chronic TTH. Depending on the type of TTH studies suggest different pathophysiological mechanisms. We retain an activation of peripheral myofascial structures and a central sensitization phenomenon. The management is based on the treatment of the pain with NSAIDs, sometimes associated with a prophylactic treatment for frequent and chronic TTH. Patients suffering from chronic TTH justify multidisciplinary management to prevent the risk of chronicization and analgesics abuse. [ABSTRACT FROM AUTHOR]

Introduction: Several attempts have been made to validate the purported aetiological mechanism after the prescribed proposal by the Ad Hoc Committee (1962), on the Classification of Headache which was recognised as muscle contraction or tension as a distinct headache diagnosis. The Electromyography (EMG) of the temporalis muscle in tension headache patients is measured to identify whether the correlation of EMG amplitude and intensity of pain reported by patients can be attributed to the diagnosis of Tension Type Headache (TTH). Aim: To correlate between Surface Electromyography (sEMG) activity and pain scale in TTH patients. Materials and Methods: The present study cross-sectional study was conducted in the Out Patient Department (OPD) of Psychiatry MLB Medical College, Jhansi, Uttar Pradesh, India during the period of 2009 to 2012 in which surface EMG responses of the temporalis muscle were recorded on 100 TTH patients before they go for any sort of treatment. Subjects aged 20 to 45 years were included, out of which 58 were females and 42 males. In this study, Pearson’s correlation coefficient was calculated to investigate the correlation between muscular activity and subjective pain scores. Results: The correlation value was (r=0.857) between EMG amplitude and pain scale in all 100 TTH patients. Male to female ratio was 1:1.38. Among the age groups 20-25 (years) and 26- 30 (years) had the maximum number of patients 32% and 25% respectively. Conclusion: All age groups showed a positive correlation between EMG amplitude and headache intensity. It was found that females in every age group was more frequently affected as compared to males and the young population had more chances of being diagnosed as TTH patients because it emerged as the largest number 32% among all age groups.

Introduction: Botulinum neurotoxin type-A (BoNTA) is licensed for the treatment of chronic migraine (CM), but it has been tested off-label as a therapeutic choice in other primary headaches (PHs). We aimed to provide a systematic review and expert opinion on BoNTA use in PHs, beyond CM. Areas covered: After providing an overview on PHs and mechanism of BoNTA action, we report the results of a systematic review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, of BoNTA therapeutic trials in PHs beyond CM. Studies and results were reviewed and discussed, and levels of evidence were graded. We also collected data on relevant ongoing trials. Expert opinion: Although there are contradictory findings on PHs other than CM, BoNTA may represent a therapeutic option for patients who do not respond to conventional prophylactic treatments. Based on limited available evidence, BoNTA may be considered in refractory tension-type headache, trigeminal autonomic cephalalgias, primary stabbing headache, nummular headache, hypnic headache, and new daily persistent headache, after the primary nature of cephalalgia has been documented and other drugs have failed. Experienced physicians in BoNTA treatment are required to guide the therapeutic protocol for each patient to optimize good and safe outcomes. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to compare the effects of acupuncture and medical training therapy alone and in combination with those of usual care on the pain sensation of patients with frequent episodic and chronic tension-type headache. Design: This was a prospective single-centre randomised controlled trial with four balanced treatment arms. The allocation was carried out by pre-generated randomisation lists in the ratio 1:1:1:1 with different permutation block sizes. Setting: The study was undertaken in the outpatient clinic of Rehabilitation Medicine of the Hannover Medical School. Participants and interventions: Ninety-six adult patients with tension-type headache were included and randomised into usual care (n = 24), acupuncture (n = 24), medical training (n = 24), and combination of acupuncture and medical training (n = 24). One patient was excluded from analysis because of withdrawing her/his consent, leaving 95 patients for intention to treat analysis. Each therapy arm consisted of 6 weeks of treatment with 12 interventions. Follow-up was at 3 and 6 months. Main outcome measures: Pain intensity (average, maximum and minimum), frequency of headache, responder rate (50% frequency reduction), duration of headache and use of headache medication. Clinical results: The combination of acupuncture and medical training therapy significantly reduced mean pain intensity compared to usual care (mean = −38%, standard deviation = 25%, p = 0.012). Comparable reductions were observed for maximal pain intensity (−25%, standard deviation = 20%, 0.014) and for minimal pain intensity (−35%, standard deviation = 31%, 0.03). In contrast, neither acupuncture nor medical training therapy differed significantly from usual care. No between-group differences were found in headache frequency, mean duration of headache episodes, and pain medication intake. At 3 months, the majority of all patients showed a reduction of at least 50% in headache frequency. At 6 months, significantly higher responder rates were found in all intervention groups compared to usual care. Conclusions: In contrast to monotherapy, only the combination of acupuncture and medical training therapy was significantly superior in reduction of pain intensity compared to usual care. Trial registration: Registered on 11 February 2019. German Clinical Trials Register, DRKS00016723. [ABSTRACT FROM AUTHOR]

Abstract Background Self-management interventions are well recognised and widely used in chronic conditions. Their application to chronic headaches has been limited and generally of low quality. We describe here our process for developing an evidence based, and theory driven, education and self-management intervention for those living with chronic headache. Methods Our intervention was designed using several core information sources; the results of three systematic reviews, qualitative material from those living with chronic headaches, our knowledge from existing self-management interventions; and finally collaborative input from a multidisciplinary team of clinicians, academics, patients, and charity partners. We manualised the intervention and associated training as a package for use in a feasibility study. We made adaptations for its use in a randomised controlled trial. Results We piloted the intervention in four groups with a total of 18 participants. Qualitative feedback from 12 participants and five facilitators allowed the intervention to be refined for the main randomised controlled trial. Some of the key changes included shortening of the overall intervention, changes to the originally planned facilitators and spreading the facilitator training over three days rather than two. We are now testing the final revised intervention in a randomised controlled trial of its clinical and cost effectiveness. The group component of the intervention is delivered over two days with the first day focused on living, understanding and dealing with chronic headaches and the second day exploring how to adapt and take control of one’s life with chronic headaches. Conclusion Our pilot work indicates that our intervention is feasible to deliver, and with the relevant changes would be acceptable for use with this population. Our randomised control trial is ongoing. We anticipate publishing final results in 2021. Trial registration ISRCTN79708100. Registered 16th December 2015, http://www.isrctn.com/ISRCTN79708100

Amaç: Bu çalışmanın amacı başağrısı olan hastalardaki psikiyatrik yüke de dikkat çekerek yaşam kalitesinin ve işlevselliğin nasıl etkilendiğini araştırmaktır.Gereç ve Yöntem: Sağlık Bakanlığı Üniversitesi Erenköy Ruh ve Sinir Hastalıkları Hastanesi Nöroloji Kliniği Baş ağrısı Özel Dal Polikliniği’ne Uluslararası Başağrısı Bozukluklarının Sınıflandırması (International Classification of Headache Disorders) ICHD-II’ye göre migren ve gerilim tipi baş ağrısı tanısı konmuş ardı sıra 100 hasta örneklem grubunu oluşturarak çalışmaya dahil edildi. Hastalara Veri Toplama Formu, Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I Ölçeği) ve Short Form (Yaşam Kalitesi Ölçeği) (SF-36 ) uygulandı. Bulgular: Baş ağrısı hastalarının tümü değerlendirildiğinde %56’sında fiziksel hastalık, %94’ünde, özgeçmişinde psikiyatrik hastalık, %73’ünde ailede psikiyatrik hastalık saptandı. Migren hastaları ‘Geçen hafta içinde kaç gün kendinizi iyi hissettiniz?’ sorusunda ortalama 3.5±1.9 gün şeklinde yanıt verirken, gerilim tipi hastalar ortalama 3.5±1.7 gün yanıtını vermişlerdir. Migren hastaları şikayetleri sebebi ile ortalama 1.3±1.7 gün işe gitmezken, gerilim tipi hastaları ortalama 1±1.2 gün işe gitmemiştir.Sonuç: Başağrısı depresyon, anksiyete bozukluğu, analjezik kötüye kullanımı, kişilik bozuklukları ve bipolarite gibi komorbid psikiyatrik hastalıklarla sık birliktelik gösterir ve etkin psikiyatrik tedavi yapılmadığında ağrı kronikleşerek işlevsellik kaybına ve hayat kalitesinin düşmesine neden olur. Bu sebeple baş ağrısına yaklaşım multidisipliner olmalıdır.

Frequency is considered as a key sign of the course of some forms of primary headaches (PH). One of the most prominent representatives is the hypnical and cluster headache, which predetermined their name. Clinical observations demonstrate a clear circadian rhythm and seasonal pattern of cluster headache (CH) and migraine (M) attacks. In accordance with modern concepts, the phenomenon of the periodicity of painful episodes of a number of forms of primary headaches is associated with dysfunction of the suprachiasmatic nucleus of the hypothalamus, the main pacemaker of biological rhythms. The connection of PH with chronopathology is confirmed by revealing the disturbances of melatonin secretion in CH and M. Melatonin has proven to be effective in treatment of these PH.

Copyright of Osmangazi Journal of Medicine / Osmangazi Tip Dergisi is the property of Eskisehir Osmangazi University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Primary headaches are remarkably prevalent worldwide and are increasingly reported among children. However, the exact trend in this age group, particularly in the Gulf region, remains largely unknown.Aims and Objectives: To examine the prevalence of primary headache disorders among primary and middle school students in Kuwait.Methods: We conducted a cross-sectional study that included Kuwaiti primary and middle school children and adolescents of both genders in randomly selected schools located in two governorates in Kuwait in the 2018/2019 academic year. Prevalence and attributable burden of headaches, definite and probable migraines, definite and probable tension-type headaches, chronic headaches (≥15 days/month), and probable medication-overuse headaches were assessed using the Headache-Attributed Restriction, Disability, Social Handicap, and Impaired Participation (HARDSHIP) questionnaire for children and adolescents.Results: Of 1,485 questionnaires that were distributed, 1,089 students completed the questionnaire with a respondent rate of 73.4%. The study population consisted of 420 boys (38.56%) and 669 girls (61.43%) students with a mean age of 11.5 ± 2.11 years. The 1-year prevalence of primary headache disorders was 42.78%, with more middle schoolers reporting headaches than primary schoolers (50.37 vs. 30.48%; p < 0.02). The mean age of students with primary headaches was 11.98 ± 2.03 years in both genders. When stratified according to diagnostic criteria, migraine headaches were the most frequently reported (20.75%), followed by tension type headaches (18.8%), chronic headaches (2.75%), and probable medication-overuse headaches (0.46%). Primary headaches were significantly higher in girls compared to boys among middle schoolers (66.46 vs. 38.49%; p < 0.001); however, no significant difference between genders was noted among primary school students (33.12 vs. 22.33%; p < 0.118).Conclusion: Primary headaches are remarkably common in Kuwaiti school students, with migraine headaches being the most frequently reported type. Age and female gender may play a role in the development of primary headaches. These findings necessitate the direction of health services and research efforts toward this age group and warrant the need for further epidemiological studies.

Background: Primary headaches are remarkably prevalent worldwide and are increasingly reported among children. However, the exact trend in this age group, particularly in the Gulf region, remains largely unknown. Aims and Objectives: To examine the prevalence of primary headache disorders among primary and middle school students in Kuwait. Methods: We conducted a cross-sectional study that included Kuwaiti primary and middle school children and adolescents of both genders in randomly selected schools located in two governorates in Kuwait in the 2018/2019 academic year. Prevalence and attributable burden of headaches, definite and probable migraines, definite and probable tension-type headaches, chronic headaches (≥15 days/month), and probable medication-overuse headaches were assessed using the Headache-Attributed Restriction, Disability, Social Handicap, and Impaired Participation (HARDSHIP) questionnaire for children and adolescents. Results: Of 1,485 questionnaires that were distributed, 1,089 students completed the questionnaire with a respondent rate of 73.4%. The study population consisted of 420 boys (38.56%) and 669 girls (61.43%) students with a mean age of 11.5 ± 2.11 years. The 1-year prevalence of primary headache disorders was 42.78%, with more middle schoolers reporting headaches than primary schoolers (50.37 vs. 30.48%; p < 0.02). The mean age of students with primary headaches was 11.98 ± 2.03 years in both genders. When stratified according to diagnostic criteria, migraine headaches were the most frequently reported (20.75%), followed by tension type headaches (18.8%), chronic headaches (2.75%), and probable medication-overuse headaches (0.46%). Primary headaches were significantly higher in girls compared to boys among middle schoolers (66.46 vs. 38.49%; p < 0.001); however, no significant difference between genders was noted among primary school students (33.12 vs. 22.33%; p < 0.118). Conclusion: Primary headaches are remarkably common in Kuwaiti school students, with migraine headaches being the most frequently reported type. Age and female gender may play a role in the development of primary headaches. These findings necessitate the direction of health services and research efforts toward this age group and warrant the need for further epidemiological studies. [ABSTRACT FROM AUTHOR]

Objectives: It was aimed to determine the etiological and clinical features of pediatric patients with headache complaints., Methods: The files of patients who were admitted to the pediatric neurology outpatient clinic with headache were reviewed retrospectively. Patients' age, gender, features of headache, symptoms accompanying headache, available blood tests, brain magnetic resonance (MR) and electroencephalography (EEG) results were recorded., Results: Of the total 470 patients, aged between 3 and 17 years, 291 (61.9%) were female and 179 (39.1%) were male. The mean age of the patients was 12.38±3.45 years. According to age groups, there were 16 (3.4%) patients under the age of 5, 159 (33.8%) between the ages of 6-11, and 295 (62.8%) patients aged 12-17 years. While 289 (61.5%) patients were diagnosed with primary headache, 122 (26.0%) patients were diagnosed with secondary headache, and headaches of 59 (12.5%) patients could not be classified. The most common primary headaches were tension-type headache (TTN) (n=177, 37.7%) and migraine (n=111, 23.6%). The 86 (70.5%) of the patients with secondary headache were diagnosed with sinusitis. Abnormal neurological examination finding was determined in 8 (1.7%) patients. Brain MR was performed in 439 (93.4%) of all patients and abnormal brain MR findings were detected in 52 (11.8%) patients. EEG was performed in 205 (43.6%) of all patients and abnormal EEG findings were detected in 24 (11.7%) patients., Conclusion: According to age groups, headache was most common in the 12-17 age group. The most common causes of headache were TTN and migraine, respectively. The most common secondary headache cause was sinusitis. We think that physical and neurological examination still maintains its priority in determining the causes of headache., Competing Interests: The authors declare that there is no conflict of interest., (© Copyright 2024 by The Medical Bulletin of Sisli Etfal Hospital.)

Background: The prevalence of primary headaches in the pediatric population is shaped by many factors, of which pubertal status may possibly play a substantial role. Epidemiological studies in the pediatric population in the gulf region remain scarce.Aims and objectives: To examine the impact of puberty on the prevalence of primary headache disorders among female schoolchildren in Kuwait.Methods: We conducted a cross-sectional study that included Kuwaiti primary and middle schoolgirls in randomly selected schools located in two governorates in Kuwait during the academic year 2018/2019. Prevalence of headache was assessed using the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire for children and adolescents. Female students were asked about their menarchal status and whether they attained menarche before or after experiencing headaches.Results: The questionnaire was completed by 669 girls with a mean age of 11.44 ± 2.14 years. The 1-year prevalence of migraine headache disorder among girls was 23.62%, and the lifetime prevalence of any headache was 84.9%, whereas the 1-year prevalence of primary headache disorders was 47.98%. The mean age of girls with headaches was 11.44 ± 2.14 years. With respect to diagnostic criteria, migraine headache was the most frequently reported (23.62%), followed by tension-type headaches (20.93%), chronic headaches (2.99%), and probable medication-overuse headaches (0.45%). Postpubertal females were at significantly higher risk of having primary headaches compared to their prepubertal counterparts (64.26 vs. 34%; p < 0.0001). All types of primary headaches were more significantly prevalent among postpubertal girls compared to those who are prepubertal.Conclusion: Migraine headache is commonly reported among Kuwaiti schoolgirls. Postpubertal females are at higher risk of developing primary headaches compared to prepubertal females. Pubertal transition and female sex hormones may play a significant role in the pathophysiology of headaches, migraines in particular, and further research is therefore needed to investigate the underlying mechanisms.

George Georgoudis,1,2 Bledjana Felah,2 Pantelis T Nikolaidis,3 Maria Papandreou,1 Evanthia Mitsiokappa,4 Andreas F Mavrogenis,4 Thomas Rosemann,5 Beat Knechtle5,6 1Musculoskeletal and Respiratory Research Lab, Department of Physiotherapy, University of West Attica, Athens, Greece; 2PhysioPain Group, Pain Specialist & Rehabilitation Centers, Athens, Greece; 3Exercise Physiology Laboratory, Nikaia, Greece; 4First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece; 5Institute of Primary Care, University of Zurich, Zurich, Switzerland; 6Medbase St. Gallen Am Vadianplatz, St. Gallen, Switzerland Introduction: Nonpharmacological therapies have been widely used to treat tension-type headache (TTH); however, limited evidence exists with regards to their effectiveness. Therefore, the aim of the present study was to examine the combined effect of acupuncture, stretching, and physiotherapy (myofascial release techniques and microwave diathermy) on psychocognitive, somatic, quality of life, and disability characteristics in such patients. Subjects and methods: Patients with TTH (n=44) performed either acupuncture or stretching (control group, n=20) or acupuncture, stretching, and physiotherapy (experimental group, n=24) during a 4-week intervention period including 10 treatment sessions. They were tested for the Greek version of the Short-Form McGill Pain Questionnaire, the Greek version of the Migraine Disability Assessment Questionnaire, the Greek version of the Hospital Anxiety and Depression Scale, Short Form Health Survey 12 9 (SF-12), and Pain Catastrophizing Scale at baseline after the fifth and tenth sessions. Results: All measures were improved throughout the first to tenth session (P0.05). Conclusion: In summary, a significant beneficial role of acupuncture, stretching, and physiotherapy on cognitive, psychosomatic pain measures, disability index, quality of life, and catastrophizing in patients with TTH was observed. Keywords: tension-type headache, acupuncture, physiotherapy, stretching, psychocognitive characteristics, myofascial release

Copyright of Neurologie Pro Praxi is the property of SOLEN sro and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Headache is a very common condition worldwide and may have serious consequences on effective functioning of an individual. It may also lead to emotional consequences or may be a result of emotional burden. Psychiatric comorbidity is also very common among patients with headache. Objectives: The main aim of the study was to assess depression among patients presenting to neurosurgery OPD with chief complaints of headache. Study Design: Cross Sectional Study. Setting: Neurosurgery OPD of a Tertiary Care Government Hospital Mardan Medical Complex located in Mardan, Khyber Pakhtunkhwa. Period: September 2018-February 2019. Material & Methods: Patients presenting to neurosurgery OPD of Mardan medical complex, Mardan with chief complaints of headache were included in the study. Demographic information sheet was used to obtain important demographic information. Informed consent form was filled and signed from each participant. Hamilton Depression rating scale was used to assess symptoms of depression among the participants. Results: Most of the study patients 93 (74.4%) had primary headache, while 32 (25.6%) had secondary headache. The results of the study found that highest prevalence of depression was present among patients with tension type headache (88 %) as compared to migraine (78 %) and secondary headache (84 %). Moderate depression was present among 32 % of the study population, while 28 % had severe depression. Conclusion: These findings suggest that depression is very common among patients with headache. Primary health care practitioners should assess for symptoms of depression for better management of the course and prognosis of the patients presenting with complaints of headache. [ABSTRACT FROM AUTHOR]

Background: Migraine, tension type headache (TTH), and hypothyroidism are clinical problems that affect patient daily activities and quality of life. Objectives: The purpose of this study was to investigate the potential association between hypothyroidism in patients with migraine and TTH. Patients and methods: Two hundred and twelve patients with migraine and TTH and one hundred control subjects underwent clinical evaluation, assessment of thyroid hormones, and thyroid ultrasound. Results: Subclinical and overt hypothyroidism were significantly higher in patients with migraine and TTH (P = 0.001) than control subjects. Patients with migraine and TTH showed significantly more abnormal thyroid gland morphology than healthy control (P = 0.027). Hypothyroidism is significantly expressed in chronic TTH more than TTH with infrequent or frequent TTH (P = 0.009). Conclusions: Patients having migraine and TTH more prone to develop hypothyroidism when compared with control group. Also patients with chronic TTH are susceptible to develop hypothyroidism (either subclinical or overt) when compared with patients having frequent or infrequent TTH. [ABSTRACT FROM AUTHOR]

Background: The prevalence of primary headaches in the pediatric population is shaped by many factors, of which pubertal status may possibly play a substantial role. Epidemiological studies in the pediatric population in the gulf region remain scarce. Aims and objectives: To examine the impact of puberty on the prevalence of primary headache disorders among female schoolchildren in Kuwait. Methods: We conducted a cross-sectional study that included Kuwaiti primary and middle schoolgirls in randomly selected schools located in two governorates in Kuwait during the academic year 2018/2019. Prevalence of headache was assessed using the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire for children and adolescents. Female students were asked about their menarchal status and whether they attained menarche before or after experiencing headaches. Results: The questionnaire was completed by 669 girls with a mean age of 11.44 ± 2.14 years. The 1-year prevalence of migraine headache disorder among girls was 23.62%, and the lifetime prevalence of any headache was 84.9%, whereas the 1-year prevalence of primary headache disorders was 47.98%. The mean age of girls with headaches was 11.44 ± 2.14 years. With respect to diagnostic criteria, migraine headache was the most frequently reported (23.62%), followed by tension-type headaches (20.93%), chronic headaches (2.99%), and probable medication-overuse headaches (0.45%). Postpubertal females were at significantly higher risk of having primary headaches compared to their prepubertal counterparts (64.26 vs. 34%; p < 0.0001). All types of primary headaches were more significantly prevalent among postpubertal girls compared to those who are prepubertal. Conclusion: Migraine headache is commonly reported among Kuwaiti schoolgirls. Postpubertal females are at higher risk of developing primary headaches compared to prepubertal females. Pubertal transition and female sex hormones may play a significant role in the pathophysiology of headaches, migraines in particular, and further research is therefore needed to investigate the underlying mechanisms. [ABSTRACT FROM AUTHOR]

Objectives: The main goal of this study was to estimate the prevalence of Tension-type headache “TTH” among students of College of Medicine\University of Baghdad “CM\UB”; to compare its prevalence between males and females, and to decide on its relationship with years of study in college; to estimate the relative proportion of episodic to chronic subtypes of TTH; and to identify aggravating\relieving factors of TTH. Method: A cross-sectional survey study was conducted from the 28th of July 2018 to the 14th of October 2018 on 150 students of CM\UB. The data were collected by using self-administered questionnaire which included demographic data and specific questions on headache based on international Headache Society criteria (ICHD-III) for diagnosis of TTH and other headache types. Results: Of 150 participant, 86 (57.3%) had TTH: in 78 (52%) it was episodic while in only 8 (5.3%) it was chronic. Neither age nor year of study had a significant relationship with TTH, but there was a significant difference between genders with higher prevalence in females (65.3%) as compared to males (49.3%). Stress, sound and lack of sleep were the most common triggering factors, while rest and sleep are the most effective relieving factors. Conclusion: TTH is common among students of CM\UB, being more in females, and mainly episodic. Its prevalence was comparable with results from medical schools in nearby countries. [ABSTRACT FROM AUTHOR]

Background and purpose: This study investigates the relationship between exposure to hot/cold weather and the characteristic clinical features of headaches in patients with migraine and tension-type headaches. Methods: This cross-sectional study was conducted with the participation of 190 patients with migraine, and 140 patients with tension-type headaches. The patients were evaluated using a form that collected data on their sociodemographic profile, the clinical features of their headaches, any accompanying symptoms and their relationships with changes in the weather (hot/cold). The headaches of all the participants in the study were thought to be triggered by exposure to hot/cold weather. Results: In the patients with migraine, the exposure to hot/cold weather as a trigger was not found to have a significant relationship with age, body mass index or the characteristic clinical features of headaches (p > 0.05). In patients with tension-type headaches, exposure to hot/cold weather as a trigger was found to have a significant relationship with body mass index (p = 0.019), but not with age or the characteristic clinical features of headaches (p > 0.05). Conclusions: In obese patients with tension-type headache, it was found that hot weather triggered headache more than cold weather. In patients with migraine and tension-type headaches, no relationship was found between exposure to hot/cold weather as a trigger and the clinical features of headaches. The accurate identification of the factors precipitating headaches by both clinicians and patients can help lower the frequency of headaches. [ABSTRACT FROM AUTHOR]

Background: Pharmacological treatment of patients with tension-type headache (TTH) includes symptomatic (acute) and prophylactic (preventive) medication. No previous study has investigated variables associated to symptomatic medication intake in TTH. Our aim was to assess the association of clinical, psychological and neurophysiological outcomes with the use and timing of the use of symptomatic medication in TTH.Methods: A longitudinal observational study was conducted. One hundred and sixty-eight (n = 168) patients with TTH participated. Pain features of the headache (intensity, frequency, duration), burden of headache (Headache Disability Inventory), sleep quality (Pittsburgh Sleep Quality Index), anxiety/depression (Hospital Anxiety and Depression Scale), trait/state anxiety levels (State-Trait Anxiety Inventory), and bilateral pressure pain thresholds on the temporalis, C5-C6 joint, second metacarpal and tibialis anterior were assessed. Symptomatic medication intake was also collected for a 6-months follow-up period. Differences between patients using or not using symptomatic medication, depending on self-perceived effectiveness, and time (early during an attack, i.e., the first 5 min, or when headache attack is intense) when the symptomatic medication was taken were calculated.Results: One hundred and thirty-six (n = 136, 80%) reported symptomatic medication intake for headache (73% NSAIDs). Sixteen (12%) reported no pain relief, 81 (59%) experienced moderate relief and 39 (29%) total pain relief. Fifty-eight (43%) took 'early medication' whereas 78 (57%) took 'late medication'. Patients taking symptomatic medication in general showed lower headache frequency and lower depressive levels than those patients not taking medication. Symptomatic medication was more effective in patients with lower headache history, frequency, and duration, and lower emotional burden. No differences in pressure pain sensitivity were found depending on the self-perceived effectiveness of medication. Patients taking 'late symptomatic' medication exhibited more widespread pressure pain sensitivity than those taking 'early medication'.Conclusions: This study found that the effectiveness of symptomatic medication was associated with better headache parameters (history, frequency, or duration) and lower emotional burden. Further, consuming early symptomatic medication at the beginning of a headache attack (the first 5 min) could limit widespread pressure pain sensitivity. [ABSTRACT FROM AUTHOR]

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