Migraine and tension-type headache in Croatia: a population-based survey of precipitating factors

Menstrual tension-type headache: evidence for its existence

OBJECTIVE

To determine whether menstrual tension-type headache is a real disorder.

BACKGROUND

An appendix was included in the second edition of the International Classification of Headache Disorders by the International Headache Society. Diagnostic criteria are proposed in this appendix for 2 types of menstrual migraine: pure menstrual migraine without aura and menstrually related migraine without aura. References to menstrual tension-type headache do not appear in this classification.

METHODS

In a neurological outpatient clinic 165 patients were identified in whom headache was related to menstruation and the criteria of the International Classification of Headache Disorders for menstrual migraine adapted to menstrual tension-type headache were applied.

RESULTS

Twenty-one patients met the criteria of menstrual tension-type headache, 6 for pure menstrual tension-type headache, and 15 for menstrually related tension-type headache.

CONCLUSION

Menstrual tension-type headache is a real condition that should be recognized in the International Classification of Headache Disorders.

[Non-alimentary trigger factors of migraine and tension-type headache]

Based on an overview of the literature, this contribution critically discusses the importance of non-alimentary trigger factors of migraine and tension-type headache. Menstruation, environmental factors, psychological effects as well as sleep disorders and fatigue are mentioned most frequently. According to controlled studies, menstruation is indubitably associated with an increased risk of headache. Although a correlation between specific meteorological parameters and the appearance of headaches was established in some patients, the subjective observations of the patients did not however correlate with the objective weather data. Sensory stimuli function as triggers particularly for migraine with aura. Psychological factors, especially stress and everyday pressures, have been confirmed as trigger factors, but further prospective trials addressing this issue would be advantageous. Additional studies are also needed to elucidate the significance of sleep (disorders) and fatigue since their importance as triggers or symptoms of a headache attack has not been conclusively determined.

[Alimentary trigger factors that provoke migraine and tension-type headache]

Based on a review of the literature the authors discuss the role of nutrition in the precipitation of migraine and tension-type headache (TTH). The available information relies largely on the subjective assessment of the patients. Controlled trials suggest that alcohol and caffeine withdrawal are the most important nutritional precipitating factors of migraine and TTH. In addition, there is some evidence that missing meals is also an important factor. Dehydration seems to deserve more attention. A selective sensitivity to red wine has been shown in some patients, the importance of chocolate has been doubted seriously, and scientific evidence for cheese as a precipitating factor is lacking. Despite a series of experimental studies demonstrating that NO donors such as nitroglycerin and parenteral histamine cause headache the role of histamine, nitrates, and nitrites in food remains unclear. Similarly, other biogenic amines and aspartame have not been proven to precipitate headache. Sodium glutamate causes adverse reactions including headache probably at large doses ingested on an empty stomach. Therefore, patients should be advised that food plays a limited role as a precipitating factor of migraine and TTH. Subjective sensitivity to certain foods should be examined critically, and proven precipitating factors should be avoided. General dietary restrictions have not been proven to be useful.

Epidemiology of headache in Europe

The present review of epidemiologic studies on migraine and headache in Europe is part of a larger initiative by the European Brain Council to estimate the costs incurred because of brain disorders. Summarizing the data on 1-year prevalence, the proportion of adults in Europe reporting headache was 51%, migraine 14%, and 'chronic headache' (i.e. > or =15 days/month or 'daily') 4%. Generally, migraine, and to a lesser degree headache, are most prevalent during the most productive years of adulthood, from age 20 to 50 years. Several European studies document the negative influence of headache disorders on the quality of life, and health-economic studies indicate that 15% of adults were absent from work during the last year because of headache. Very few studies have been performed in Eastern Europe, and there are also surprisingly little data on tension-type headache from any country. Although the methodology and the quality of the published studies vary considerably, making direct comparisons between different countries difficult, the present review clearly demonstrates that headache disorders are extremely prevalent and have a vast impact on public health. The data collected should be used as arguments to increase resources to headache research and care for headache patients all over the continent.

Weather and emergency room visits for migraine headaches in Ottawa, Canada

BACKGROUND

Self-reported surveys have indicated that weather can trigger migraine headaches. However, to date, we know of no previous study that has examined the relationship between weather and emergency room (ER) visits for this condition.

OBJECTIVE

To examine associations between ER visits for migraines and selected meteorological conditions within the 24 hours preceding the visit.

DESIGN AND METHODS

A case-crossover design was used to study 4039 visits for migraines (ICD-9: 346) that occurred at an Ottawa hospital between 1993 and 2000. Meteorological conditions were defined using hourly readings from a fixed-site monitoring station. Conditional logistic regression was used to compare the occurrence of meteorological conditions during the 24 hours leading up to the time of the visit to control periods occurring 1 week before and after.

RESULTS

Precipitation-related weather events (fog, snow, rain, thunder) were not associated with migraine visits. Similarly, no associations were observed with changes in atmospheric pressure, wind speed, and relative humidity during the 24 hours preceding presentation. No statistically significant differences in the frequency distribution of clusters defined by relative humidity, atmospheric pressure, and temperature were found between case and control intervals. Conversely, a mean wind speed in excess of 19 km per hour was associated with a reduction in ER visits 8 to 12 hours later.

CONCLUSIONS

Our findings provide little support for the hypothesis that ER visits for migraines are related to weather conditions occurring within the 24 hours preceding presentation. These results should be interpreted cautiously as some comparisons are based on a small number of cases, and ER visits for migraine may represent a highly selective group of patients who suffer from this condition.

Increasing the daily water intake for the prophylactic treatment of headache: a pilot trial

Dehydration is commonly believed to result in headache, but the effectiveness of increasing the water intake in patients who frequently suffer from headaches has not been studied thus far. In a pilot study, we examined the possible effects and feasibility of increased water intake in headache patients. Eighteen headache patients (all had migraine, two also had tension-type headache) were randomly allocated to placebo medication, or the advice to additionally drink 1.5 l of water per day, for a period of 12 weeks. Effect measurements consisted of a 2 weeks headache diary and the Migraine Specific Quality of Life (MSQOL) questionnaire. The advice to increase the daily fluid intake by 1.5 l increased the fluid intake in the intervention group by approximately 1 l. This reduced the total hours of headache in 2 weeks by 21 h (95% CI: -48 to 5). Mean headache intensity decreased by 13 mm (95% CI: -32 to 5) on a visual analogue scale (VAS). The effects on MSQOL, number of headache episodes, and medication seemed to be small. The data of the present study suggest a reduction in the total number of hours and intensity of headache episodes after increased water intake. Our results seem to justify larger scaled research on the effectiveness of increased water intake in headache patients.

Leisure activities in adolescents with headache

AIM

To investigate the association between different types of headache and leisure activities in 13-y-old schoolchildren.

METHODS

A population-based, cross-sectional study was performed through face-to-face interviews with age-matched cohorts with headache and asymptomatic controls. The present study comprised 59 children with migraine, 65 with episodic tension-type headache (TTHA) and 59 headache-free controls. In the interview, besides questions concerning headache, the children were asked open and structured questions about the type and amount of their leisure activities.

RESULTS

Children with migraine spent more time in sports activities than children with episodic tension-type headache or children without headache (test for trend, p<0.01; migraine: OR 1.4, 95% CI 1.1-1.9; tension-type headache: OR 0.9, 95% CI 0.7-1.1). The type of leisure activity was not significantly associated with headache type (p>0.05). Children with both migraine and episodic tension-type headache used computers more often than children without headache (test for trend, p<0.05; migraine: OR 1.2, 95% CI 1.1-1.5; tension-type headache: OR 1.3, 95% CI 1.1-1.5).

CONCLUSION

This study provides additional data on the activity status and headache complaints in adolescents. The results indicate that frequent computer use is associated with both tension-type headache and migraine, and intensive overall sports activities are characteristic of adolescents with migraine.

Effect of episodic tension-type headache on the health-related quality of life in employees of a Brazilian public hospital

OBJECTIVE: To evaluate the impact of ETTH on HRQoL in a sample of employees of a Brazilian public hospital. METHOD: Three hundred and sixty Mário Gatti Hospital employees were asked about headache occurrence in the previous 6 months and completed a SF-36 and a pain questionnaires concerning impact of pain (0 to 10 scale) on daily activities, work efficiency, leisure and social activities in previous six months. Two groups were studied: 1. Episodic Tension-type headache group: 127 employees - 81 (63.8%) female and 46 (36.2%), male. 2. Control group: 124, 71 (57.3%) female and 53 (42.7%) male. RESULTS: ETTH had lowers scores than control in all domains of SF-36; in vitality and bodily pain the difference was statistically significant. CONCLUSION: Our results indicate that ETTH suffers have impact on HRQoL predominantly in vitality. Psychological factors associated to pain may explain this finding.