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Kristoffersen ES, Waage S, Pallesen S, Bjorvatn B. Changes in work schedule affect headache frequency among Norwegian nurses: a 3-year-follow-up study. Occup Environ Med 2024; 81:191-200. [PMID: 38418222 DOI: 10.1136/oemed-2023-109164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 02/16/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVES To explore whether changes in work schedule, number of night shifts and number of quick returns were related to changes in headache frequencies. METHODS A longitudinal study with questionnaire data from 2014 (baseline) and 2017 (follow-up) on work schedule (day only, shift work without nights and shift work with nights), number of night shifts, number of quick returns (less than 11 hours in-between shifts) and validated headache diagnoses among 1104 Norwegian nurses. Associations were explored by adjusted multivariate regression analyses. RESULTS The median age at baseline was 37 years (IQR 31-43) and 90.5% were women. In the adjusted logistic regression analysis of changed work schedule between baseline and follow-up, changing from night work was associated with increased odds for reversion from headache >1 days/month to no headache at all last year (OR 2.77 (1.29; 5.95)). Changes towards less night shifts (>10) or quick returns (>10) during the last year were associated with increased odds of reversion of headache to no headache (OR 2.23 (1.20; 4.17) and OR 1.90 (1.04; 3.49)). Only decrease in number of night shifts (>10) during the last year reduced risk of onset of any new headache between baseline and follow-up (OR of 0.39 (0.18; 0.84)). CONCLUSION Changing from night work and reducing the number of night shifts and quick returns were associated with less headache in this 3-year-follow-up of Norwegian nurses. This adds to the growing body of evidence that night work may have direct negative health consequences.
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Affiliation(s)
- Espen Saxhaug Kristoffersen
- Department of General Practice, University of Oslo, Oslo, Norway
- Norwegian Centre for Headache Research, Department of Neurology, Akershus University Hospital, Lorenskog, Norway
| | - Siri Waage
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
- Department of Psychosocial Science, Universitetet i Bergen, Bergen, Norway
| | - Staale Pallesen
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
- Department of Psychosocial Science, Universitetet i Bergen, Bergen, Norway
| | - Bjørn Bjorvatn
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Bugge NS, Grøtta Vetvik K, Alstadhaug KB, Braaten T. Cumulative exposure to estrogen may increase the risk of migraine in women. Cephalalgia 2024; 44:3331024231225972. [PMID: 38215242 DOI: 10.1177/03331024231225972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
BACKGROUND Migraine is a common disorder, particularly affecting women during their reproductive years. This female preponderance has been linked to exposure to female sex hormones. METHODS We used self-reported data from women born in 1943-1965 enrolled in the Norwegian Women and Cancer Study to examine the differences between women with migraine and women without migraine in a prospective design with respect to both endogenous and exogenous female sex hormone exposure. RESULTS In total, 62,959 women were included in the study, of whom 24.8% reported previous migraine (n = 15,635). Using a Cox proportional hazards model, we found that higher age at menarche reduced the risk of migraine (hazards ratio (HR) = 0.96, 95% confidence interval (CI) = 0.95-0.98) and that oral contraceptive use and parity increased the risk of migraine (HR = 1.12, 95% CI = 1.06-1.18 and HR = 1.37, 95% CI = 1.29-1.46, respectively). CONCLUSIONS Older age at menarche appears to reduce migraine risk, whereas oral contraceptive use and having children appear to increase the risk. Further research is required to investigate the causality of these associations.
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Affiliation(s)
- Nora Stensland Bugge
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsoe, Norway
| | - Kjersti Grøtta Vetvik
- Department of Neurology, Akershus University Hospital, Nordbyhagen, Norway
- NorHEAD - Norwegian Centre for Headache Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Karl Bjørnar Alstadhaug
- Department of Neurology, Nordland Hospital, Bodø, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsoe, Norway
| | - Tonje Braaten
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsoe, Norway
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Piccininni M, Brinks R, Rohmann JL, Kurth T. Estimation of migraine prevalence considering active and inactive states across different age groups. J Headache Pain 2023; 24:83. [PMID: 37430201 DOI: 10.1186/s10194-023-01624-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/28/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Migraine is a very common headache disorder on the population level, characterized by symptomatic attacks (activity). For many people with migraine, the migraine symptoms intermittently or permanently cease during their lifetime (inactive migraine). The current diagnostic classification of migraine considers two states: active migraine (having migraine symptoms within the last year) and not having active migraine (including both individuals with inactive migraine and those who never had migraine). Defining a state of inactive migraine that has gone into remission may better capture the trajectories of migraine across the lifespan and contribute to a better understanding of its biological processes. We aimed to quantify the prevalence of never, active, and inactive migraine separately, using modern prevalence and incidence estimation methodology to better describe the complexity of migraine trajectories at the population level. METHODS Using a multistate modeling approach, data from the Global Burden of Disease (GBD) study, and results from a population-based study, we estimated the transition rates by which individuals moved between migraine disease states and estimated prevalences of never, active and inactive migraine. We used data from the GBD project and a hypothetical cohort of 100,000 people with a starting age of 30 and 30 years of follow-up, both in Germany and globally, stratified by sex. RESULTS In Germany, the estimated rate of transition from active to inactive migraine (remission rate) increased after the age of 22.5 in women and 27.5 in men. The pattern for men in Germany was similar to the one observed on the global level. The prevalence of inactive migraine among women reaches 25.7% in Germany and 16.5% globally at age 60. For men, the inactive migraine prevalence estimates at the same age were 10.4% in Germany and 7.1% globally. CONCLUSIONS Considering an inactive migraine state explicitly reflects a different epidemiological picture of migraine across the lifecourse. We have demonstrated that many women of older ages may be in an inactive migraine state. Many pressing research questions can only be answered if population-based cohort studies collect information not only on active migraine but also on inactive migraine states.
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Affiliation(s)
- Marco Piccininni
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Ralph Brinks
- Chair for Medical Biometry and Epidemiology, Faculty of Health/School of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 45, 58455, Witten, Germany
| | - Jessica L Rohmann
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Robert-Rössle-Straße 10, 13125, Berlin, Germany
| | - Tobias Kurth
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Global epidemiology of migraine and its implications for public health and health policy. Nat Rev Neurol 2023; 19:109-117. [PMID: 36693999 DOI: 10.1038/s41582-022-00763-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2022] [Indexed: 01/25/2023]
Abstract
Migraine is one of more than 200 headache disorders but stands out among these as a major cause of population ill health. In migraine epidemiology, the key variable is prevalence, but, from the perspective of public health, prevalence is uninformative without burden estimates. Here, we discuss how migraine epidemiology, from a quite recent start, has evolved into the respectable though imperfect science of today, but with the legacy that much of the large corpus of older literature is of questionable reliability. Newer studies have benefited from a universally accepted definition of migraine, while methodological developments have broadened the scope of migraine caseness, and published guidelines address important methodological issues. In the light of these developments, we question the apparent increase in migraine prevalence over time, offering explanations as to why this may be illusory. We suggest that the current best estimates are that global migraine prevalence is 14-15%, and that migraine accounts for 4.9% of global population ill health quantified in years lived with disability (YLDs). These evaluations are probably under-quantified rather than over-quantified, and YLDs are not a comprehensive measure of migraine-attributed burden. Despite these uncertainties, such high estimates of population ill health have clear implications for health policy.
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Giri S, Tronvik E, Linde M, Hagen K. The impact of topiramate, botulinum toxin type A, and CGRP-antibodies on medication overuse headache in patients with chronic migraine: A protocol for systematic review and meta-analysis. CEPHALALGIA REPORTS 2022. [DOI: 10.1177/25158163221096867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Medication overuse headache (MOH) is defined as headache occurring ≥15 days/month developing as a consequence of regular overuse of acute or symptomatic headache medication for more than 3 months. MOH is present in more than 50% of patients with chronic migraine (CM). Although, studies have shown a positive impact for MOH patients of early introduction of preventive treatment and withdrawal of overused medication, uncertainties remain. The main purpose of this systematic review and meta-analysis is to assess the relative impact of topiramate, botulinum toxin type A, and human monoclonal antibodies (mAbs) targeting calcitonin gene-related peptide (CGRP) or its receptor (CGRPr) among MOH patients with CM. The PRISMA guideline for conducting systematic review will be followed. CENTRAL, MEDLINE, Embase and Web of Science databases will be searched. RCTs reporting outcomes such as change in migraine/headache frequency, change from MOH to no MOH, and ≥50% response rate will be included. The effect will be measured as mean difference (MD) for continuous data and odds ratio (OR) for dichotomous data. Heterogeneity across studies will be assessed using the Cochrane I2 statistics. The Cochrane RoB2 tool will be used to assess risk of bias, and the quality of evidence for outcomes will be rated according to five factors defined in Cochrane GRADE approach. The revision of the included articles, data extraction, risk of bias assessment, and quality rating of evidence will be independently done by two reviewers. Any discrepancies will be resolved through consensus with the third reviewer.
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Affiliation(s)
- Samita Giri
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Erling Tronvik
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian Advisory Unit on Headache, Department of Neurology and Clinical Neurophysiology, St. Olavs University Hospital, Trondheim, Norway
| | - Mattias Linde
- Norwegian Advisory Unit on Headache, Department of Neurology and Clinical Neurophysiology, St. Olavs University Hospital, Trondheim, Norway
| | - Knut Hagen
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Clinical Research Unit Central Norway, St. Olavs University Hospital, Trondheim, Norway
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Stovner LJ, Hagen K, Linde M, Steiner TJ. The global prevalence of headache: an update, with analysis of the influences of methodological factors on prevalence estimates. J Headache Pain 2022; 23:34. [PMID: 35410119 PMCID: PMC9004186 DOI: 10.1186/s10194-022-01402-2] [Citation(s) in RCA: 245] [Impact Index Per Article: 122.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/09/2022] [Indexed: 01/01/2023] Open
Abstract
Background According to the Global Burden of Disease (GBD) study, headache disorders are among the most prevalent and disabling conditions worldwide. GBD builds on epidemiological studies (published and unpublished) which are notable for wide variations in both their methodologies and their prevalence estimates. Our first aim was to update the documentation of headache epidemiological studies, summarizing global prevalence estimates for all headache, migraine, tension-type headache (TTH) and headache on ≥15 days/month (H15+), comparing these with GBD estimates and exploring time trends and geographical variations. Our second aim was to analyse how methodological factors influenced prevalence estimates. Methods In a narrative review, all prevalence studies published until 2020, excluding those of clinic populations, were identified through a literature search. Prevalence data were extracted, along with those related to methodology, world region and publication year. Bivariate analyses (correlations or comparisons of means) and multiple linear regression (MLR) analyses were performed. Results From 357 publications, the vast majority from high-income countries, the estimated global prevalence of active headache disorder was 52.0% (95%CI 48.9–55.4), of migraine 14.0% (12.9–15.2), of TTH 26.0% (22.7–29.5) and of H15+ 4.6% (3.9–5.5). These estimates were comparable with those of migraine and TTH in GBD2019, the most recent iteration, but higher for headache overall. Each day, 15.8% of the world’s population had headache. MLR analyses explained less than 30% of the variation. Methodological factors contributing to variation, were publication year, sample size, inclusion of probable diagnoses, sub-population sampling (e.g., of health-care personnel), sampling method (random or not), screening question (neutral, or qualified in severity or presumed cause) and scope of enquiry (headache disorders only or multiple other conditions). With these taken into account, migraine prevalence estimates increased over the years, while estimates for all headache types varied between world regions. Conclusion The review confirms GBD in finding that headache disorders remain highly prevalent worldwide, and it identifies methodological factors explaining some of the large variation between study findings. These variations render uncertain both the increase in migraine prevalence estimates over time, and the geographical differences. More and better studies are needed in low- and middle-income countries. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-022-01402-2.
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Affiliation(s)
- Lars Jacob Stovner
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway. .,Department of Neurology and Clinical Neurophysiology, Norwegian Advisory Unit on Headache, St Olavs University Hospital, Trondheim, Norway.
| | - Knut Hagen
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway.,NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Mattias Linde
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway.,Tjörns Headache Clinic, Rönnäng, Sweden
| | - Timothy J Steiner
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway.,Division of Brain Sciences, Imperial College London, London, UK
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Giri S, Tronvik EA, Hagen K. The bidirectional temporal relationship between headache and affective disorders: longitudinal data from the HUNT studies. J Headache Pain 2022; 23:14. [PMID: 35062883 PMCID: PMC8903630 DOI: 10.1186/s10194-022-01388-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/07/2022] [Indexed: 12/24/2022] Open
Abstract
Background Few prospective population-based studies have evaluated the bidirectional relationship between headache and affective disorder. The aim of this large-scale population-based follow-up study was to investigate whether tension-type headache (TTH) and migraine had increased risk of developing anxiety and depression after 11 years, and vice-versa. Methods Data from the Trøndelag Health Study (HUNT) conducted in 2006-2008 (baseline) and 2017-2019 (follow-up) were used to evaluate the bidirectional relationship between migraine and TTH and anxiety and depression measured by Hospital Anxiety and depression Scale (HADS). The population at risk at baseline consisted of respectively 18,380 persons with HADS score ≤ 7 and 13,893 without headache, and the prospective data was analyzed by Poisson regression. Results In the multi-adjusted model, individuals with HADS anxiety (HADS-A) and depression scores (HADS-D) of ≥8 at baseline nearly doubled the risk of migraine (Risk rations (RR) between 1.8 and 2.2) at follow-up whereas a 40% increased risk (RR 1.4) was found for TTH. Vice versa, the risk of having HADS-A and HADS-D scores of ≥8 at follow-up were increased for TTH (RR 1.3) and migraine (RR 1.3-1.6) at baseline. Migraine with aura was associated with 81% (RR 1.81, 95% 1.52-2.14) increased risk of HADS-A score of ≥8. Conclusions In this large-scale population-based follow-up study we found a bidirectional relationship between anxiety and depression and migraine and TTH. For anxiety, this bidirectional association was slightly more evident for migraine than TTH.
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8
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Prevalence of Migraine in General Spanish Population; Factors Related and Use of Health Resources. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111145. [PMID: 34769668 PMCID: PMC8583596 DOI: 10.3390/ijerph182111145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 11/17/2022]
Abstract
Migraine is a common neurological disorder considered the second most disabling condition worldwide. Its prevalence ranges from 2.6% to 21.7% in population studies. This study aimed to know the prevalence of diagnosed and undiagnosed migraine in the general Spanish adult population, their health care use, and factors related. A descriptive cross-sectional study was undertaken with 23,089 individuals >15 years from the 2017 Spanish National Health Survey. Three groups were defined: people diagnosed with migraine (DM), people reporting undiagnosed migraine (UM) and people without migraine. Sociodemographic, clinical and use of health resources data were collected. The scales Duke Social Support Index (DSSI) and General Health Questionnaire (GHQ-12) were used. Prevalence of DM and UM were determined with 95% confidence intervals. To determine the factors associated with DM and UM, a multinomial logistic regression model was used. The prevalence of DM was 8.6% (95%CI: 8.2–9), and UM, 0.9% (95%CI: 0.8–1). People with DM more frequently visited healthcare professionals (47.8%), required more supplementary tests (86.8), had a higher percentage of hospitalization (11.3%), and used emergency services (45.1%). Women had nearly three times the risk of DM and UM. Worse mental health was a risk factor for UM (OR = 1.20) and DM (OR = 1.18). The greater the work stress, the greater the risk of DM (OR = 1.12). An adequate monitoring and management of migraine in people with these characteristics could contribute to improving their quality of life and reducing costs in the system.
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Milošević N, Trajković JZ, Mijajlović M, Milošević J, Podgorac A, Vitošević Z, Novaković T, Pekmezović T. The first prevalence study of primary headaches in adults in a post-conflict area of Serbia. Cephalalgia 2021; 41:959-967. [PMID: 33938250 DOI: 10.1177/03331024211006043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
AIM The aim of the present study was to establish annual prevalence of primary headaches, migraine, and tension-type headache among adults in a post-conflict area of Serbia. METHODS The data for this cross-sectional study was obtained via face-to-face interviews using questionnaires specifically designed for this purpose, in line with the available guidelines. The study sample included adults aged 18-65 years whose native language is Serbian with residence in six predominantly Serbian communities in Kosovo and Metohija. Relevant diagnoses were established according to the diagnostic criteria of the International Classification of Headache Disorders, 3rd edition. RESULTS The study included 1062 adults. Analyses indicated 47.7% prevalence of primary headaches. The 1-year prevalence of migraine (with aura and without aura) and tension-type headache was established at 15.2% (3.3% and 11.9%), and 32.2%, respectively. One-year prevalence of chronic headache was calculated at 3.5%, while the prevalence of medication overuse headache was slightly lower at 2.9%. Primary headaches were more prevalent among women, participants residing south of the river Ibar, married or cohabiting individuals, as well as among interviewees (persons) who reported feeling unsafe in Kosovo and Metohija. This is the first study of the prevalence of primary headache disorders in Serbia. The obtained data is comparable to the data available for other countries, especially those in the Balkan region.
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Affiliation(s)
- Nenad Milošević
- University of Pristina - Kosovska Mitrovica, Faculty of Medicine, Serbia.,Clinical-Hospital Center Pristina-Gracanica, Kosovska Mitrovica, Serbia
| | - Jasna Zidverc Trajković
- Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia.,University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - Milija Mijajlović
- Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia.,University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - Jovana Milošević
- University of Pristina - Kosovska Mitrovica, Faculty of Medicine, Serbia
| | | | - Zdravko Vitošević
- University of Pristina - Kosovska Mitrovica, Faculty of Medicine, Serbia
| | - Tatjana Novaković
- University of Pristina - Kosovska Mitrovica, Faculty of Medicine, Serbia.,Clinical-Hospital Center Pristina-Gracanica, Kosovska Mitrovica, Serbia
| | - Tatjana Pekmezović
- University of Belgrade, Faculty of Medicine, Institute of Epidemiology, Belgrade, Serbia
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Mahon R, Lang A, Vo P, Huels J, Cooney P, Danyliv A, Vudumula U, Vadapalle S, Maniyar F, Goadsby PJ. Cost-Effectiveness of Erenumab for the Preventive Treatment of Migraine in Patients with Prior Treatment Failures in Sweden. PHARMACOECONOMICS 2021; 39:357-372. [PMID: 33491167 DOI: 10.1007/s40273-020-00996-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/24/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Migraine is a common neurological disease that disproportionately affects females and has a peak incidence during productive years, resulting in significant burden. OBJECTIVE The aim of the study was to determine the cost effectiveness of erenumab for the preventive treatment of migraine. METHODS A hybrid decision-tree plus Markov model was developed to evaluate the cost effectiveness of erenumab as a migraine treatment compared with best supportive care only for patients experiencing at least 4 monthly migraine days for whom at least two prior preventive treatments had failed. Clinical efficacy data were based on results from four randomized controlled trials of erenumab against placebo. The primary outcomes were costs, migraine days, and quality-adjusted life-years (QALYs). An incremental cost-effectiveness ratio (ICER) was estimated as the cost per QALY gained. The cost per migraine day avoided was also estimated, as were disaggregated direct and indirect costs. The analysis was conducted from Swedish societal and healthcare system perspectives based on total migraine, chronic migraine and episodic migraine populations, using a discount rate of 3% applied to both costs and health benefits and using year 2019 values. RESULTS In the base-case deterministic analyses, erenumab treatment resulted in ICERs of Swedish krona (SEK) 34,696 (€3310) and SEK301,565 (€28,769) per QALY gained in the total migraine and episodic migraine populations, respectively. Erenumab was dominant in the chronic migraine population. In the total migraine population, the use of erenumab resulted in a net benefit to society of SEK81,739 (€7773) per patient, assuming a willingness-to-pay threshold of SEK300,000 (€28,528) per QALY. CONCLUSIONS Our analysis suggests that erenumab is a cost-effective treatment for migraine with a willingness-to-pay threshold of SEK300,000 per QALY.
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Affiliation(s)
- Ronan Mahon
- Value and Access, Novartis Ireland Limited, Dublin, Ireland.
| | - Andrea Lang
- Market Access, Novartis Sverige AB, Kista, Sweden
| | - Pamela Vo
- Global Patient Access, Novartis Pharma AG, Basel, Switzerland
| | - Jasper Huels
- WW Market Access and HEOR, Novartis Pharma AG, Basel, Switzerland
| | - Philip Cooney
- Value and Access, Novartis Ireland Limited, Dublin, Ireland
| | - Andriy Danyliv
- Value and Access, Novartis Ireland Limited, Dublin, Ireland
| | - Umakanth Vudumula
- Value and Access, Novartis Healthcare Private Limited, Hyderabad, India
| | | | - Farooq Maniyar
- Basildon and Thurrock University Hospitals and Queen Mary University, London, UK
| | - Peter J Goadsby
- NIHR-Wellcome Trust King's Clinical Research Facility, SLaM Biomedical Research Centre, King's College London, London, UK
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11
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Krymchantowski AV, Jevoux CC, Krymchantowski AG, Vivas RS, Silva-Néto R. Medication overuse headache: an overview of clinical aspects, mechanisms, and treatments. Expert Rev Neurother 2020; 20:591-600. [PMID: 32463304 DOI: 10.1080/14737175.2020.1770084] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Medication-overuse headache (MOH) is a common debilitating neurological disorder, with a prevalence of 1% to 7% in general population. It affects more than 60 million people worldwide and provokes substantial burden. Despite that, most practitioners don't know MOH. This review aims at presenting MOH clinical features, pathophysiology insights, and recent knowledge and guidance regarding treatments. AREAS COVERED A literature search in the major medical databases including the terms 'medication overuse headache,' 'chronic daily headache,' 'chronic migraine,' 'symptomatic medication overuse' and others, published between 1990 and 2020, was carried out. EXPERT COMMENTARY Primary headache sufferers such as migraineurs and tension-type headache patients may increase the headache frequency and induce the transition from episodic to chronic forms, as well as develop MOH, in the presence of medication overuse. There is evidence of structural and functional changes in some areas of the brain, which may identify those likely to respond or not to treatments. Despite the geographical differences and lack of consensus regarding approaches, to educate the patients about reducing medication intake, to withdraw overused medications and to start prophylaxis in some sufferers are crucial steps. Emerging treatments as monoclonal antibodies to migraine may result in better adherence and tolerability profiles as well as outcomes.
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Affiliation(s)
| | | | | | | | - Raimundo Silva-Néto
- Department of Neurology, Universidade Federal do Delta do Parnaíba , Piauí, Brazil
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12
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Guido D, Leonardi M, Mellor-Marsá B, Moneta MV, Sanchez-Niubo A, Tyrovolas S, Giné-Vázquez I, Haro JM, Chatterji S, Bobak M, Ayuso-Mateos JL, Arndt H, Koupil I, Bickenbach J, Koskinen S, Tobiasz-Adamczyk B, Panagiotakos D, Raggi A. Pain rates in general population for the period 1991-2015 and 10-years prediction: results from a multi-continent age-period-cohort analysis. J Headache Pain 2020; 21:52. [PMID: 32404046 PMCID: PMC7218619 DOI: 10.1186/s10194-020-01108-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/13/2020] [Indexed: 12/04/2022] Open
Abstract
Background Pain is a common symptom, often associated with neurological and musculoskeletal conditions, and experienced especially by females and by older people. The aims of this study are to evaluate the temporal variations of pain rates among general populations for the period 1991–2015 and to project 10-year pain rates. Methods We used the harmonized dataset of ATHLOS project, which included 660,028 valid observations in the period 1990–2015 and we applied Bayesian age–period–cohort modeling to perform projections up to 2025. The harmonized Pain variable covers the content “self-reported pain experienced at the time of the interview”, with a dichotomous (yes or no) modality. Results Pain rates were higher among females, older subjects, in recent periods, and among observations referred to cohorts of subjects born between the 20s and the 60s. The 10-year projections indicate a noteworthy increase in pain rates in both genders and particularly among subjects aged 66 or over, for whom a 10–20% increase in pain rate is foreseen; among females only, a 10–15% increase in pain rates is foreseen for those aged 36–50. Conclusions Projected increase in pain rates will require specific interventions by health and welfare systems, as pain is responsible for limited quality of subjective well-being, reduced employment rates and hampered work performance. Worksite and lifestyle interventions will therefore be needed to limit the impact of projected higher pain rates.
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Affiliation(s)
- Davide Guido
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
| | - Blanca Mellor-Marsá
- Parc Sanitari Sant Joan de Déu, Fundacion Sant Joan de Deu, Barcelona, Spain
| | - Maria V Moneta
- Parc Sanitari Sant Joan de Déu, Fundacion Sant Joan de Deu, Barcelona, Spain
| | - Albert Sanchez-Niubo
- Parc Sanitari Sant Joan de Déu, Fundacion Sant Joan de Deu, Barcelona, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Stefanos Tyrovolas
- Parc Sanitari Sant Joan de Déu, Fundacion Sant Joan de Deu, Barcelona, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.,Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Iago Giné-Vázquez
- Parc Sanitari Sant Joan de Déu, Fundacion Sant Joan de Deu, Barcelona, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Josep M Haro
- Parc Sanitari Sant Joan de Déu, Fundacion Sant Joan de Deu, Barcelona, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Somnath Chatterji
- Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | - Martin Bobak
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Jose L Ayuso-Mateos
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.,Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain.,Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | | | - Ilona Koupil
- Department of Public Health Sciences, Centre for Health Equity Studies, Stockholm University, Stockholm, Sweden.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Jerome Bickenbach
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland.,Swiss Paraplegic Research, Nottwil, Switzerland
| | - Seppo Koskinen
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Beata Tobiasz-Adamczyk
- Department of Epidemiology and Population Studies, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Alberto Raggi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
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13
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Raggi A, Leonardi M, Mellor-Marsá B, Moneta MV, Sanchez-Niubo A, Tyrovolas S, Giné-Vázquez I, Haro JM, Chatterji S, Bobak M, Ayuso-Mateos JL, Arndt H, Hossin MZ, Bickenbach J, Koskinen S, Tobiasz-Adamczyk B, Panagiotakos D, Corso B. Predictors of pain in general ageing populations: results from a multi-country analysis based on ATHLOS harmonized database. J Headache Pain 2020; 21:45. [PMID: 32375641 PMCID: PMC7201730 DOI: 10.1186/s10194-020-01116-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/24/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Pain is a common symptom, often associated with neurological and musculoskeletal conditions, and experienced especially by females and by older people, and with increasing trends in general populations. Different risk factors for pain have been identified, but generally from studies with limited samples and a limited number of candidate predictors. The aim of this study is to evaluate the predictors of pain from a large set of variables and respondents. METHODS We used part of the harmonized dataset of ATHLOS project, selecting studies and waves with a longitudinal course, and in which pain was absent at baseline and with no missing at follow-up. Predictors were selected based on missing distribution and univariable association with pain, and were selected from the following domains: Socio-demographic and economic characteristics, Lifestyle and health behaviours, Health status and functional limitations, Diseases, Physical measures, Cognition, personality and other psychological measures, and Social environment. Hierarchical logistic regression models were then applied to identify significant predictors. RESULTS A total of 13,545 subjects were included of whom 5348 (39.5%) developed pain between baseline and the average 5.2 years' follow-up. Baseline risk factors for pain were female gender (OR 1.34), engaging in vigorous exercise (OR 2.51), being obese (OR 1.36) and suffering from the loss of a close person (OR 1.88) whereas follow-up risk factors were low energy levels/fatigue (1.93), difficulties with walking (1.69), self-rated health referred as poor (OR 2.20) or average to moderate (OR 1.57) and presence of sleep problems (1.80). CONCLUSIONS Our results showed that 39.5% of respondents developed pain over a five-year follow-up period, that there are proximal and distal risk factors for pain, and that part of them are directly modifiable. Actions aimed at improving sleep, reducing weight among obese people and treating fatigue would positively impact on pain onset, and avoiding vigorous exercise should be advised to people aged 60 or over, in particular if female or obese.
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Affiliation(s)
- Alberto Raggi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
| | - Blanca Mellor-Marsá
- Parc Sanitari Sant Joan de Déu, Fundacion Sant Joan de Deu, Barcelona, Spain
| | - Maria V Moneta
- Parc Sanitari Sant Joan de Déu, Fundacion Sant Joan de Deu, Barcelona, Spain
| | - Albert Sanchez-Niubo
- Parc Sanitari Sant Joan de Déu, Fundacion Sant Joan de Deu, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Stefanos Tyrovolas
- Parc Sanitari Sant Joan de Déu, Fundacion Sant Joan de Deu, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Iago Giné-Vázquez
- Parc Sanitari Sant Joan de Déu, Fundacion Sant Joan de Deu, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Josep M Haro
- Parc Sanitari Sant Joan de Déu, Fundacion Sant Joan de Deu, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Somnath Chatterji
- Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | - Martin Bobak
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Jose L Ayuso-Mateos
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | | | - Muhammad Z Hossin
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Jerome Bickenbach
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Seppo Koskinen
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Beata Tobiasz-Adamczyk
- Department of Epidemiology and Population Studies, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Barbara Corso
- National Research Council, Neuroscience Institute, Padova, Italy
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14
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Hagen K, Stovner LJ, Zwart JA. Time trends of major headache diagnoses and predictive factors. Data from three Nord-Trøndelag health surveys. J Headache Pain 2020; 21:24. [PMID: 32160857 PMCID: PMC7066736 DOI: 10.1186/s10194-020-01095-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/06/2020] [Indexed: 12/12/2022] Open
Abstract
AIMS The primary aim of this study was to investigate time trends of major headache diagnoses using cross-sectional data from two population-based health surveys. In addition, we aimed to perform a longitudinal assessment of baseline characteristics and subsequent risk for having headache at 22-years' follow-up among those participating in three health surveys. METHODS Data from the Nord-Trøndelag Health Study (HUNT) performed in 1995-1997 (HUNT2), 2006-2008 (HUNT3) and 2017-2019 (HUNT4) were used. The 1-year prevalence time trends of major headache diagnoses were estimated among 41,460 participants in HUNT4 and among 39,697 participants in HUNT3, two surveys with identical headache questions. 16,118 persons participated in all three surveys, and among these, a Poisson regression was used to evaluate health-related baseline information in HUNT2 and the risk ratios (RRs) with 95% confidence interval (CIs) of consistently reporting headache during follow-up. RESULTS Compared with the 1-year prevalence in HUNT3, a higher proportion of participants in HUNT4 had tension-type headache (20.7% vs. 15.9%, p < 0.001), whereas a lower 1-year prevalence was found for migraine (11.1% vs. 12.0%, p < 0.001) and medication overuse headache (MOH) (0.3% vs. 1.0%, p < 0.001). Participants in the age group 20-39 years at baseline nearly three times increased risk (RR = 2.8, 95% CI 2.5-3.1) of reporting headache in HUNT2, HUNT3 and HUNT4 than persons aged 50 years or more. Female sex, occurrence of chronic musculoskeletal complaints and high score of depression or anxiety at baseline doubled the risk of having headache in all three surveys. CONCLUSIONS The 1-year prevalence of migraine and MOH was lower in HUNT4 than in HUNT3. Young age, female sex, and occurrence of musculoskeletal complaints and high score of anxiety and/or depression were all associated with substantially increased risk of reporting headache in all three surveys.
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Affiliation(s)
- Knut Hagen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway. .,Clinical Research Unit Central Norway, St. Olavs Hospital, Trondheim, Norway. .,Norwegian Advisory Unit on Headaches, St. Olavs University Hospital, 7489, Trondheim, Norway.
| | - Lars Jacob Stovner
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Norwegian Advisory Unit on Headaches, St. Olavs University Hospital, 7489, Trondheim, Norway
| | - John-Anker Zwart
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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15
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Solheim O, Jakola AS. Quality of life outcomes in meningioma surgery. HANDBOOK OF CLINICAL NEUROLOGY 2020; 170:311-321. [PMID: 32586504 DOI: 10.1016/b978-0-12-822198-3.00050-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Patient-reported quality of life measures hold the potential to capture the results of meningioma surgery in a more patient-centered and sensitive way than common morbidity measures. However, quality of life measures have not so far been used much in meningioma studies. Disease specific instruments are also lacking along with validation studies in patients with meningioma. While patient-reported quality of life measures may overestimate improvements and underestimate surgery-related deteriorations, quality of life studies still report worse outcomes than the common retrospective review of hospital records. A more widespread use of longitudinal assessment of quality of life would also have the benefit in moving meningioma research from retrospective to prospective, which would lead to superior data quality. Comparisons across studies would also be more valid as the assessment bias resulting from surgeons judging their own results would be avoided.
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Affiliation(s)
- Ole Solheim
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway; Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway.
| | - Asgeir Store Jakola
- Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden; Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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16
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Westergaard ML, Lau CJ, Allesøe K, Gjendal ST, Jensen RH. Monitoring chronic headache and medication-overuse headache prevalence in Denmark. Cephalalgia 2019; 40:6-18. [DOI: 10.1177/0333102419876909] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objectives To study chronic headache and medication-overuse headache (MOH) prevalence; to identify groups with high prevalence of these conditions; and to identify the most frequently used pain medications among respondents with chronic headache. Background Chronic headache and MOH prevalence in Denmark were last estimated in 2010. Methods In this cross-sectional study, 104,950 individuals aged ≥16 years were randomly sampled for the 2017 Danish Capital Region Health Survey. Responses to questions about headache and use of acute pain medications were linked to demographic registries. MOH was defined as headache ≥15 days/month plus self-report of use of pain medications ≥10 or 15 days/month, in the last three months. Weighted prevalence proportions were calculated. Results Among 55,185 respondents, chronic headache prevalence was 3.0% (95% CI: 2.3–3.2) and MOH prevalence was 2.0% (95% CI: 1.8–2.1). Both conditions were more common among females and the middle-aged. Respondents on social welfare or receiving early retirement pensions had the highest prevalences. Among those with chronic headache, 44.7% overused over-the-counter analgesics for headache; paracetamol 41.5%; a combination of different pain relievers 25.3%; ibuprofen 21.9%; opioids 17.0%; combination preparations 14.3%; and triptans 9.1%. Conclusions The highest prevalence of chronic headache and MOH was seen among people with low socioeconomic position. Overuse of paracetamol was most common. Reported opioid use was higher than expected. Groups with high prevalence of MOH should be the focus of public health interventions on rational use of OTC and prescription pain medications.
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Affiliation(s)
| | - Cathrine Juel Lau
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Karen Allesøe
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Signe Thorup Gjendal
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
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17
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Nordhaug LH, Linde M, Follestad T, Skandsen ØN, Bjarkø VV, Skandsen T, Vik A. Change in Headache Suffering and Predictors of Headache after Mild Traumatic Brain Injury: A Population-Based, Controlled, Longitudinal Study with Twelve-Month Follow-Up. J Neurotrauma 2019; 36:3244-3252. [PMID: 31195890 PMCID: PMC6857461 DOI: 10.1089/neu.2018.6328] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Headache attributed to traumatic injury to the head (HAIH) is claimed to be the most common sequela following mild traumatic brain injury (MTBI), but epidemiological evidence is scarce. We explored whether patients with MTBI had an increase in headache suffering following injury compared with controls. We also studied predictors of headache. The Trondheim MTBI follow-up study is a population-based, controlled, longitudinal study. We recruited patients exposed to MTBI and controls with minor orthopedic injuries from a trauma center and a municipal outpatient clinic, and community controls from the surrounding population. Information on headache was collected through questionnaires at baseline, and 3 and 12 months post-injury. We used a generalized linear mixed model to investigate the development of headache over time in the three groups, and logistic regression to identify predictors of headache. We included 378 patients exposed to MTBI, 82 trauma controls, and 83 community controls. The MTBI-group had a larger increase in odds of headache from baseline to the first 3 months post-injury than the controls, but not from baseline to 3–12 months post-injury. Predictors for acute HAIH were female sex and pathological imaging findings on computed tomography (CT) or magnetic resonance imaging (MRI). Predictors for persistent HAIH were prior MTBI, being injured under the influence of alcohol, and acute HAIH. Patients who experience HAIH during the first 3 months post-injury have a good chance to improve before 12 months post-injury. Female sex, imaging findings on CT or MRI, prior MTBI, and being injured under the influence of alcohol may predict exacerbation of headache.
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Affiliation(s)
- Lena H Nordhaug
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mattias Linde
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Turid Follestad
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Øystein Njølstad Skandsen
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Vera Vik Bjarkø
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Division of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Toril Skandsen
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Physical Medicine and Rehabilitation, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Anne Vik
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurosurgery, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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18
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Hagen K, Åsberg AN, Uhlig BL, Tronvik E, Brenner E, Sand T. The HUNT4 study: the validity of questionnaire-based diagnoses. J Headache Pain 2019; 20:70. [PMID: 31195960 PMCID: PMC6734226 DOI: 10.1186/s10194-019-1021-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 06/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Questionnaire-based headache diagnoses should be validated against diagnoses made by the gold standard, which is personal interview by a headache expert. The diagnostic algorithm with the best diagnostic accuracy should be used when later analysing the data. METHODS The Nord-Trøndelag Health Study (HUNT4) was performed between 2017 and 2019. Among HUNT4 participants, a total of 232 (19.3%) out of 1201 randomly invited were interviewed by a headache expert to assess the sensitivity, specificity and kappa value of the questionnaire-based headache diagnoses. RESULTS The median interval between answering the headache questions and the validation interview was 60 days (95% CI 56-62 days). The best agreements were found for self-reported lifetime migraine (sensitivity of 59%, specificity of 99%, and a kappa statistic of 0.65, 95% CI 0.55-0.75), self-reported active migraine (sensitivity of 50%, specificity of 97%, and a kappa statistic of 0.55, 95% 0.39-0.71), liberal criteria of migraine (sensitivity of 64%, specificity of 93%, and a kappa statistic of 0.58, 95% CI 0.43-0.73) and ICDH3-based migraine ≥1 days/month (sensitivity of 50%, specificity of 94%, and a kappa statistic of 0.49, 95% CI 0.30-0.68). For headache suffering ≥1 days/month a sensitivity of 90%, specificity 80%, and a kappa statistic of 0.55, 95% CI 0.41-0-69 were found. For tension-type headache (TTH) ≥ 1 days/month the agreement was 0.33 (95% CI 0.17-0.49). CONCLUSION The HUNT4 questionnaire is a valid tool for identifying persons with lifetime migraine, self-reported active migraine and active migraine applying liberal modified criteria. The agreement for TTH was fair.
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Affiliation(s)
- Knut Hagen
- Department of Neuromedicine and Movement science, Faculty of Medicine, Norwegian University of Science and Technology, 7489, Trondheim, Norway. .,Norwegian Advisory Unit on Headaches, St. Olavs University Hospital, Trondheim, Norway. .,Clinical Trial Unit, St. Olavs Hospital, Trondheim, Norway.
| | - Anders Nikolai Åsberg
- Department of Neuromedicine and Movement science, Faculty of Medicine, Norwegian University of Science and Technology, 7489, Trondheim, Norway
| | - Benjamin L Uhlig
- Department of Neuromedicine and Movement science, Faculty of Medicine, Norwegian University of Science and Technology, 7489, Trondheim, Norway
| | - Erling Tronvik
- Department of Neuromedicine and Movement science, Faculty of Medicine, Norwegian University of Science and Technology, 7489, Trondheim, Norway.,Norwegian Advisory Unit on Headaches, St. Olavs University Hospital, Trondheim, Norway
| | - Eiliv Brenner
- Department of Neurology and Clinical Neurophysiology, St. Olavs University Hospital, Trondheim, Norway
| | - Trond Sand
- Department of Neuromedicine and Movement science, Faculty of Medicine, Norwegian University of Science and Technology, 7489, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, St. Olavs University Hospital, Trondheim, Norway
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Kristoffersen ES, Lundqvist C, Russell MB. Illness perception in people with primary and secondary chronic headache in the general population. J Psychosom Res 2019; 116:83-92. [PMID: 30654999 DOI: 10.1016/j.jpsychores.2018.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 12/02/2018] [Accepted: 12/02/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronic headache (headache ≥15 days/month) is a leading cause of disability. Illness perception, beliefs and cognitive models are likely central for patient understanding of their chronic pain condition and are associated with treatment outcome. However, these factors are insufficiently described in chronic headache. OBJECTIVE To describe illness perception, and to explore the effect of background variables and headache characteristics on illness perceptions in primary and secondary chronic headaches in the general population. METHODS 30,000 persons aged 3044 from the general population were screened for chronic headache by a mailed questionnaire. Those with self-reported chronic headache were interviewed by headache specialists. The questionnaire response rate was 71%, and the interview participation rate was 74%. The International Classification of Headache Disorders III was applied. Illness perception was assessed by the Revised Illness Perception Questionnaire (IPQ-R). The statistical approach was exploratory. RESULTS 405 of the 516 eligible participants (78%) completed the IPQ-R. Confirmatory factor analysis showed good internal validity in chronic headache. People believed their chronic headache to be long-lasting, with negative life consequences including emotional distress. Severe headache-related disability was associated with more perception of chronicity, more perceived consequences, emotional load and illness identity and less illness coherence. People with secondary chronic headache scored significantly higher on chronicity and life consequences, and had less personal control than those with primary chronic headache. CONCLUSION Chronic primary and secondary headache is associated with a high symptom burden and chronicity with large perceived negative consequences for daily living, suggesting multidisciplinary management may be necessary.
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Affiliation(s)
- Espen Saxhaug Kristoffersen
- Head and Neck Research Group, Research Centre, Akershus University Hospital, Lørenskog, Norway; Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Christofer Lundqvist
- Head and Neck Research Group, Research Centre, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Nordbyhagen, Norway; HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway; Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Michael Bjørn Russell
- Head and Neck Research Group, Research Centre, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Nordbyhagen, Norway
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20
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Bjorvatn B, Pallesen S, Moen BE, Waage S, Kristoffersen ES. Migraine, tension-type headache and medication-overuse headache in a large population of shift working nurses: a cross-sectional study in Norway. BMJ Open 2018; 8:e022403. [PMID: 30455385 PMCID: PMC6252763 DOI: 10.1136/bmjopen-2018-022403] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To investigate associations between different types of headaches and shift work. DESIGN, PARTICIPANTS AND OUTCOME MEASURES Nurses with different work schedules (day work, two-shift rotation, night work, three-shift rotation) participated in a cohort study with annual surveys that started in 2008/2009. In 2014 (wave 6), a comprehensive headache instrument was included in the survey, in which 1585 nurses participated. Headaches were assessed according to the International Classification of Headache Disorders IIIb. Frequent headache (≥1 day per month), migraine, tension-type headache, chronic headache (headache >14 days per month) and medication-overuse headache (chronic headache + acute headache medication ≥10 days last month) comprised the dependent variables. Adjusted (for sex, age, percentage of full-time equivalent, marital status, children living at home) logistic regression analyses were conducted with work schedule, number of night shifts worked last year, number of quick returns (<11 hours in-between shifts) last year, shift work disorder and insomnia disorder as predictors. RESULTS Frequent headache, migraine and chronic headache were associated with shift work disorder (OR 2.04, 95% CI 1.62 to 2.59; 1.60, 1.21 to 2.12; 2.45, 1.25 to 4.80, respectively) and insomnia disorder (OR 1.79, 95% CI 1.43 to 2.23; 1.55, 1.18 to 2.02; 3.03, 1.54 to 5.95, respectively), but not with work schedule, number of night shifts or number of quick returns. Tension-type headache was only associated with >20 night shifts last year (OR 1.41, 95% CI 1.07 to 1.86). Medication-overuse headache was only associated with insomnia disorder (OR 7.62, 95% CI 2.48 to 23.41). CONCLUSIONS We did not find any association between different types of headaches and work schedule. However, tension-type headache was associated with high number of night shifts. Nurses with sleep disorders (insomnia disorder and shift work disorder) reported higher prevalence of frequent headaches, migraine, chronic headache and medication-overuse headache (only insomnia) compared with nurses not having insomnia disorder and shift work disorder, respectively.
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Affiliation(s)
- Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Ståle Pallesen
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Bente E Moen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Siri Waage
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
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21
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Jellestad PL, Carlsen LN, Westergaard ML, Munksgaard SB, Bendtsen L, Lainez M, Fadic R, Katsarava Z, Goicochea MT, Spadafora S, Jensen RH, Nappi G, Tassorelli C. Economic benefits of treating medication-overuse headache – results from the multicenter COMOESTAS project. Cephalalgia 2018; 39:274-285. [DOI: 10.1177/0333102418786265] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Medication-overuse headache is a costly disease for individuals and society. Objective To estimate the impact of medication-overuse headache treatment on direct and indirect headache-related health care costs. Methods This prospective longitudinal study was part of the COMOESTAS project (COntinuous MOnitoring of Medication Overuse Headache in Europe and Latin America: development and STAndardization of an Alert and decision support System). Patients with medication-overuse headache were included from four European and two Latin American headache centers. Costs of acute medication, costs of health care services, and measurements of productivity were calculated at baseline and at 6-month follow-up Treatment consisted of overused drug withdrawal with optional preventive medication. Results A total of 475 patients (71%) completed treatment and were followed up for 6 months. Direct health care costs were on average reduced significantly by 52% ( p < 0.001) for the total study population. Significant reductions were seen in both number of consumed tablets (−71%, p < 0.001) and number of visits to physicians (−43%, p < 0.001). Fifty percent of patients reduced their number of consumed tablets ≥ 80%. Headache-related productivity loss, calculated either as absence from work or ≥ 50% reduction of productivity during the workday, were reduced by 21% and 34%, respectively ( p < 0.001). Conclusion Standardized treatment of medication-overuse headache in six countries significantly reduced direct health care costs and increased productivity. This emphasizes the importance of increasing awareness of the value of treating medication-overuse headache. Trial registration The trial was registered at ClinicalTrials.gov (no. NCT02435056)
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Affiliation(s)
| | - Louise Ninett Carlsen
- Danish Headache Centre, Department of Neurology, Rigshospitalet Glostrup, Glostrup, Denmark
| | | | - Signe Bruun Munksgaard
- Danish Headache Centre, Department of Neurology, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Lars Bendtsen
- Danish Headache Centre, Department of Neurology, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Miguel Lainez
- Department of Neurology, Pontificia Catolica University of Chile, Santiago, Chile
| | - Ricardo Fadic
- Foundation of the Valencian Community, University Clinical Hospital, Valencia, Spain
| | - Zaza Katsarava
- Department of Neurology, University of Essen, Essen, Germany
| | | | | | - Rigmor Højland Jensen
- Danish Headache Centre, Department of Neurology, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Giuseppe Nappi
- Headache Science Centre, C. Mondino National Neurological Institute, Pavia, Italy
| | - Cristina Tassorelli
- Headache Science Centre, C. Mondino National Neurological Institute, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Italy
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22
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Ravn Munkvold BK, Sagberg LM, Jakola AS, Solheim O. Preoperative and Postoperative Headache in Patients with Intracranial Tumors. World Neurosurg 2018; 115:e322-e330. [DOI: 10.1016/j.wneu.2018.04.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 04/05/2018] [Accepted: 04/06/2018] [Indexed: 11/28/2022]
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23
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Johnsen MB, Winsvold BS, Børte S, Vie GÅ, Pedersen LM, Storheim K, Skorpen F, Hagen K, Bjørngaard JH, Åsvold BO, Zwart JA. The causal role of smoking on the risk of headache. A Mendelian randomization analysis in the HUNT study. Eur J Neurol 2018; 25:1148-e102. [PMID: 29747220 DOI: 10.1111/ene.13675] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 05/03/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Headache has been associated with various lifestyle and psychosocial factors, one of which is smoking. The aim of the present study was to investigate whether the association between smoking intensity and headache is likely to be causal. METHOD A total of 58 316 participants from the Nord-Trøndelag Health (HUNT) study with information on headache status were genotyped for the rs1051730 C>T single-nucleotide polymorphism (SNP). The SNP was used as an instrument for smoking intensity in a Mendelian randomization analysis. The association between rs1051730 T alleles and headache was estimated by odds ratios with 95% confidence intervals. Additionally, the association between the SNP and migraine or non-migrainous headache versus no headache was investigated. All analyses were adjusted for age and sex. RESULTS There was no strong evidence that the rs1051730 T allele was associated with headache in ever smokers (odds ratio 0.99, 95% confidence interval 0.95-1.02). Similarly, there was no association between the rs1051730 T allele and migraine or non-migrainous headache versus no headache. CONCLUSION The findings from this study do not support that there is a strong causal relationship between smoking intensity and any type of headache. Larger Mendelian randomization studies are required to examine whether higher smoking quantity can lead to a moderate increase in the risk of headache subtypes.
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Affiliation(s)
- M B Johnsen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Research and Communication Unit for Musculoskeletal Health, Oslo University Hospital, Oslo, Norway.,K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - B S Winsvold
- Research and Communication Unit for Musculoskeletal Health, Oslo University Hospital, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - S Børte
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Research and Communication Unit for Musculoskeletal Health, Oslo University Hospital, Oslo, Norway
| | - G Å Vie
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - L M Pedersen
- Research and Communication Unit for Musculoskeletal Health, Oslo University Hospital, Oslo, Norway
| | - K Storheim
- Research and Communication Unit for Musculoskeletal Health, Oslo University Hospital, Oslo, Norway
| | - F Skorpen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - K Hagen
- Department of Neuromedicine and Movement Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Norwegian Advisory Unit on Headaches, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - J H Bjørngaard
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Forensic Department and Research Centre Brøset, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - B O Åsvold
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Endocrinology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - J A Zwart
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Research and Communication Unit for Musculoskeletal Health, Oslo University Hospital, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
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24
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Diener HC, Holle D, Dresler T, Gaul C. Chronic Headache Due to Overuse of Analgesics and Anti-Migraine Agents. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:365-370. [PMID: 29932046 PMCID: PMC6039717 DOI: 10.3238/arztebl.2018.0365] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 10/30/2017] [Accepted: 03/15/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND The frequent or regular use of analgesics and anti-migraine drugs can make headache more frequent and induce the transformation of episodic to chronic headache. Chronic headache due to medication overuse is defined as headache that is present on ≥ 15 days per month for at least three months in a patient who previously suffered from primary headaches, and who takes analgesics on ≥ 15 days per month or anti-migraine drugs (triptans or ergot alkaloids), opioid drugs, or combined analgesics on ≥ 10 days per month. METHODS This review is based on pertinent articles published up to December 2017 that were retrieved by a selective search in PubMed employing the terms "medication overuse AND headache" and "medication overuse headache." RESULTS The prevalence of medication overuse headache in the general population in Germany is 0.7% -1%. This disorder is more common in women and in persons suffering from comorbid mental disorders or other painful conditions. The treatment of medication overuse headache consists of three steps. Patient education and counseling are given with the goal of reducing the intake of medication for acute headache treatment. The ensuing headache prophylaxis is with topiramate, amitriptyline, or onabotulinum toxin A. If these treatment strategies fail, a drug holiday is recommended. This can be in the outpatient, day clinic, or inpatient setting, depending on the severity of the condition and its comorbidities. CONCLUSION Patients who frequently take acute medication to treat headache episodes must be identified early in order to avoid headache chronification and medication overuse headache. The suggested treatment algorithm is still in need of validation by randomized trials.
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Affiliation(s)
| | - Dagny Holle
- Department of Neurology and West German Headache Center, Essen
| | - Thomas Dresler
- Department of Psychiatry and Psychotherapy, University Hospital and Faculty of Medicine, Tübingen LEAD Graduate School & Research Network, University of Tübingen
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25
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Hagen K, Kristoffersen ES, Winsvold BS, Stovner LJ, Zwart JA. Remission of chronic headache: An 11-year follow-up study. Data from the Nord-Trøndelag Health Surveys 1995-1997 and 2006-2008. Cephalalgia 2018; 38:2026-2034. [PMID: 29629599 DOI: 10.1177/0333102418769940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To estimate remission rates of chronic headache and predictors of remission. METHODS In this longitudinal population-based cohort study, we used validated headache questionnaire data from the second (1995-1997, baseline; n = 51,856 aged ≥ 20 years, response rate: 55%) and third wave (2006-2008, follow-up, response rate: 42%) of the Nord-Trøndelag Health Study. Chronic headache was defined as ≥15 headache days/month during the last year. Chronic headache remission was defined as headache less than 15 days/month at follow-up. Potential predictors of remission were evaluated using logistic regression. RESULTS At baseline, 1266 (2.4%) participants reported chronic headache. Of these, 605 (48%) answered headache questions at follow-up. Remission was observed in 452 (74.7%), the proportion being almost identical in men and women (74.4% vs. 74.9, p = 0.92). In analyses adjusting for age, gender and education level, remission at follow-up was more than two times more likely among individuals without medication overuse headache (OR = 2.4, 95% CI 1.7-3.6) and without chronic musculoskeletal complaints (OR = 2.9, 95% CI 1.5-5.0) at baseline. CONCLUSIONS In this longitudinal population-based cohort study, three-quarters of chronic headache participants remitted from chronic headache. Remission was associated with no medication overuse headache and no chronic musculoskeletal complaints at baseline.
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Affiliation(s)
- Knut Hagen
- 1 Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.,2 Norwegian Advisory Unit on Headache, St. Olav's Hospital, Trondheim, Norway
| | - Espen Saxhaug Kristoffersen
- 3 Department of General Practice, HELSAM, University of Oslo, Oslo, Norway.,4 Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Bendik Slagvold Winsvold
- 5 Department of Neurology and FORMI; Oslo University Hospital, Oslo, Norway.,6 Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lars Jacob Stovner
- 1 Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.,2 Norwegian Advisory Unit on Headache, St. Olav's Hospital, Trondheim, Norway
| | - John-Anker Zwart
- 5 Department of Neurology and FORMI; Oslo University Hospital, Oslo, Norway.,6 Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Honningsvåg LM, Håberg AK, Hagen K, Kvistad KA, Stovner LJ, Linde M. White matter hyperintensities and headache: A population-based imaging study (HUNT MRI). Cephalalgia 2018. [DOI: 10.1177/0333102418764891] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective To examine the relationship between white matter hyperintensities and headache. Methods White matter hyperintensities burden was assessed semi-quantitatively using Fazekas and Scheltens scales, and by manual and automated volumetry of MRI in a sub-study of the general population-based Nord-Trøndelag Health Study (HUNT MRI). Using validated questionnaires, participants were categorized into four cross-sectional headache groups: Headache-free (n = 551), tension-type headache (n = 94), migraine (n = 91), and unclassified headache (n = 126). Prospective questionnaire data was used to further categorize participants into groups according to the evolution of headache during the last 12 years: Stable headache-free, past headache, new onset headache, and persistent headache. White matter hyperintensities burden was compared across headache groups using adjusted multivariate regression models. Results Individuals with tension-type headache were more likely to have extensive white matter hyperintensities than headache-free subjects, with this being the case across all methods of white matter hyperintensities assessment (Scheltens scale: Odds ratio, 2.46; 95% CI, 1.44–4.20). Migraine or unclassified headache did not influence the odds of having extensive white matter hyperintensities. Those with new onset headache were more likely to have extensive white matter hyperintensities than those who were stable headache-free (Scheltens scale: Odds ratio, 2.24; 95% CI, 1.13–4.44). Conclusions Having tension-type headache or developing headache in middle age was linked to extensive white matter hyperintensities. These results were similar across all methods of assessing white matter hyperintensities. If white matter hyperintensities treatment strategies emerge in the future, this association should be taken into consideration.
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Affiliation(s)
- Lasse-Marius Honningsvåg
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Asta Kristine Håberg
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Department of Radiology and Nuclear Medicine, St. Olav's University Hospital, Trondheim, Norway
| | - Knut Hagen
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian Advisory Unit on Headache, St. Olav's University Hospital, Trondheim, Norway
| | - Kjell Arne Kvistad
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Department of Radiology and Nuclear Medicine, St. Olav's University Hospital, Trondheim, Norway
| | - Lars Jacob Stovner
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian Advisory Unit on Headache, St. Olav's University Hospital, Trondheim, Norway
| | - Mattias Linde
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian Advisory Unit on Headache, St. Olav's University Hospital, Trondheim, Norway
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Hagen K, Åsberg AN, Stovner L, Linde M, Zwart JA, Winsvold BS, Heuch I. Lifestyle factors and risk of migraine and tension-type headache. Follow-up data from the Nord-Trøndelag Health Surveys 1995-1997 and 2006-2008. Cephalalgia 2018. [PMID: 29517305 DOI: 10.1177/0333102418764888] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIMS The aim of this population-based historical cohort study was to investigate the influence of lifestyle factors on the risk of developing migraine or tension-type headache (TTH). METHODS Data from the Nord-Trøndelag Health Study performed in 1995-1997 and 2006-2008 was used. A total of 15,276 participants without headache at baseline were included. A Poisson regression was used to evaluate the associations between lifestyle factors and risk ratios (RRs) of migraine and TTH 11 years later. Precision of the estimates was assessed by 95% confidence interval (CIs). RESULTS Increased risk of migraine (RR 1.30, 95% CI 1.11-1.52) was found in smokers (past or current) compared to those who had never smoked. Hard physical exercise 1-2 hours per week reduced the risk of migraine (OR 0.71, 95% CI 0.54-0.94) compared to inactivity, and the risk of migraine was also lower among those who consumed alcohol (RR 0.73, 95% CI 0.57-0.94) compared to abstainers. No association was found between smoking, physical activity, alcohol use and risk of TTH. CONCLUSIONS The main finding was that current and previous smoking was associated with increased risk of migraine, but not of TTH.
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Affiliation(s)
- Knut Hagen
- 1 Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,2 Norwegian Advisory Unit on Headaches, St. Olav's University Hospital, Trondheim, Norway
| | - Anders Nikolai Åsberg
- 1 Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars Stovner
- 1 Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,2 Norwegian Advisory Unit on Headaches, St. Olav's University Hospital, Trondheim, Norway
| | - Mattias Linde
- 1 Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,2 Norwegian Advisory Unit on Headaches, St. Olav's University Hospital, Trondheim, Norway
| | - John-Anker Zwart
- 3 Department of Neurology and FORMI, Oslo University Hospital, Oslo, Norway.,4 Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,5 Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Bendik Slagsvold Winsvold
- 3 Department of Neurology and FORMI, Oslo University Hospital, Oslo, Norway.,4 Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Heuch
- 5 Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
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Nordhaug LH, Hagen K, Vik A, Stovner LJ, Follestad T, Pedersen T, Gravdahl GB, Linde M. Headache following head injury: a population-based longitudinal cohort study (HUNT). J Headache Pain 2018; 19:8. [PMID: 29356960 PMCID: PMC5777966 DOI: 10.1186/s10194-018-0838-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 01/12/2018] [Indexed: 12/15/2022] Open
Abstract
Background Headache is the most frequent symptom following head injury, but long-term follow-up of headache after head injury entails methodological challenges. In a population-based cohort study, we explored whether subjects hospitalized due to a head injury more often developed a new headache or experienced exacerbation of previously reported headache compared to the surrounding population. Methods This population-based historical cohort study included headache data from two large epidemiological surveys performed with an 11-year interval. This was linked with data from hospital records on exposure to head injury occurring between the health surveys. Participants in the surveys who had not been hospitalized because of a head injury comprised the control group. The head injuries were classified according to the Head Injury Severity Scale (HISS). Multinomial logistic regression was performed to investigate the association between head injury and new headache or exacerbation of pre-existing headache in a population with known pre-injury headache status, controlling for potential confounders. Results The exposed group consisted of 294 individuals and the control group of 25,662 individuals. In multivariate analyses, adjusting for age, sex, anxiety, depression, education level, smoking and alcohol use, mild head injury increased the risk of new onset headache suffering (OR 1.74, 95% CI 1.05–2.87), stable headache suffering (OR 1.70, 95% CI 1.15–2.50) and exacerbation of previously reported headache (OR 1.93, 95% CI 1.24–3.02). The reference category was participants without headache in both surveys. Conclusion Individuals hospitalized due to a head injury were more likely to have new onset and worsening of pre-existing headache and persistent headache, compared to the surrounding general population. The results support the entity of the ICHD-3 beta diagnosis “persistent headache attributed to traumatic injury to the head”.
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Affiliation(s)
- Lena Hoem Nordhaug
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postbox 8905, 7491, Trondheim, Norway.
| | - Knut Hagen
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postbox 8905, 7491, Trondheim, Norway.,Norwegian Advisory Unit on Headaches, St. Olavs University Hospital, Trondheim, Norway
| | - Anne Vik
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postbox 8905, 7491, Trondheim, Norway.,Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway
| | - Lars Jacob Stovner
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postbox 8905, 7491, Trondheim, Norway.,Norwegian Advisory Unit on Headaches, St. Olavs University Hospital, Trondheim, Norway
| | - Turid Follestad
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Torunn Pedersen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Gøril Bruvik Gravdahl
- Norwegian Advisory Unit on Headaches, St. Olavs University Hospital, Trondheim, Norway
| | - Mattias Linde
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postbox 8905, 7491, Trondheim, Norway.,Norwegian Advisory Unit on Headaches, St. Olavs University Hospital, Trondheim, Norway
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Serrano D, Lipton RB, Scher AI, Reed ML, Stewart WBF, Adams AM, Buse DC. Fluctuations in episodic and chronic migraine status over the course of 1 year: implications for diagnosis, treatment and clinical trial design. J Headache Pain 2017; 18:101. [PMID: 28980171 PMCID: PMC5628086 DOI: 10.1186/s10194-017-0787-1] [Citation(s) in RCA: 142] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 07/14/2017] [Indexed: 01/03/2023] Open
Abstract
Background Relatively little is known about the stability of a diagnosis of episodic migraine (EM) or chronic migraine (CM) over time. This study examines natural fluctuations in self-reported headache frequency as well as the stability and variation in migraine type among individuals meeting criteria for EM and CM at baseline. Methods The Chronic Migraine Epidemiology and Outcomes (CaMEO) Study was a longitudinal survey of US adults with EM and CM identified by a web-questionnaire. A validated questionnaire was used to classify respondents with EM (<15 headache days/month) or CM (≥15 headache days/month) every three months for a total of five assessments. We described longitudinal persistence of baseline EM and CM classifications. In addition, we modelled longitudinal variation in headache day frequency per month using negative binomial repeated measures regression models (NBRMR). Results Among the 5464 respondents with EM at baseline providing four or five waves of data, 5048 (92.4%) had EM in all waves and 416 (7.6%) had CM in at least one wave. Among 526 respondents with CM at baseline providing four or five waves of data, 140 (26.6%) had CM in every wave and 386 (73.4%) had EM for at least one wave. Individual plots revealed striking within-person variations in headache days per month. The NBRMR model revealed that the rate of headache days increased across waves of observation 19% more per wave for CM compared to EM (rate ratio [RR], 1.19; 95% CI, 1.13–1.26). After adjustment for covariates, the relative difference changed to a 26% increase per wave (RR, 1.26; 95% CI, 1.2–1.33). Conclusions Follow-up at three-month intervals reveals a high level of short-term variability in headache days per month. As a consequence, many individuals cross the CM diagnostic boundary of ≥15 headache days per month.Nearly three quarters of persons with CM at baseline drop below this diagnostic boundary at least once over the course of a year. These findings are of interest in the consideration of headache classification and diagnosis, the design and interpretation of epidemiologic and clinical studies, and clinical management. Electronic supplementary material The online version of this article (doi:10.1186/s10194-017-0787-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Richard B Lipton
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA. .,Montefiore Headache Center; Department of Neurology and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Ann I Scher
- Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | | | | | - Dawn C Buse
- Montefiore Medical Center, Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
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Kropp P, Meyer B, Meyer W, Dresler T. An update on behavioral treatments in migraine - current knowledge and future options. Expert Rev Neurother 2017; 17:1059-1068. [PMID: 28877611 DOI: 10.1080/14737175.2017.1377611] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Besides pharmacological and interventional treatments a variety of non-medical therapeutic options exist for migraine, which has largely been derived from behavioral therapy. Areas covered: For our update we collected available studies via PubMed searches. This review highlights that already consulting of the patient is able to reduce the frequency of migraine attacks. Relaxation techniques, especially progressive muscle relaxation, and various types of biofeedback are effective, as is the implementation of cognitive behavioral therapy. However, recent reviews also point to some existing inconsistencies and methodological limitations. The advent of modern information technology based approaches (e.g. online therapy, smartphone applications) further advanced the arsenal of behavioral treatment regimes. The combination of behavioral treatment options and the combination with pharmacotherapy lead to additive effects. In modern multidisciplinary treatment approaches, behavioral therapy is an indispensable component. Expert commentary: Behavioral treatment in prophylaxis of migraine is as effective as pharmacological treatment with additional effects when pharmacological and behavioral treatment is applied in combination. Novel treatment approaches using online technology and electronic devices offer interesting options that will spread more in the future.
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Affiliation(s)
- Peter Kropp
- a Institute of Medical Psychology and Medical Sociology , University Medicine Rostock , Rostock , Germany
| | - Bianca Meyer
- a Institute of Medical Psychology and Medical Sociology , University Medicine Rostock , Rostock , Germany
| | - Wolfgang Meyer
- b Barts and the London School of Medicine and Dentistry , Queen Mary University of London , London , United Kingdom
| | - Thomas Dresler
- c Department of Psychiatry & Psychotherapy , University Hospital Tuebingen , Tuebingen , Germany.,d LEAD Graduate School & Research Network , University of Tuebingen , Tuebingen , Germany
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The PACE study: lifetime and past-year prevalence of headache in Parma's adult general population. Neurol Sci 2017; 38:789-795. [PMID: 28210911 DOI: 10.1007/s10072-017-2845-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 02/08/2017] [Indexed: 10/20/2022]
Abstract
Headache is a widespread disorder and therefore it has a strong impact on quality of life. In the present work we focused on lifetime and past-year prevalence of headache in general and by gender, in a population-based sample in Parma. A total of 904 subjects representative of Parma's adult general population were interviewed face-to-face by a physician from the Parma Headache Centre, using a validated questionnaire. The lifetime prevalence of headache was 69.1%, i.e. 75.8% in women and 60.6% in men; the crude past-year prevalence of headache was 42.8%, i.e. 52.0% in women and 31.1% in men. Both lifetime and past-year prevalence rates were significantly higher in females than in males (odds ratio, respectively, 2.0 and 2.4). In our study, past-year prevalence decreased after age 50 in both genders. Most people suffer from one headache subtype. In over 80% of cases, headache starts before age 40 and therefore people were not very likely to develop headache after 50 years. The past-year and lifetime prevalence rate of headache in general that we found in our study falls within the lower range of values for headache prevalence in European countries. Further researches need to be set in the Italian epidemiological background.
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Hagen K, Åsvold BO, Midthjell K, Stovner LJ, Zwart JA, Linde M. Inverse relationship between type 1 diabetes mellitus and migraine. Data from the Nord-Trøndelag Health Surveys 1995-1997 and 2006-2008. Cephalalgia 2017; 38:417-426. [PMID: 28114807 DOI: 10.1177/0333102417690488] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Aims The aim of this cross-sectional population-based study was to investigate the associations between migraine and type 1 and type 2 diabetes mellitus (DM). Methods We used data from the second (1995-1997) and third survey (2006-2008) in the Nord-Trøndelag Health Study. Analyses were made for the 26,121 participants (30-97 years of age, median 58.3 years) with known headache and DM status in both surveys, and for the 39,584 participants in the third survey (20-97 years, median 54.1 years). The diagnosis of migraine was given to those who fulfilled the questionnaire-based migraine diagnosis in the second and/or third survey. Associations were assessed using multiple logistic regression, estimating prevalence odds ratio (OR) with 95% confidence intervals (CIs). Results In the multivariate analysis of the 26,121 participants in both surveys, adjusting for age, gender, years of education, and smoking, classical type 1 DM (n = 81) was associated with a lower prevalence of any headache (OR = 0.55, 95% CI 0.34-0.88),and migraine (OR = 0.47, 95% CI 0.26-0.96) compared to those without DM (n = 24,779). Correspondingly, the merged group of classical type 1 DM and latent autoimmune diabetes of adults (LADA) (n = 153) were less likely to have migraine (OR = 0.53, 95% CI 0.31-0.91). Similarly, an inverse relationship between type 1 DM and migraine was found in analyses of 39,584 participants in the third survey. No clear association was found between headache and type 2 DM. Conclusions In this cross-sectional population-based study of mainly middle-aged participants, type 1 DM was inversely associated with headache, in particular migraine.
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Affiliation(s)
- Knut Hagen
- 1 Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.,2 Norwegian Advisory Unit on Headache, St. Olavs Hospital, Trondheim, Norway
| | - Bjørn Olav Åsvold
- 3 Department of Endocrinology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,4 Department of Public Health and General Practice, Norwegian University of Science and Technology, HUNT research Centre, Levanger, Norway
| | - Kristian Midthjell
- 4 Department of Public Health and General Practice, Norwegian University of Science and Technology, HUNT research Centre, Levanger, Norway
| | - Lars Jacob Stovner
- 1 Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.,2 Norwegian Advisory Unit on Headache, St. Olavs Hospital, Trondheim, Norway
| | - John-Anker Zwart
- 5 Department of Neurology and FORMI; Oslo University Hospital, Oslo, Norway.,6 Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mattias Linde
- 1 Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.,2 Norwegian Advisory Unit on Headache, St. Olavs Hospital, Trondheim, Norway
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Winsvold BS, Palta P, Eising E, Page CM, van den Maagdenberg AMJM, Palotie A, Zwart JA. Epigenetic DNA methylation changes associated with headache chronification: A retrospective case-control study. Cephalalgia 2017; 38:312-322. [DOI: 10.1177/0333102417690111] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background The biological mechanisms of headache chronification are poorly understood. We aimed to identify changes in DNA methylation associated with the transformation from episodic to chronic headache. Methods Participants were recruited from the population-based Norwegian HUNT Study. Thirty-six female headache patients who transformed from episodic to chronic headache between baseline and follow-up 11 years later were matched against 35 controls with episodic headache. DNA methylation was quantified at 485,000 CpG sites, and changes in methylation level at these sites were compared between cases and controls by linear regression analysis. Data were analyzed in two stages (Stages 1 and 2) and in a combined meta-analysis. Results None of the top 20 CpG sites identified in Stage 1 replicated in Stage 2 after multiple testing correction. In the combined meta-analysis the strongest associated CpG sites were related to SH2D5 and NPTX2, two brain-expressed genes involved in the regulation of synaptic plasticity. Functional enrichment analysis pointed to processes including calcium ion binding and estrogen receptor pathways. Conclusion In this first genome-wide study of DNA methylation in headache chronification several potentially implicated loci and processes were identified. The study exemplifies the use of prospectively collected population cohorts to search for epigenetic mechanisms of disease.
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Affiliation(s)
- Bendik S Winsvold
- FORMI and Department of Neurology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Priit Palta
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
- Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - Else Eising
- Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Christian M Page
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Norwegian Institute of Public Health, Oslo, Norway
| | - Arn MJM van den Maagdenberg
- Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Aarno Palotie
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston, USA
- Medical and Population Genetics Program, Broad Institute of MIT and Harvard, Cambridge, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - John-Anker Zwart
- FORMI and Department of Neurology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Mendonça MD, Caetano A, Viana-Baptista M. "Dr Google" will see you now - time trends in online searches on headache. Cephalalgia 2016; 38:407-408. [PMID: 27895210 DOI: 10.1177/0333102416681572] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Marcelo D Mendonça
- 1 Neurology Department, Hospital Egas Moniz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- 2 CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
- 3 Champalimaud Research, Champalimaud Center for the Unknown, Lisbon, Portugal
| | - André Caetano
- 1 Neurology Department, Hospital Egas Moniz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Miguel Viana-Baptista
- 1 Neurology Department, Hospital Egas Moniz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- 2 CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
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Bøe MG, Thortveit E, Vatne A, Mygland Å. Chronic headache with medication overuse: Long-term prognosis after withdrawal therapy. Cephalalgia 2016; 37:1215-1221. [PMID: 27707950 DOI: 10.1177/0333102416672493] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Magne Geir Bøe
- 1 Neurological department, Sørlandet hospital, Kristiansand, Norway
| | - Erik Thortveit
- 1 Neurological department, Sørlandet hospital, Kristiansand, Norway
| | - Anita Vatne
- 1 Neurological department, Sørlandet hospital, Kristiansand, Norway
| | - Åse Mygland
- 1 Neurological department, Sørlandet hospital, Kristiansand, Norway.,2 Department for rehabilitation, Sørlandet hospital, Kristiansand, Norway.,3 Clinical Institute I, University of Bergen, Norway
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Larsen JS, Skaug EA, Wisløff U, Ellingsen Ø, Stovner LJ, Linde M, Hagen K. Migraine and endothelial function: The HUNT3 Study. Cephalalgia 2016; 36:1341-1349. [DOI: 10.1177/0333102416631961] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/08/2016] [Accepted: 01/17/2016] [Indexed: 11/17/2022]
Abstract
Background Reduced endothelial function is associated with elevated risk of cardiovascular disease, but evidence on the association between migraine and endothelial function is conflicting. The aim of this population-based study was to examine the relationship between flow-mediated dilatation (FMD) and migraine with aura, migraine without aura and tension-type headache. Methods In the third Nord-Trøndelag Healthy Study (HUNT3) FMD was measured by ultrasound during reactive hyperaemia of the brachial artery in a sample of 4739 healthy adult participants, 3929 of whom answered headache questions. The cross-sectional association between different headache diagnoses and FMD was evaluated by logistic regression, using a categorical approach. Results Mean FMD did not differ between the headache groups and headache-free controls. In multi-adjusted analyses, no consistent association was found between FMD quintiles and headache groups. Conclusions There was no relationship between FMD and migraine or other headache diagnoses in this large cross-sectional study of otherwise healthy respondents including freedom from pulmonary and cardiovascular diseases.
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Affiliation(s)
| | - Eli-Anne Skaug
- K.G. Jebsen Center of Exercise in Medicine, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Norway
| | - Ulrik Wisløff
- K.G. Jebsen Center of Exercise in Medicine, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Norway
- Department of Cardiology, St. Olavs Hospital, Norway
| | - Øyvind Ellingsen
- K.G. Jebsen Center of Exercise in Medicine, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Norway
- Department of Cardiology, St. Olavs Hospital, Norway
| | - Lars Jacob Stovner
- Department of Neuroscience, Norwegian University of Science and Technology, Norway
- Norwegian Advisory Unit on Headaches, St Olavs Hospital, Norway
| | - Mattias Linde
- Department of Neuroscience, Norwegian University of Science and Technology, Norway
- Norwegian Advisory Unit on Headaches, St Olavs Hospital, Norway
| | - Knut Hagen
- Department of Neuroscience, Norwegian University of Science and Technology, Norway
- Norwegian Advisory Unit on Headaches, St Olavs Hospital, Norway
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Hoem Nordhaug L, Vik A, Hagen K, Stovner LJ, Pedersen T, Gravdahl GB, Linde M. Headaches in patients with previous head injuries: A population-based historical cohort study (HUNT). Cephalalgia 2016; 36:1009-1019. [PMID: 26634833 DOI: 10.1177/0333102415618948] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Headache attributed to head injury is claimed to be among the most common secondary headache disorders, yet available epidemiological evidence is scarce. We evaluated the prevalence of headache among individuals previously exposed to head injury by a comparison to an uninjured control group. Methods This population-based historical cohort study used data from hospital records on previous exposure to head injury linked to a large epidemiological survey with data on headache occurrence. Participants without head injury, according to hospital records, were used as controls. The head injuries were classified according to the Head Injury Severity Scale (HISS) and the International Classification of Headache Disorders (ICHD-3 beta). Binary logistic regression was performed to investigate the association between headache and head injury, controlling for potential confounders. Results The exposed group consisted of 940 individuals and the control group of 38,751 individuals. In the multivariate analyses, adjusting for age, sex, anxiety, depression and socioeconomic status, there were significant associations between mild head injury and any headache, migraine, chronic daily headache and medication overuse headache. Conclusion Headache was more likely among individuals previously referred to a hospital for a mild head injury compared to uninjured controls.
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Affiliation(s)
- Lena Hoem Nordhaug
- 1 Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anne Vik
- 1 Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.,2 Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway
| | - Knut Hagen
- 1 Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.,3 Norwegian Advisory Unit on Headaches, St. Olavs University Hospital, Trondheim, Norway
| | - Lars Jacob Stovner
- 1 Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.,3 Norwegian Advisory Unit on Headaches, St. Olavs University Hospital, Trondheim, Norway
| | - Torunn Pedersen
- 1 Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gøril Bruvik Gravdahl
- 3 Norwegian Advisory Unit on Headaches, St. Olavs University Hospital, Trondheim, Norway
| | - Mattias Linde
- 1 Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.,3 Norwegian Advisory Unit on Headaches, St. Olavs University Hospital, Trondheim, Norway
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Westergaard ML, Munksgaard SB, Bendtsen L, Jensen RH. Medication-overuse headache: a perspective review. Ther Adv Drug Saf 2016; 7:147-58. [PMID: 27493718 DOI: 10.1177/2042098616653390] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Medication-overuse headache (MOH) is a debilitating condition in which frequent and prolonged use of medication for the acute treatment of pain results in the worsening of the headache. The purpose of this paper is to review the most recent literature on MOH and discuss future avenues for research. MOH accounts for a substantial share of the global burden of disease. Prevalence is often reported as 1-2% but can be as high as 7% overall, with higher proportions among women and in those with a low socioeconomic position. Management consists of withdrawing pain medication, focusing on prophylactic and nonmedical treatments, and limiting acute symptomatic medication. Stress reduction and lifestyle interventions may support the change towards rational pain medication use. Support, follow up, and education are needed to help patients through the detoxification period. There is fertile ground for research in MOH epidemiology, pathophysiology, and neuroimaging. Randomized and long-term follow-up studies on MOH treatment protocols are needed. Further focused research could be of major importance for global health.
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Affiliation(s)
- Maria Lurenda Westergaard
- Danish Headache Center, Rigshospitalet - Glostrup, University of Copenhagen, Nordre Ringvej 67, Område Nord Bygning 14, 2600 Glostrup, Denmark
| | - Signe Bruun Munksgaard
- Danish Headache Center, Rigshospitalet - Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Lars Bendtsen
- Danish Headache Center, Rigshospitalet - Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Rigmor Højland Jensen
- Danish Headache Center, Rigshospitalet - Glostrup, University of Copenhagen, Glostrup, Denmark
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Gravdahl GB, Tronvik EA, Fougner SL, Solheim O. Pituitary Adenoma and Non-acute Headache: Is There an Association, and Does Treatment Help? World Neurosurg 2016; 92:284-291. [PMID: 27132176 DOI: 10.1016/j.wneu.2016.04.071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 04/17/2016] [Accepted: 04/20/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Headache is a controversial indication for treatment of pituitary adenoma. We studied the possible relationship between pituitary adenomas and headache as well as the symptomatic effects of treatment. METHODS Current and prior headache complaints were assessed in structured telephone interviews in 201 patients with pituitary adenoma. Clinical variables and headache history were retrieved from medical records. Headache prevalence among patients was compared with a regional population-based cohort. RESULTS The presence of headache was higher in patients before the diagnosis of pituitary adenoma compared with the general population (P < 0.001). At follow-up, overall prevalence was lower (P < 0.001), but chronic headache was more prevalent (P = 0.001) than in the general population. With the exception of family history, no associations between headache and clinical or radiologic variables were identified. At follow-up evaluation, 77% of patients with headache reported improvement, 5% reported worsening, and 11% reported new headaches. Patients with nonfunctional adenoma who underwent surgical treatment reported improvement more often (85%) than patients who did not undergo surgery (58%) (P = 0.042). CONCLUSIONS In a cohort with both treated and untreated patients with pituitary adenoma, headache prevalence was low compared with the general population. We found no link between clinical or radiologic variables and headache. Although a higher proportion of patients who underwent surgical treatment reported symptomatic relief, most patients who did not undergo treatment also improved. We believe that the unpredictable dynamics of headache over time and the lack of predictive and modifiable tumor-related variables associated with headache or treatment of headache weaken headache as a sole indication for pituitary adenoma treatment.
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Affiliation(s)
- Gøril Bruvik Gravdahl
- Norwegian Advisory Unit on Headaches, St. Olavs University Hospital, Trondheim, Norway.
| | - Erling Andreas Tronvik
- Department of Neurology, St. Olavs University Hospital, Trondheim, Norway; Norwegian Advisory Unit on Headaches, St. Olavs University Hospital, Trondheim, Norway; Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stine Lyngvi Fougner
- Department of Endocrinology, St. Olavs University Hospital, Trondheim, Norway; Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ole Solheim
- Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway; National Competence Centre for Ultrasound and Image-Guided Therapy, St. Olavs University Hospital, Trondheim, Norway; Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
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Abstract
The objectives of this systematic review were to examine age dependency of headache prevalence in school age children and to assess secular trends of headache prevalence in the last decade, gender and regional differences. A literature search was performed in MEDLINE to identify all prevalence studies in children and adolescents. Five hundred seventy studies were found, of which 37 studies could be included for this review. Headache prevalence in school children increases with their age as demonstrated in cohorts of identical children and cross-sectional surveys covering different age groups of children in one population. Regarding a potential general increase in the prevalence of headache in children and adolescents in the last decade, there are four studies which all show some increase of headache prevalence; however, the degree of increase is varying. Prevalence of headache in girls appears to be higher than in boys. There were no clear regional differences in the prevalence of headache.
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Lebedeva ER, Kobzeva NR, Gilev D, Olesen J. Prevalence of primary headache disorders diagnosed according to ICHD-3 beta in three different social groups. Cephalalgia 2015; 36:579-88. [DOI: 10.1177/0333102415596442] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 05/29/2015] [Indexed: 11/17/2022]
Abstract
Background The aim of our study was to estimate the one-year prevalence of primary headache disorders in three different social groups using the third edition beta of the International Classification of Headache Disorders (ICHD-3 beta). Material and methods The study population included a total of 3124 participants: 1042 students (719 females, 323 males, mean age 20.6, age range 17–40), 1075 workers (146 females, 929 males, mean age 40.4, age range 21–67) and 1007 blood donors (484 females, 523 males, mean age 34.1, age range 18–64). We used a semi-structured, validated face-to-face interview. Results The age-adjusted one-year prevalence of migraine in females was significantly higher ( p < 0.001) in students (41.9%) than in workers (19.2%) and blood donors (18.7%). Age-adjusted prevalence of migraine among males did not differ among the three groups: 4.5% in students, 4.9% in workers and 4.5% in blood donors. Age-adjusted prevalence of tension-type headache (TTH) among females was almost the same in students and blood donors (68.8% and 66.7%) but female workers had a lower prevalence of TTH (57%). Age-adjusted prevalence of TTH among males did not differ significantly between students and blood donors (55.8% and 58.1%) but male workers had a significantly lower ( p < 0.001) prevalence of TTH (30.7%). The prevalence of chronic headache in students (TTH and/or migraine) was 3% and of probable medication-overuse headache 3%, significantly more than in workers and blood donors. Conclusion Headache prevalence was high and differed markedly among the three social groups. It is important that headache epidemiology also focus on socially defined groups in order to target future preventive efforts.
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Affiliation(s)
- Elena R Lebedeva
- Department of Neurology and Neurosurgery, Urals State Medical University, Russia
- International Headache Center “Europe-Asia,” Russia
| | | | - Denis Gilev
- Department of Econometrics and Statistics, the High School of Economics, Urals Federal University, Russia
| | - Jes Olesen
- Danish Headache Center, Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark
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One-year prevalence of migraine using a validated extended French version of the ID Migraine™: A Belgian population-based study. Rev Neurol (Paris) 2015; 171:707-14. [DOI: 10.1016/j.neurol.2015.04.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 02/23/2015] [Accepted: 04/18/2015] [Indexed: 11/18/2022]
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Hagen K, Wisløff U, Ellingsen Ø, Stovner LJ, Linde M. Headache and peak oxygen uptake: The HUNT3 study. Cephalalgia 2015. [DOI: 10.1177/0333102415597528] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Evidence on the association between headache and physical fitness is conflicting. The aim of this population-based study was to examine the relationship between peak oxygen uptake (VO2peak) and headache, including migraine and tension-type headache (TTH). Methods In the third Nord-Trøndelag Health study (HUNT3), VO2peak was measured by ergospirometry in a sample of 4631 healthy adult participants. Of these, 3899 (54% women) also answered headache questions. The cross-sectional association between headache and VO2peak was evaluated by logistic regression using a categorical approach based on quintiles. Scores in the upper quintile were used as reference. Results Participants age 20–50 years had significant trends of increasing prevalence of any headache ( p < 0.001), migraine ( p < 0.001), TTH ( p = 0.002) and unclassified headache ( p = 0.027) with lower VO2peak. The highest prevalence odds ratios (ORs) were found in those with VO2peak in the lower quintile: For any headache the OR was 2.3 (95% confidence interval (1.6–3.3), for TTH 1.8 (1.2–2.8), for unclassified headache 1.9 (1.1–3.8), and for migraine 3.7 (2.1–6.6). Similar results were also found among those who reported physical activity levels in accordance with current recommendations of the American College of Sports Medicine but nevertheless had low VO2peak. Being in the lowest VO2peak quintile was also strongly associated with migraine aggravated by physical activity (OR 4.1, 2.1–8.1). No significant association was found between VO2peak and headache for those 50 years or older. Conclusions In this large cross-sectional study, an inverse relationship was found between VO2peak and headache for adults younger than 50 years of age.
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Affiliation(s)
- Knut Hagen
- Department of Neuroscience, Norwegian University of Science and Technology, Norway
- Norwegian Advisory Unit on Headaches, St Olavs Hospital, Norway
| | - Ulrik Wisløff
- K.G. Jebsen Center of Exercise in Medicine at Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Norway
- Department of Cardiology, St Olavs Hospital, Norway
| | - Øyvind Ellingsen
- K.G. Jebsen Center of Exercise in Medicine at Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Norway
- Department of Cardiology, St Olavs Hospital, Norway
| | - Lars Jacob Stovner
- Department of Neuroscience, Norwegian University of Science and Technology, Norway
- Norwegian Advisory Unit on Headaches, St Olavs Hospital, Norway
| | - Mattias Linde
- Department of Neuroscience, Norwegian University of Science and Technology, Norway
- Norwegian Advisory Unit on Headaches, St Olavs Hospital, Norway
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Abstract
Medication overuse headache (MOH) is a common and disabling headache disorder. It has a prevalence of about 1-2 % in the general population. The International Classification of Headache Disorders 3rd edition (beta version) has defined MOH as a chronic headache disorder in which the headache occurs on 15 or more days per month due to regular overuse of medication. These headaches must have been present for more than 3 months. The pathophysiology is complex and not completely known. It involves genetic and behavioural factors. There is evidence that cortical spreading depression, trigeminovascular system and neurotransmitters contribute to the pain pathway of MOH. The treatment of MOH includes patient education, stopping the offending drug(s), rescue therapy for withdrawal symptoms and preventative therapy. Relapse rates for MOH are high at 41 %. MOH can severely impact quality of life, so it is important to identify patients who are at risk of analgesic overuse.
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Åsberg AN, Stovner LJ, Zwart JA, Winsvold BS, Heuch I, Hagen K. Migraine as a predictor of mortality: The HUNT study. Cephalalgia 2015; 36:351-7. [DOI: 10.1177/0333102415593090] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 05/11/2015] [Indexed: 11/17/2022]
Abstract
Background There is conflicting evidence for the association between migraine and increased mortality risk. The aim of this study was to investigate the relationship between migraine and non-migrainous headache, and all-cause mortality and cardiovascular mortality. Methods In this prospective population-based cohort study from Norway, we used baseline data from the second Nord-Trøndelag Health Survey (HUNT2), performed between 1995 and 1997 in the County of Nord-Trøndelag. These data were linked with a comprehensive mortality database with follow-up through the year 2011. A total of 51,853 (56% of invited) people were categorized based on their answers to the headache questions in HUNT2 (headache free, migraine or non-migrainous headache). Hazard ratios (HRs) of mortality during a mean of 14.1 years of follow-up were estimated using Cox regression. Results During the follow-up period 9408 died, 4321 of these from cardiovascular causes. There was no difference in all-cause mortality between individuals with migraine and non-migrainous headache compared to those without headache or between headache status and mortality by cardiovascular disease. There was, however, among men with migraine without aura a reduced risk of death by cardiovascular diseases (HR 0.72, 95% confidence interval 0.56–0.93). This relationship was not evident in women. Conclusion In this large, prospective cohort study there was no evidence for a higher all-cause mortality or cardiovascular mortality among individuals with migraine.
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Affiliation(s)
| | - Lars Jacob Stovner
- Department of Neuroscience, Norwegian University of Science and Technology, Norway
- Norwegian Advisory Unit of Headache, St Olavs Hospital, Norway
| | - John-Anker Zwart
- Department of Neurology and FORMI; Oslo University Hospital, Norway
- Institute of Clinical Medicine, University of Oslo, Norway
| | - Bendik Slagsvold Winsvold
- Department of Neurology and FORMI; Oslo University Hospital, Norway
- Institute of Clinical Medicine, University of Oslo, Norway
| | - Ingrid Heuch
- Department of Neurology and FORMI; Oslo University Hospital, Norway
| | - Knut Hagen
- Department of Neuroscience, Norwegian University of Science and Technology, Norway
- Norwegian Advisory Unit of Headache, St Olavs Hospital, Norway
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Ferrari A, Baraldi C, Sternieri E. Medication overuse and chronic migraine: a critical review according to clinical pharmacology. Expert Opin Drug Metab Toxicol 2015; 11:1127-44. [PMID: 26027878 DOI: 10.1517/17425255.2015.1043265] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Chronic migraine is often complicated by medication-overuse headache (MOH), a headache due to excessive intake of acute medications. Chronic migraine and MOH are serious and disabling disorders. Since chronic migraine derives from the progression of originally episodic migraine, the fundamental therapeutic strategy is prevention. This narrative review describes how to try to prevent the development of MOH and how to manage it once it has appeared. AREAS COVERED A PubMed database search (from 1988 to January 2015) and a review of published studies on chronic migraine and MOH were conducted. EXPERT OPINION In spite of progress in migraine treatment, the prevalence of chronic headaches and MOH has not changed in the course of time. Today, a large number of migraine patients have turned to numerous expert physicians and experienced all sorts of prophylactic treatments without decisive benefits. Their condition seems to have crystallized even more as chronic and intractable. This means that to prevent chronification and MOH, we need more effective drugs and better strategies to use them. In particular, we must detect disease biomarkers and predictive factors for drug response that allow for personalized treatment when migraine is still episodic and make analgesic overuse pointless.
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Affiliation(s)
- Anna Ferrari
- University of Modena and Reggio Emilia, Headache and Drug Abuse Research Centre, Department of Diagnostic, Clinical and Public Health Medicine , Via del Pozzo, 71 - 41124 Modena , Italy +39 05 9422 4064 ; +39 05 9422 4069 ;
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Husøy AK, Indergaard MK, Honningsvåg LM, Håberg AK, Hagen K, Linde M, Gårseth M, Stovner LJ. Perivascular spaces and headache: A population-based imaging study (HUNT-MRI). Cephalalgia 2015; 36:232-9. [DOI: 10.1177/0333102415587691] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 04/25/2015] [Indexed: 11/15/2022]
Abstract
Background In four previous clinic-based MRI studies headache sufferers (in particular migraineurs) had more perivascular spaces (PVS) than individuals who were headache-free. Methods The present study was part of a large longitudinal, epidemiological study (Nord-Trøndelag Health Survey (HUNT)). The 1006 participants, age 50–65 years at inclusion, had participated in all previous HUNT surveys (1–3), and been randomly selected to a population-based imaging study of the head (HUNT-MRI, 2007–2009). The number of visible PVS in the basal ganglia (BG) and hemispheric white matter (HWM) was compared in headache sufferers (migraine with and without aura, non-migrainous headache) and people who were headache-free. Results The results showed in general small differences between headache sufferers and headache-free participants. In the cross-sectional analysis migraineurs without aura had fewer PVS than headache-free individuals in BG (OR = 0.84, 95% CI = 0.76--0.94, p value = 0.003) and in BG and HWM together (OR = 0.97, 95% CI = 0.95-1.00, p value = 0.046). No difference between long-term headache sufferers and long-term headache-free individuals with regard to number of PVS was found. Discussion In contrast to previous studies, the present large, blinded, population-based study showed no increase in number of dilated PVS among headache sufferers. Fewer PVS among those with migraine without aura may be a spurious finding.
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Affiliation(s)
- Andreas Kattem Husøy
- Department of Neuroscience, Norwegian University of Science and Technology, Norway
| | | | | | - Asta K Håberg
- Department of Neuroscience, Norwegian University of Science and Technology, Norway
- Department of Medical Imaging, St Olavs University Hospital, Norway
| | - Knut Hagen
- Department of Neuroscience, Norwegian University of Science and Technology, Norway
- Norwegian National Headache Centre, St Olavs University Hospital, Norway
| | - Mattias Linde
- Department of Neuroscience, Norwegian University of Science and Technology, Norway
- Norwegian National Headache Centre, St Olavs University Hospital, Norway
| | - Mari Gårseth
- Department of Radiology, Levanger Hospital, Norway
| | - Lars Jacob Stovner
- Department of Neuroscience, Norwegian University of Science and Technology, Norway
- Norwegian National Headache Centre, St Olavs University Hospital, Norway
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Honningsvåg LM, Hagen K, Håberg A, Stovner LJ, Linde M. Intracranial abnormalities and headache: A population-based imaging study (HUNT MRI). Cephalalgia 2015; 36:113-21. [DOI: 10.1177/0333102415583147] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 03/14/2015] [Indexed: 01/03/2023]
Abstract
Background Most studies on intracranial abnormalities among headache sufferers were performed in selected clinical populations. The aim of this study was to evaluate the relationship between intracranial abnormalities and headache among middle-aged adults in the general population. Methods Participants in a large epidemiological study (the HUNT 3 study; 2006–2008) who answered a headache questionnaire and participated in a population-based imaging study of the head (HUNT MRI; 2007–2009) were included ( n = 864; age, 50–65 at enrollment). Based on the responses to the HUNT 3 questionnaire, respondents were categorized as having migraine, tension-type headache, or unclassified headache. Logistic regression was used to compare the occurrence of intracranial abnormalities between groups. Results Intracranial abnormalities were more common in headache sufferers than in headache-free individuals (29% vs. 22%, respectively; p = 0.041). Adjusted multivariate analyses revealed that those with tension-type headache had higher odds of having minor abnormalities (odds ratio, 2.13; 95% confidence interval = 1.18–3.85). This association disappeared when those with only white matter hyperintensities were removed from the analysis. Conclusions Headache sufferers had increased odds of minor intracranial abnormalities. The increased odds were primarily related to the presence of white matter hyperintensities.
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Affiliation(s)
| | - Knut Hagen
- Department of Neuroscience, Norwegian University of Science and Technology, Norway
- Norwegian Advisory Unit on Headache, St. Olavs University Hospital, Norway
| | - Asta Håberg
- Department of Neuroscience, Norwegian University of Science and Technology, Norway
| | - Lars Jacob Stovner
- Department of Neuroscience, Norwegian University of Science and Technology, Norway
- Norwegian Advisory Unit on Headache, St. Olavs University Hospital, Norway
| | - Mattias Linde
- Department of Neuroscience, Norwegian University of Science and Technology, Norway
- Norwegian Advisory Unit on Headache, St. Olavs University Hospital, Norway
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Kaniecki RG, Taylor FR, Cooper WM. Abstracts and Citations. Headache 2015. [DOI: 10.1111/head.12549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Straube A, Heinen F, Ebinger F, von Kries R. Headache in school children: prevalence and risk factors. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 110:811-8. [PMID: 24333367 DOI: 10.3238/arztebl.2013.0811] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 08/13/2013] [Accepted: 08/13/2013] [Indexed: 01/03/2023]
Abstract
BACKGROUND Recurrent headache is a common problem in school children. Evaluation generally leads to the diagnosis of a primary headache syndrome (migraine or tension-type headache). This review is addressed to the question whether headaches in school children are becoming more common and, if so, what risk factors are associated with the rise in frequency. METHOD We selectively searched the PubMed database for pertinent publications that contained the terms "primary headache AND children/adolescent AND risk factors/prevalence." Articles published in either English or German up to April 2013 were considered. Articles on secondary types of headache were excluded. RESULTS Headaches are becoming more common among school children. At present, 66% to 71% of 12- to 15- year-olds have at least one headache every three months, and 33% to 40% have at least one per week. Headache is often accompanied by other physical and/or emotional manifestations. Studies from Scandinavia reveal increasing prevalence in age groups from 8 years of age and upward. Various studies have identified the following risk factors for headache or for its chronification (up to 5.8-fold elevation of risk): a dysfunctional family situation, the regular consumption of alcohol, caffeine ingestion, smoking, a low level of physical activity, physical or emotional abuse, bullying by peers, unfair treatment in school, and insufficient leisure time. CONCLUSION Headaches are becoming more common among children and adolescents. They are often associated with other physical and emotional complaints.
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Affiliation(s)
- Andreas Straube
- Department of Neurology, University of Munich, Campus Grosshadern, Department of Pediatric Neurology, University of Munich, Campus Innenstadt, Dr. von Haunersches Kinderspital, Clinic for Child and Adolescent Medicine, St. Vincent Hospital, Paderborn, and Center for Child and Adolescent Medicine, University of Heidelberg, Institute of Social Paediatrics and Adolescent Medicine, University of Munich
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