Quality-of-life assessment in patients with headache

Although headache is the most common pain complaint seen by primary care physicians, the measurement of quality of life in patients with headache is in its earliest stages. Most of the research has been published within the past 2 years, much of it only in abstract form. Quality-of-life data derived from the Medical Outcomes Study instrument (SF-20) demonstrate that chronic headache disorders are associated with significant limitations in all 6 health categories of patient well-being and functioning. The outcomes profile for each of the common benign headache disorders appear to be unique for the specific headache diagnosis. Migraine is primarily associated with an impairment in role (work) functioning. Chronic tension-type headache is associated with a marked impairment in mental health and a generalised impairment in functioning. Cluster headache is associated with the greatest amount of pain, but with little impairment in physical functioning. The economic toll of recurrent headache is considerable. Lost productivity in the US due to migraine is estimated at $US6.5 to 17.2 billion per year. Chronic headache disorders cause significantly more morbidity, impairment of function, and economic loss than has previously been recognised.     

Medication overuse headache in patients with primary headache disorders: epidemiology, management and pathogenesis

Medication overuse headache (MOH) is a common medical condition that is associated with considerable long-term morbidity and disability. Patients experiencing MOH have primary headache disorders (migraine, tension-type headache [TTH] or the combination of migraine and TTH) that change to a pattern of daily or near-daily headaches over a period of years or decades following the overuse of symptomatic headache medications. Overused drugs include analgesics, ergot alkaloids, serotonin 5-HT(1B/1D) receptor agonists ('triptans') and medications containing barbiturates, codeine, caffeine, tranquillisers and mixed analgesics. Affected patients usually have a long history of primary headache, overuse of medications and MOH before they consult a physician for care. Patients with MOH are usually managed in specialist centres by withdrawal of the overused drugs and treatment of withdrawal symptoms (on an inpatient or outpatient basis), headache prophylaxis and limited use of symptomatic acute medications. Most patients respond to this therapy, although the prognosis is not always good and >or=50% may lapse over an initial 5-year follow-up period. The best practical strategy at present is to prevent the overuse of drugs in the first place by patient education and formal management approaches conducted in primary care to treat the primary headache before it changes to MOH. The quality of the clinical evidence on MOH is suboptimal and further biological and clinical research is urgently required to help facilitate the management of these patients more effectively in the future.     

Medication-overuse headache: similarities with drug addiction

Medication-overuse headache (MOH) is a clinically important entity and it is now well documented that the regular use of acute symptomatic medication by people with migraine or tension-type headache increases the risk of aggravation of the primary headache. MOH is one the most common causes of chronic migraine-like syndrome. In this article, we analyse the possible mechanisms that underlie sensitization in MOH by comparing these mechanisms with those reported for other forms of drug addiction. Moreover, the evidence for cognitive impulsivity in drug overuse in headache and in other forms of addiction associated with dysfunction of the frontostriatal system will be discussed. An integrative hypothesis for compulsive reward-seeking in MOH will be presented.     

头痛粉所致药物滥用性头痛1例

在中国头痛粉是最便宜的止痛药,尤其针对偏头痛,效果甚好。但是,由于头痛粉的滥用,常常导致药物滥用性头痛,头痛粉的剂量逐渐增加,药物治疗效果差。本研究举例分析头痛粉所致药物滥用性头痛的个案,同时总结药物滥用性头痛的定义、流行病学、产生药物滥用性头痛的危险因素以及药物滥用性头痛的治疗。     

Ischaemic stroke with headache as its only manifestation

We present two cases of middle-aged men with chronic hypertension presenting with acute severe hemicranial headache with otherwise a normal neurological examination. Investigation revealed occlusion of the ipsilateral middle cerebral artery. We reviewed the literature of ischaemic strokes with headache as the only manifestation and elaborated on the pathophysiology of headaches in ischaemic strokes.     

Migraine headache prophylaxis and treatment with low-dose mirtazapine

Other than amitriptyline, few antidepressants have shown consistent efficacy in migraine treatment prophylaxis. Only one other case supporting the use of mirtazapine for migraine prophylaxis has been reported. To our knowledge, there are no reports suggesting dose dependence in mirtazapine effectiveness for migraine treatment, nor proposals to explain the mechanism of this effect. A 25-year-old patient was followed in our outpatient department for DSM-IV treatment-resistant recurrent major depression. Multiple antidepressants were used and discontinued because of migraine exacerbation. Mirtazapine was then initiated for residual depressive symptoms. Decreased frequency and intensity of migraines were observed with low-dose mirtazapine, which reoccurred with higher doses. Migraine treatment with mirtazapine can be explained through two possible mechanisms. First, mirtazapine prevents migraine initiation through histamine and 5-HT(2) receptor family inhibition. Second, it treats migraines through 5-HT(1) receptor family activation. However, at higher doses, histamine activation may explain reoccurrence of migraines.     

氟哌噻吨-美利曲辛治疗伴焦虑抑郁的头痛

目的探讨心理异常与头痛发作的可能关系,并观察氟哌噻吨-美利曲辛对伴焦虑抑郁头痛发作的疗效。方法采用焦虑自评量表(SAS)及汉密尔顿抑郁量表(HAMD)对头痛患者及健康体检者(对照组)进行心理测评,比较2组焦虑、抑郁的发生率。随机将心理测评异常的头痛患者(73例)分为常规组(36例)和综合组(37例)。常规组予头痛的常规治疗(尼莫地平20mg,po,tid;阿司匹林25mg,po,qd),综合组在此基础上加用氟哌噻吨-美利曲辛1粒,po,qd。疗程均为8wk。结果82例头痛患者中73例伴焦虑或抑郁状态,60名健康体检者发生焦虑或抑郁状态为15例;治疗总有效率综合组为81．08％,常规组为58．33％。结论头痛患者存在明显焦虑、抑郁的心理异常,加用氟哌噻吨-美利曲辛可明显提高头痛治疗的有效率。     

女性丛集性头痛的临床特点观察

目的探讨女性丛集性头痛(CH)的临床特点、合并症状及诊断标准。方法对23例女性CH患者(1990-03～2001-11)和同期随机选择的40例男性患者进行对比分析。结果女性有20～29岁和50～59岁两个高发病年龄段,男性仅30～39岁一个高发病年龄段;女性CH头痛持续时间稍短于男性;有6例女性患者在20岁左右和30岁左右有过3～4次典型发作,直到50岁后才发展达到诊断标准。女、男患者有约50%左右的合并恶心、呕吐、畏光或恐响症。结论女性CH临床特点除头痛发作持续时间短于男性外,其他特点无显著性差异(P>0.05);发病年龄女性有两个高发病年龄段;CH患者约有40%～80%的在发作时合并恶心、呕吐、畏光和恐响症,这4项症状被排除诊断标准外有可能降低CH的流行病学结果,部分女性病例需较长时期发展到诊断标准。     

Medication overuse headache

Medication overuse headache (MOH) has developed into the third most common type of headache after tension-type headache and migraine. The prevalence of MOH is approximately 1% of the world's population and it shows an increasing trend as recent studies reveal a common involvement throughout the ages, even starting in childhood. All antiheadache drugs, such as triptans, analgesics, ergots and opioids, along with the common combination substances currently on the pharmacological market are capable of inducing MOH. New data on specific clinical features and mean critical monthly dosages and mean critical monthly intake frequencies are now available. The only effective treatment concept is consequent withdrawal therapy. Data of prospective studies on relapse rates and predictors of relapse after successful withdrawal therapy are presented.     

Medication overuse headache

The frequent use (>15 times/month) of medication for the treatment of acute migraine attacks may cause medication overuse headache. This kind of headache can be caused by the intake of a combination of analgesics, opioids, ergot alkaloids and triptans. The delay between first intake and these attacks is shortest for triptans (1-2 years), longer for ergots (3-5 years) and longest for analgesics (5-10 years). Treatment includes drug withdrawal followed by structured acute therapy and initiation of migraine prophylactic treatment.     

顺铂引起剧烈头痛

患者女,56岁。因便血半年,经直肠镜检查诊断为直肠癌,于2002年9月7日入院,行直肠癌根治术。术后病理为溃疡型,中分化腺癌,浸达浆膜,无淋巴结转移。术后恢复良好。术后半月进行首次全身化疗。方案为第一组5%葡萄糖注射液500mL 氟尿嘧啶0.75g;第二组5%葡萄糖注射液500mL 亚叶酸钙0.1g静滴。2003年12月10日患者再次入院,经临床医师检查后调整化疗方案如下:第一组,5%葡萄糖注射液500mL 氟尿嘧啶0.5g;第二组,5%葡萄糖注射液500mL 顺铂20mg;静脉滴注。当患者输入第二组液体约20min后,患者出现头痛、恶心、呕吐、头部不能转动,疼痛剧烈难忍,而呈…