Epidemiological and clinical characteristics of primary headaches in adolescent population: is there a relationship with the way of life?

The headache in the adolescent population is one of the most common conditions that doctors deal with. It is an important source of disability with several health-related considerations. The aim of the study was to investigate the frequency, as well as different epidemiological and clinical characteristics, of primary headaches in adolescents. An epidemiological study was conducted on 1800 adolescents of both sexes based on a questionnaire consisting of 65 questions referring to sociodemographic and clinical characteristics of headaches. Based on the questionnaire information, the examinees were divided into four groups: adolescents with migraine, tension-type and mixed headache and the fourth group were examinees without headaches. The information was statistically processed and the level of significance < 0.05 is considered statistically significant. Out of 1800 respondents, 1160 subjects were those with headache (64.4%) and 640 subjects were without headache (35.6%). The most common primary headache is tension-type headache. The majority of subjects with tension-type headaches attend elementary school and with migraine and mixed headaches high school. There were significantly more headaches among adolescents who had their own computer and who spent more than 2 h using it. More frequent headaches were found in those who travel by public transport and spend more time on Facebook. Primary headaches in adolescent population occur frequently and despite numerous studies, they are still not taken seriously enough. It is necessary to educate parents, teachers and adolescents to avoid risk factors or at least reduce their impact.

A Historical Review of Headaches: Who First Described Them and When did This Occur?

BACKGROUND: Headache is as old as human history and has been able to report, and the first descriptions were found in Greece and Mesopotamia. OBJECTIVE: Our objective was to know the date of the first description of ICHD-3 headaches, with their respective author. METHODS: We searched for articles that addressed the historical aspects of primary and secondary headaches and painful cranial neuropathies. RESULTS: Twenty-seven different headaches were analyzed according to the occurrence of their first description, with the respective author and country of origin. CONCLUSIONS: The knowledge of the first description of ICHD-3 headaches, with their respective author, showed us how and when the different headaches appeared over the years.

Experts' opinion about the primary headache diagnostic criteria of the ICHD-3rd edition beta in children and adolescents.

BACKGROUND: The 2013 International Classification of Headache Disorders-3 (ICHD-3) was published in a beta version to allow the clinicians to confirm the validity of the criteria or to suggest improvements based on field studies. The aim of this work was to review the Primary Headache Disorders Section of ICHD-3 beta data on children and adolescents (age 0-18 years), and to suggest changes, additions, and amendments. METHODS: Several experts in childhood headache across the world applied different aspects of ICHD-3 beta in their normal clinical practice. Based on their personal experience and the literature available on pediatric headache, they made observations and proposed suggestions for the primary headache disorders section of ICHD-3 beta data on children and adolescents. RESULTS: Some headache disorders in children have specific features which are different from those seen in adults and which should be acknowledged and considered. Some features in children were found to be age-dependent: clinical characteristics, risks factors and etiologies have a strong bio psycho-social basis in children and adolescents making primary headache disorders in children distinct from those in adults. CONCLUSIONS: Several recommendations are presented in order to make ICHD-3 more appropriate for use with children.

Diagnostic Accuracy Comparison of Artificial Immune Algorithms for Primary Headaches.

The present study evaluated the diagnostic accuracy of immune system algorithms with the aim of classifying the primary types of headache that are not related to any organic etiology. They are divided into four types: migraine, tension, cluster, and other primary headaches. After we took this main objective into consideration, three different neurologists were required to fill in the medical records of 850 patients into our web-based expert system hosted on our project web site. In the evaluation process, Artificial Immune Systems (AIS) were used as the classification algorithms. The AIS are classification algorithms that are inspired by the biological immune system mechanism that involves significant and distinct capabilities. These algorithms simulate the specialties of the immune system such as discrimination, learning, and the memorizing process in order to be used for classification, optimization, or pattern recognition. According to the results, the accuracy level of the classifier used in this study reached a success continuum ranging from 95% to 99%, except for the inconvenient one that yielded 71% accuracy.

Description of series of 10 patients with hypnic headache: Discussion of the diagnostic criteria.

INTRODUCTION: Hypnic headache is a rare primary headache. The diagnostic criteria of the International Headache Classification (IHS) for this condition are discussed, as they have been modified in the new edition of the 2013. PATIENTS AND METHODS: The clinical characteristics, and fulfilment of the criteria of the IHS classification in a series of 10patients diagnosed in our Headaches Clinic, are analyzed. RESULTS: The mean age of onset of symptoms was 52.1years (SD: 13.4; range: 28-69). The pain was reported as oppressive in 60% of the patients, and as sharp in 30%. The headache was described as holocranial in 60% and hemicranial in 40%. They occurred exclusively during night-time sleep in 80% of the patients. The mean duration of headache was 136.5minutes (range: 10-480). The mean number of days per month was 16.4 (range: 3-30), and 50% had less than 15 headache days per month. No patient had autonomic manifestations, 70% had phonophobia, 50% had photophobia, and 50% had both. All of them (100%) had a VAS score equal to or higher than 8. CONCLUSIONS: The criteria for hypnic headache of the new classification are best suited to the characteristics of these patients. Our results show the major changes in the criteria: pain is not always dull, headache frequency may be less than 15days a month, and it can occur in people under age 50. There may be phonophobia or photophobia only, or both. Although it does not form part of the diagnostic criteria, the pain intensity in our series was higher than described.

Headache in Behçet's syndrome: review of literature and NYU Behçet's syndrome center experience.

Headache, a common and disabling symptom in Behçet's syndrome, may be associated with a variety of neurologic syndromes and ocular inflammation, or may present as an isolated feature. Our objective is to describe the various neurologic and ocular syndromes of Behçet's syndrome of which headache is a symptom, and to review the features of isolated headaches in Behçet's. We also report results of a study of headache in Behçet's syndrome patients who are followed at NYU Hospital for Joint Diseases, the first study of its kind in North American patients, and the first to document prevalence of both episodic and chronic daily headache in Behçet's.

[The Rostock Headache Questionnaire ("Rokoko")--validation of a tool to screen and to qualify primary headaches]. / Der Rostocker Kopfschmerzfragen-Komplex ("Rokoko")--Validierung einer schnellen diagnostischen Hilfe bei der Einordnung primärer Kopfschmerzen.

Primary headache disorders should be diagnosed based on the detailed history of the patient. However, only few questions are necessary to allocate the symptoms to migraine, tension-type headache or other primary headaches in most cases. The "Rostock Headache Questionnaire" (Rokoko) is suitable for being completed by the investigator or the patient him/herself within a few minutes. Validation parameters of a sample of n = 87 patients (median: 44 years), diagnosed by headache experts in a personal interview ("gold standard"), are presented. Sensitivity and specificity for migraine without aura (0.87/0.51), migraine with aura (0.71/0.95), tension-type headache (0.57/0.93), or a combination of both (0.22/0.93) are based on the parameters pain frequency (recurrent vs. permanent), and the presence or absence of aura symptoms. To differentiate tension-type headache into episodic or chronic forms, the questionnaire can be analysed individually based on the frequency of headache days. The questionnaire enables the fast acquisition of relevant data in headache diagnosis and headache research with sufficient sensitivity and specificity. In addition, further information about triggering and symptoms of headaches can be assessed. The questionnaire can be used both by neurologists or psychiatrists and by general practitioners. The questionnaire does not replace the physical examination.

Primary headaches in pediatric patients with chronic rheumatic disease.

OBJECTIVES: To assess the presence, prevalence and clinical characteristics of primary headaches in pediatric patients with chronic rheumatic diseases such as juvenile idiopathic arthritis (JIA) and familial Mediterranean fever (FMF), and to analyze the common pathophysiological mechanisms. STUDY DESIGN: In this noncontrolled, cross-sectional study, a semi-structured 53 item headache questionnaire was administered to subjects with FMF and JIA, and interviewed a total sample size of 601 patients younger than16years of age. The questionnaires were then analyzed according to the International Headache Society's diagnostic criteria. RESULTS: Children with FMF (n=378) and JIA (n=223) were studied. Each group was then divided into two subgroups according to whether the subjects reported headache or not. 29.5% of subjects with FMF reported having migraine, 37.6% probable migraine and 32.9% tension type headache (TTH). In JIA group 28.2% were diagnosed with migraine; 41.2% with probable migraine and 30.6% with TTH. No significant difference was found between all subjects with (n=258) and without (n=343) headache for variables such as living in a crowded family (p=0.95), being the first child in the family (p=0.63), academic achievement of the child (p=0.63), high education level (higher than high school) of the mother (p=0.52) and father (p=0.46). The presence of systemic disease was reported not to be effecting the daily life at the time of evaluation by 90.2% of the children with headache and 91.0% of the children without headache (p=0.94). 81.4% of the children reported their headaches were not aggravating with the exacerbation periods of their systemic disease. Family history of hypertension was reported higher by the subjects with headache (13.5% with headache and 4.0% without headache p=0.001). Diabetes mellitus was also reported higher (5.8% with headache; 0.5% without headache; p=0.006). Family history of headache was reported in 28.2% of the patients with headache whereas it was 17.4% of the patients without headache (p<0.001). Family history of headache was reported in 28.2% of the FMF subjects with headache whereas it was 17.4% of the patients without headache (p<0.001). For JIA patients a positive family history for headache was obtained in 25.9% of children with headache notably in migraineurs (81.8%). CONCLUSION: Patients with JIA and FMF should be asked specifically about accompanying primary headaches particularly migraine headaches as they may be additional disabilities for these patients.

How specific are risk factors for headache in adolescents? Results from a cross-sectional study in Germany.

BACKGROUND: The identified preventable risk factors for primary headache in adolescents are smoking; consumption of coffee or alcoholic mixed drinks; physical inactivity; muscle pain in the head, neck, or shoulder region; and chronic stress. OBJECTIVE: To investigate the interrelation of headache with other health complaints and the specificity of the above-mentioned risk factors for headache in adolescents. METHODS: A total of 1,260 students (grades 10 and 11) filled in questionnaires on headache, dietary, and lifestyle factors. The type of headache and health complaints such as dizziness, abdominal pain, musculoskeletal pains, symptoms of possible fatigue syndrome, and psychic complaints were assessed. RESULTS: Isolated headache was found in 18% of the headache sufferers; most frequently isolated tension-type headache (78.2%). Only among adolescents with a combination of headache (mainly migraine) and other health complaints, significant associations for almost all analyzed risk factors were found. The strength of the associations with the considered risk factors was very similar in all three analyzed strata except for considerably lower odds ratios for isolated headache. CONCLUSION: All analyzed risk factors are nonspecific for headache in adolescents because they also increase the risk for other health complaints. Interventions, therefore, should consider a holistic approach focusing not only on headache but also on a broader spectrum of health complaints.

Diagnosis and management of headache attributed to airplane travel.

The headache attributed to airplane travel, also named "airplane headache", is characterized by the sudden onset of a severe head pain exclusively in relation to airplane flights, mainly during the landing phase. Secondary causes, such as upper respiratory tract infections or acute sinusitis, must be ruled out. Although its cause is not thoroughly understood, sinus barotrauma should be reasonably involved in the pathophysiological mechanisms. Furthermore, in the current International Classification of Headache Disorders, rapid descent from high altitude is not considered as a possible cause of headache, although the onset of such pain in airplane travellers or aviators has been well known since the beginning of the aviation era. On the basis of a survey we conducted with the courteous cooperation of people who had experienced this type of headache, we proposed diagnostic criteria to be added to the forthcoming revision of the International Classification of Headache Disorders. Their formal validation would favour further studies aimed at improving knowledge of the pathophysiological mechanisms involved and at implementing preventative measures.

New prospects in the taxonomic classification of primary headaches.

In the field of primary headaches, we have a very useful classification tool for the clinical characterization of individual attacks, but we lack a classification tool for the characterization of primary headache patients. Just because the reasons for this lack have been partially overcome by the knowledge that has been gained in the meantime and because clinicians and researchers are increasingly pressed to find new and reliable ways to manage certain primary headache forms, including so-called chronic migraine, we now have an imperative commitment to provide a syndrome classification.

A redefinition of primary headache: chronic migraine.

In the field of so-called chronic daily headache, it is not easy for migraine that worsens progressively until it becomes daily or almost daily to find a precise and universally recognized place within the current international headache classification systems. A proposal is advanced to differentiate between a form of high-frequency migraine without aura (10-20 days of headache per month for at least 3 months), to be considered as a migraine without aura subtype, and a form of transformed migraine (TM), to be considered as a complication of migraine. TM--a name that should be preferred to chronic migraine (CM)--would then replace the latter, from which it would distinguish itself by the more restrictive diagnostic criteria (at least 20 days of headache per month for at least 1 year, with no more than 5 consecutive days free of symptoms; same clinical features of migraine without aura for at least 10 of those 20 days).

Primary continuous unilateral headaches: a nosologic model for hemicrania continua.

BACKGROUND: Hemicrania continua was originally described as a strictly unilateral, continuous headache with an absolute response to indomethacin. Recognition of an increasing number of patients with the same clinical features except for a lack of response to indomethacin has generated controversy about whether the responsive/non-responsive phenotypes belong to the same disorder. DISCUSSION: We suggest that the non-responsive phenotype should be differentiated from the original concept of hemicrania continua, because it probably indicates a separate type of headache of undetermined nature, i.e. hemicrania incerta. However, differentiating hemicrania incerta from hemicrania continua does not imply that the two headaches are unrelated. Both hemicranias may outline a continuum, giving rise to a broader diagnostic field. CONCLUSION: There seems to be a syndrome of 'primary continuous unilateral headache' with at least two distinctive categories: hemicrania continua and hemicrania incerta, which are differentiated by their respective response to indomethacin. This division means plurality but adds precision, and allows a clear-cut diagnosis of some controversial cases.

Primary headache and epilepsy: a multicenter cross-sectional study.

The prevalence and characteristics of interictal headache, epilepsy and headache/epilepsy comorbidity were assessed in 858 women and 309 men aged 18-81 years from headache and epilepsy centers in Italy. The research hypothesis was that comorbidity among patients with either disorder would be expected to be higher than in the general population. Interictal headache was diagnosed in 675 cases (migraine 482; tension-type headache 168; other types 25), epilepsy in 336 (partial 171; generalized 165) and comorbidity in 156 (1.6% from headache centers; 30.0% from epilepsy centers). Patients with epilepsy, headache and comorbidity differed in a number of demographic and clinical aspects. However, for both headache and epilepsy, a family history of the same clinical condition was equally prevalent in patients with and without comorbidity. These findings do not support the purported association between headache and epilepsy.

Frequency of headache among the employees of a rubber company in the state of São Paulo, Brazil.

CONTEXT AND OBJECTIVE: Primary headaches may be responsible for absenteeism and a fall in the yield and productivity of work. The aim of this study was to establish the presence and frequency of primary headache among employees of a rubber shoe sole company, and its link to absenteeism. DESIGN AND SETTING: Cross-sectional study carried out with help from the staff of the medical and social department of a rubber factory located in the municipality of Franca, São Paulo. METHOD: A questionnaire on headache characteristics was distributed to all employees. The returned and completed questionnaires were divided into two groups: with and without reports of headache. The headaches were classified into four main groups: migraine, tension-type headache (TTH), cluster headache and others. In terms of the reported frequency, headaches were also classified as chronic daily headache (CDH). RESULTS: The number of valid questionnaires was 392 (59%); 80.9% were from male and 19.1% from female employees. Headaches were reported by 120 subjects (30.6%), with 17.4% belonging to the migraine group and 8.9% to the TTH group. Migraine was more frequent (p < 0.001) among all participants and also among the women (p < 0.05). TTH was more frequent among the men (p < 0.05). CDH was identified in 14 individuals (3.6%). CONCLUSIONS: Headache was a common problem among the employees of this company and was a cause of absenteeism for 8.7% of the respondents to the questionnaire.

Frequency of headache among the employees of a rubber company in the state of São Paulo, Brazil / Frequência de cefaleia em trabalhadores de uma empresa de borracha no Estado de São Paulo, Brasil

CONTEXT AND OBJECTIVE: Primary headaches may be responsible for absenteeism and a fall in the yield and productivity of work. The aim of this study was to establish the presence and frequency of primary headache among employees of a rubber shoe sole company, and its link to absenteism. DESIGN AND SETTING: Cross-sectional study carried out with help from the staff of the medical and social department of a rubber factory located in the municipality of Franca, São Paulo. METHOD: A questionnaire on headache characteristics was distributed to all employees. The returned and completed questionnaires were divided into two groups: with and without reports of headache. The headaches were classified into four main groups: migraine, tension-type headache (TTH), cluster headache and others. In terms of the reported frequency, headaches were also classified as chronic daily headache (CDH). RESULTS: The number of valid questionnaires was 392 (59 percent); 80.9 percent were from male and 19.1 percent from female employees. Headaches were reported by 120 subjects (30.6 percent), with 17.4 percent belonging to the migraine group and 8.9 percent to the TTH group. Migraine was more frequent (p < 0.001) among all participants and also among the women (p < 0.05). TTH was more frequent among the men (p < 0.05). CDH was identified in 14 individuals (3.6 percent). CONCLUSIONS: Headache was a common problem among the employees of this company and was a cause of absenteeism for 8.7 percent of the respondents to the questionnaire.

CONTEXTO E OBJETIVO: Cefaleias primárias podem ser causa de absenteísmo, e de queda no rendimento e na produtividade do trabalho. O objetivo do estudo foi estabelecer a presença e frequência de cefaleia primária em funcionários de uma empresa de solados de borracha,e sua relação com absenteísmo. TIPO DE ESTUDO E LOCAL: Estudo transversal realizado com a ajuda do pessoal do departamento médico e social de uma empresa localizada no município de Franca, São Paulo. MÉTODO: Um questionário sobre as características da cefaleia foi distribuído a todos os funcionários. Os questionários devolvidos e preenchidos foram divididos em dois grupos: com e sem relato de cefaleia. As cefaleias foram classificadas em quatro grupos principais: migrânea, cefaleia do tipo tensional (CTT), cefaleia em salvas e outras cefaleias. Através da frequência da cefaleia, foi possível a classificação em cefaleia crônica diária (CCD). RESULTADOS: O número de questionários válidos foi de 392 (59 por cento), 80,9 por cento questionários eram de funcionários do gênero masculino, e 19,1 por cento, do gênero feminino. Cento e vinte (30,6 por cento) dos funcionários relataram apresentar cefaleia, sendo que 17,4 por cento pertenceram ao grupo migrânea e 8,93 por cento ao grupo CTT. O diagnóstico de migrânea foi o mais frequente (p < 0,001) dentre todos, e também entre as mulheres (p < 0,05). O diagnóstico de CTT foi mais frequente entre os homens (p < 0,05). CCD foi identificada em 14 indivíduos (3,6 por cento). CONCLUSÕES: Cefaleia é um problema frequente entre os funcionários da empresa participante da pesquisa sendo a causa de absentismo em 8,7 por cento dos que responderam o questionário.