Search

Migraine affects work productivity in terms of missed workdays and days with reduced productivity. In this literature review, we looked for papers addressing specific difficulties in work-related activities. Twenty-three papers were included in the review, reporting data on 51,135 patients. Results showed that there is some evidence for limitations in skills such as problem solving, and activities such as speaking and driving. However, the way in which problems with remunerative employment are addressed is limited to concepts such as reduced performance or inability to work as usual. Given the paucity of data, a return to patient-derived data will be needed to develop an assessment instrument that is able to collect information on headache-related problems in work activities. [ABSTRACT FROM AUTHOR]

Patients with chronic migraine developing medication-overuse headache (MOH) show dependency-like behaviors such as loss of control over analgesics despite adverse consequences on headaches, high rates of relapse after withdrawal from symptomatic medications, and compromised social functioning. Neuroimaging research suggests a common pathophysiology between substance-use disorders and MOH, which involves functional alterations in fronto-striatal networks, particularly in the orbitofrontal region of prefrontal cortex. These findings could explain the impaired decision-making observed in substance-use disorders. We hypothesize that MOH could share fronto-striatal circuit dysfunction and relative decision-making deficit with addiction. We further examine whether this deficit is a persistent cognitive trait or a reversible consequence of medication overuse. This study shows a dataset of 50 patients with MOH before the detoxification. All patients underwent a complete neurological and psychiatric examination. Psychiatric examination consisted of a clinical interview, Structured Clinical Interview for DSM-IV TR Axis II Personality Disorders, Anxiety and Depression Hamilton Scales, Severity of Dependence Scale. The neurological examination included the migraine disability assessment questionnaire. Neuropsychological assessment of fronto-striatal circuits was investigated using the Iowa gambling task (IGT). Twenty patients monitored for any relapse into medication overuse had 12 months of follow-up. Our sample, characterized by high rates of disability and dependency-like behaviors, exhibited a deficit in IGT performance, indicating an overall impairment in decision-making. All the 20 patients showed neurological and psychiatric improvement at 12-month follow-up, notwithstanding the overuse relapse, but a persistent IGT deficit was found. To our knowledge this is the first study that assesses this cognitive function in patients with MOH. Medication-overuse headache seems to share a persistent decision-making deficit with substance abuse that confirms the orbitofrontal cortex hypometabolism described in literature from a neuropsychological perspective. Looking at these shared neurocognitive features, our results suggest that MOH could belong to the addiction spectrum. Fronto-striatal dysfunction could be a premorbid psychobiological condition of vulnerability explaining the clinical onset of medication overuse and recurrent relapses. We propose that IGT could be used to identify chronic migraine patients with higher risk for medication overuse and relapse. [ABSTRACT FROM AUTHOR]

It has been postulated that chronic pain and chronic migraine in particular, can be connected to immunologic disturbances. Moreover the psychiatric comorbidity is often responsible of migraine chronification, but also of developing of particular immune function alterations. The role of the immune system in migraine precipitation is still under debate also if speculations about the evidence of infections in migraine patients has been performed, but not always corroborated by clinical and scientific explanations. In this report we present an evaluation of specific immune parameters in patients suffering from different forms of migraine respect to controls in order to determine possible alterations in immune function: speculations about the evidenced abnormalities are attempted. [ABSTRACT FROM AUTHOR]

Changes in numerical indices of the intensity, duration and frequency of attacks are traditionally used to assess the effectiveness of treatments for migraine and other primary headaches. However, recent clinical and therapeutic guidelines and guidelines for conducting clinical trials specify that the essential aim of symptomatic and prophylactic migraine treatments should be to reduce the global impact of the headaches on the patient’s life. Some standardised instruments for assessing disability and health-related quality of life seem sensitive to treatment-induced changes in primary headache patients. However, further studies to determine the suitability of these instruments as outcome measures in clinical practice are necessary. [ABSTRACT FROM AUTHOR]

Headaches may have a wide range of impact on patients’ lives. We report the results of Italian studies in which disability and health-related quality of life (HRQOL) in patients with different primary headaches were evaluated. The Short Form 36 (SF-36) was used to assess HRQOL; the Migraine Disability Assessment Score questionnaire (MIDAS) was used to assess disability in patients with migraine without aura or with chronic migraine. Mean MIDAS total scores were evaluated in migraine without aura and chronic migraine patients. The scores at the eight SF-36 scales were calculated in patients with the three studied headaches, and were compared with Italian normative data (Student’st-test with Bonferroni correction). Primary headaches had a considerable negative impact on patients’ lives, with poor quality of life and decreased ability to function in daily duties. The mean MIDAS total score was 23.4 in 264 patients with migraine without aura, and 79.2 in 150 patients with chronic migraine. Mean SF-36 scores in migraine without aura (68 subjects), chronic migraine (84) and cluster headache (56) were lower than those from the Italian general population, with significant differences for 3 scales in migraine without aura, for 6 in chronic migraine, and for all scales in cluster headache. Our results confirmed a marked personal and social burden in patients with migraine without aura, and also in the less well-studied forms of primary headaches, cluster headache and chronic migraine. [ABSTRACT FROM AUTHOR]

Patients with chronic migraine and medication overuse are particularly difficult to treat. No clear consensus exists about treatment strategies to be used and little data exists about the functional impact of headache in these patients. The purpose of the study was to determine (1) the clinical course of a sample of chronic migraine patients with medication overuse 36 months following treatment intervention and (2) whether functional impairment, assessed by the Migraine Disability Assessment (MIDAS) questionnaire, improved upon treatment. Of 106 patients meeting the criteria for chronic migraine with medication overuse (according to Silberstein and Lipton [1]), 71 went on to complete a structured inpatient treatment, consisting of medication withdrawal and then prophylactic treatment. As a group, the patients were significantly improved at 36-month follow-up, with respect to 2 headache parameters (days of headache per month and number of used medications per month assessed by the diary card) and 2 measures of functional impact extracted from the MIDAS questionnaire (MIDAS total score and frequency of headache). Chronic migraine accompanied with medication overuse led to considerable disability prior to treatment. However, notable improvement both in headache parameters and in disability measures occurred concurrently with treatment. This suggests that successful treatment has more wide-ranging positive benefits beyond mere symptom reduction. To our knowledge, this is the first investigation where the MIDAS questionnaire has been used as an outcome measure in patients with chronic headache to assess disability during such a long follow-up period. [ABSTRACT FROM AUTHOR]

During the last decade researchers have begun to employ standardised methodologies to investigate the global impact of primary headaches. Disease-specific instruments have been developed to measure headache-related disability. The MIDAS questionnaire, which is the most extensively studied of these instruments, was designed to assess the overall impact of headaches over the 3 months before compilation. The MIDAS questionnaire is an optimal tool to assess headache-related disability in adults in relation to patients’ daily activities [1]. Primary headaches are a recurrent problem for children and adolescents. Forty percent of children have experienced headaches by the age of 7 years increasing to 75% by the age of 15 [2]. In a recent report [3] we determined the suitability of the MIDAS questionnaire in its original form for assessing disability in children and adolescents suffering from different kinds of headache. This was the first step of a line of research aimed to develop a new MIDAS questionnaire adapted for young patients. In this second study the aims were: (1) to produce a new version of the MIDAS questionnaire specific for young patients suffering from different forms of headache; (2) to assess the reliability of this new instrument; (3) to assess its sensitivity to treatment intervention. [ABSTRACT FROM AUTHOR]

Recurrent headaches are common in children and adolescents. Most current investigations have employed limited modalities (either medication or behavioural) and few have included comparisons of different treatments. In this study relaxation training, administered in a limited contact format, and amitriptyline were compared for juvenile episodic tension-type headache. The clinical improvement was significant for both groups at 1- and 2-year follow-up; in particular for behavioural treatment, the patients came regularly for the sessions, practised routinely, and appeared to be compliant and accepting of treatment, although we did not assess this formally. In this group of patients the percentage of drop-outs was lower than in the pharmacological tratment. Although clinical results were similar in both groups, relaxation therapy seems to be more accepted than medication. The limited contact modality seems to be as useful as other behavioural approaches that require a greater investment of time (by patients and therapists), without unpleasant side effects. Because the sample sizes are small, these conclusions are tentative. [ABSTRACT FROM AUTHOR]

The term "chronic daily headache" (CDH) is used to describe a patient who suffers from recurrent headache, at an average frequency of 15 days per month without an underlying serious medical condition. CDH, sometimes referred to as chronic non-progressive headache, was described in adults by Mathew et al. in 1987. Estimating the incidence and prevalence of this disorder has been difficult, because universally agreed criteria regarding the classification of CDH in children and adolescents have not been reached. This condition is a source of concern and disability both for the patient as well as their family. CDH may be associated with comorbid anxiety or depression, resulting in a tremendous amount of dysfunction for the youngster and the family. [ABSTRACT FROM AUTHOR]

Clinicians long have suspected that symptomatic medications taken by those with headache can cause rebound or drug-induced headaches if overused. This problem has been considered in the classification of headache disorders made by the International Headache Society. Patients who overuse medication must be withdrawn before their headache can be treated effectively. Sustained improvement following treatment for drug-induced headache can be difficult to achieve and at the moment there is no consensus on what approach may be more effective, in particular regarding out-patient or inpatient treatment withdrawal strategy. Clinical aspects and different therapeutic strategies for chronic daily headache patients with medication overuse are considered. [ABSTRACT FROM AUTHOR]

We assessed functional disability and health-related quality of life (HRQOL) in Italian patients suffering from chronic migraine and medication overuse (150 subjects) or chronic cluster headache (22 subjects). We used the validated Italian versions of the Migraine Disability Assessment Score (MIDAS) and of the Short Form 36 (SF-36). Patients with both conditions were characterised by significantly lower scores on most SF-36 scales than Italian normative data (Student's t test with Bonferroni correction). MIDAS scores revealed that patients had severe limitations in their ability to function, with high proportions forced to stop work and non-work activities, or experiencing significantly reduced productivity in all activity domains. These findings show that primary chronic headaches have a marked negative influence on patients' lives, compromising their sense of well being and their ability to function in different roles. We also found that MIDAS and SF-36 were sensitive to clinical changes in a group of 84 patients with chronic migraine and medication overuse who completed the both questionnaires before and after treatment. [ABSTRACT FROM AUTHOR]

Cluster headache is characterized by excruciatingly painful headaches which occur one or several times during the day. Little is known about the functional consequences of this severe headache form. We assessed health-related quality of life in 56 consecutive patients, 34 of whom were episodic cluster headache patients during an active period, and 22 had chronic cluster headache. All patients completed the Short Form-36 (SF-36). We found lower scores in the studied patients than in those reported in the general population for all SF-36 domains. For most scales the difference was significant (P < 0.0001, Student's t -test, Bonferroni correction). Our findings suggest that cluster headache has marked functional consequences even when appropriate treatments are used. [ABSTRACT FROM AUTHOR]

Migraine, particularly migraine with aura (MA), may be a risk factor for ischemic stroke (IS). The reasons for this association are unknown. We investigated the presence of genetic abnormalities of the protein C system in 83 MA patients, 31 IS patients, and 124 healthy controls, all aged under 45 years. We found an increased frequency of activated protein C resistance due to Arg5O6Gln factor V mutation, and of protein S deficiency in both disorders, with figures higher than those reported in the general population and significantly different from those found in controls. These prothrombotic genetic abnormalities may be shared risk factors in IS and MA, and may play a role in increasing the risk of cerebrovascular disease in migraineurs. [ABSTRACT FROM AUTHOR]