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Central pain sensitivity (CS) is defined as an increased responsiveness of nociceptive neurons in the central nervous system to normal or subthreshold inputs. The main aim of this paper is to investigate if and how specific psychological constructs are related with CS burden in patients with chronic headache (CH). Specifically, research question 1 explores the association of temperament, personality, childhood adversities, defense mechanisms and mental pain with CS burden. Research question 2 aims to test the role of the best predictors of CS burden in affecting the quality of life (QoL) using path analysis. A total of 508 women with CH completed a psycho-diagnostic survey. Results showed that higher levels of low sensory threshold (β = 0.200), bodily threat traumatic experiences (β = 0.156), neurotic defenses (β = 0.109) and mental pain (β = 0.343) emerged as the best predictors of higher CS burden. The model presented demonstrated a satisfactory fit (GFI = 0.984; NFI = 0.966; CFI = 0.979; RMSEA = 0.056 [95% CI 0.028–0.085]) with large and medium effect sizes on physical (−0.654) and psychological QoL (−0.246). The study showed a key role of psychological dimensions in CS burden levels and their relationships with QoL in CH patients. From a clinical perspective, these results suggest the importance of evaluating the level of CS burden during the clinical assessment for chronic pain conditions such as CH, since it may contribute to guide patients to tailored psychological and medical treatments, thereby saving time and costs on diagnostic procedures for chronic pain. [ABSTRACT FROM AUTHOR]

Background: Headache disorders are among the most prevalent neurological disorders worldwide. However, whether groups differing in socioeconomic position (SEP) are disproportionately affected by headache disorders has not yet been adequately clarified. Our aim was to analyse (1) the headache prevalence by socioeconomic position (SEP) and (2) the attack frequency by SEP in a German population-based adult sample. Methods: Cross-sectional data from a random general population were used. The sample included N = 2,189 participants aged ≥ 18 years. SEP was measured using net equivalised income (NEI) and education. A binary logistic regression model tested the effect of SEP in predicting the prevalence of headache in general. Ordinal logistic regressions were modeled to predict the effect of SEP on the likelihood of attack frequency. Attack frequency was categorized in low frequency episodic headache (LFEH: 0–3 days per month), moderate frequency episodic headache (MFEH: 4–14 days per month) and chronic headache (CH: ≥ 15 days per month). Results: Of the 2,189 participants, 891 reported headache in the last six months. Neither income nor education was associated with headache prevalence. However, significant differences between income groups were found for attack frequency. Compared to participants with NEI > 150%, those with NEI < 60% were 5.21 times more likely (95%CI 2.03, 13.36) to experience higher headache frequency, and those with NEI between 60 and 150% were 2.29 times more likely (95%CI 1.02, 5.11), with adjustments made for a set of potential confounders, including depressive symptoms. Conclusions: To reduce headache attacks, it is essential to address both low- and middle-income groups affected by headaches. Universal public health prevention campaigns are particularly appropriate. [ABSTRACT FROM AUTHOR]

Introduction: Headache is an illness with high prevalence and adverse effects on quality of life. As oral or dental problems such as pain can trigger or aggravate it, we aimed to investigate and compare oral and dental health status in patients affected with chronic headaches and healthy individuals. Methods: The present case-control study included 60 patients with chronic headaches (case) and 60 healthy individuals (control) in Rasht, Iran. The demographic characteristics and clinical examinations, including decayed/missing/filled teeth (DMF-T) and community periodontal index of treatment needs (CPITN) indices, as well as bruxism, frequency of tooth brushing and flossing, and maxillary and mandibular tooth wear were recorded in a checklist. Data analysis was performed using the IBM SPSS version 28 at a significance level of 0.05. Results: The case group consisted of 25 men (41.7%) and 35 women (58.3%) with an average age of 32.55 ± 6.62 years, while the control group had 27 men (45%) and 33 women (55%) with an average age of 30.95 ± 6.33 years. The study groups were not significantly different in bruxism, frequency of tooth brushing and flossing, DMFT, CPTIN, and maxillary and mandibular tooth wear. Conclusion: It seems that chronic headaches do not significantly affect the oral and dental health of the sufferers. Moreover, it appears that these patients are well aware of the role of oral and dental hygiene in triggering or aggravating the episodes of headaches. [ABSTRACT FROM AUTHOR]

Background: Making clinical and economic decisions it is important to distinguish between the primary and the secondary cause of headache, which is often associated with brain pathology. Present study was aimed to study CT findings and MRI findings correlation in chronic headache and its outcome. Material and Methods: Present study was single-center, cross-sectional, observational study, conducted patients of age 10-70 years who are presented with chronic headache as chief complaint to the OPD, underwent imaging by CT & MRI. Results: The percentage of females (53%) was slightly higher than males (47%). M:F ratio was found to be 1:1.13. Average age of the population was 50.5± 13.8 years. Majority of the patient population were from urban areas (85%). 7% Patients were found to be overweight whereas 2% were underweight. Average BMI of the population was 22± 2.9 kg/m2. A vast majority (66%) of the patients had complaints between 6-9 months. Average duration of complaints was 8.72± 2.7 months. Majority of the patients (43%) had frontal headache. One sided headache was reported by 38% patients. 5% cases had headache at the back of the neck whereas 2% had it around the eyes. The most common detected pathology was paranasal sinusitis (n= 08), followed by brain tumours (5 %). 2 Pineal lesions were identified in MRI which were missed out by CT scans. 3 Vascular malformations were identified on MRI compared to 2 on CT. Calcified granuloma was defined better compared to CT. The detection rate of CT was found to be 20 % whereas detection rate of MRI was found to be 23%. Conclusion: This study has provided detection rate of 20-23% using CT and MRI and thus given reasonable evidence for radiodiagnosis of chronic headache cases with normal neurological examination and significant intracranial pathology. [ABSTRACT FROM AUTHOR]

Introduction: Patients with chronic headaches and chronic oro‐facial pain commonly present psychosocial issues that can affect social interactions. A possible reason could be that patients with these disorders might present impairments in facial recognition, laterality judgement and also alexithymia. However, a systematic review summarizing the effects of facial emotion recognition, laterality judgement and alexithymia in individuals with headaches and oro‐facial pain is still not available. Aim: The main objective of this systematic review (SR) and meta‐analysis (MA) was to compile and synthesize the evidence on the occurrence of alexithymia, deficits in laterality or left–right (LR) recognition and/or facial emotion recognition (FER) in patients with chronic headache and facial pain. Methods: Electronic searches were conducted in five databases (up to September 2023) and a manual search to identify relevant studies. The outcomes of interest were alexithymia scores, speed and accuracy in LR and/or FER, or any other quantitative data assessing body image distortions. The screening process, data extraction, risk of bias and data analysis were performed by two independent assessors following standards for systematic reviews. Results: From 1395 manuscripts found, only 34 studies met the criteria. The overall quality/certainty of the evidence was very low. Although the results should be interpreted carefully, individuals with chronic headaches showed significantly higher levels of alexithymia when compared to healthy individuals. No conclusive results were found for the other variables of interest. Conclusion: Although the overall evidence from this review is very low, people with chronic primary headaches and oro‐facial pain could be regularly screened for alexithymia to guarantee appropriate management. [ABSTRACT FROM AUTHOR]

Background: Between 2015 and 2019 the Chronic Headache Education and Self-management Study (CHESS) developed and tested a supportive self-management approach that aimed to improve outcomes for people with chronic migraine or chronic tension type headache with/without episodic migraine. However, a paucity of qualitative research which explored the lived experiences of people with chronic headache was evidenced. In response, we undertook to explore the experiences of living with chronic headaches of people who participated in the CHESS study. Methods: We adopted qualitative methodologies, inviting participants in the CHESS study to participate in semi-structured interviews. In phase 1 (feasibility study), a thematic analysis was conducted. In phase 2 (main CHESS trial), interviews were informed by topic guides developed from our learning from the phase 1 interviews. Pen portrait methodology and thematic analysis was employed allowing us to explore the data longitudinally. Results: Phase 1, 15 interviews (10 female) age range 29 to 69 years (median 47 years) revealed the complexities of living with chronic headache. Six overarching themes were identified including the emotional impact and the nature of their headaches. Phase 2, included 66 interviews (26 participants; median age group 50s (range 20s-60s); 20 females. 14 were interviewed at three points in time (baseline, 4 and 12 months) Through an iterative process four overlapping categories of headache impact emerged from the data and were agreed: i) 'I will not let headaches rule my life'; ii) 'Headaches rule my life'; iii) 'Headaches out of control—something needs to change'; and iv) 'Headaches controlled—not ruling my life'. One of these categories was assigned to each pen portrait at each timepoint. The remaining 12 participants were interviewed at two time points during a year; pen portraits were again produced. Analysis revealed that the headache impact categories developed above held true in this sample also providing some validation of the categories. Conclusions: These data give an insight into the complexities of living with chronic headache. Chronic headache is unpredictable, permeating all aspects of an individual's life; even when an individual feels that their headache is controlled and not interfering, this situation can rapidly change. It shows us that more work needs to be done both medically and societally to help people living with this often-hidden condition. Trial registration: ISRCTN79708100 [ABSTRACT FROM AUTHOR]

Purpose of Review: As artificial intelligence (AI) and machine learning (ML) are becoming more pervasive in medicine, understanding their ethical considerations for chronic pain and headache management is crucial for optimizing their safety. Recent Findings: We reviewed thirty-eight editorial and original research articles published between 2018 and 2023, focusing on the application of AI and ML to chronic pain or headache. The core medical principles of beneficence, non-maleficence, autonomy, and justice constituted the evaluation framework. The AI applications addressed topics such as pain intensity prediction, diagnostic aides, risk assessment for medication misuse, empowering patients to self-manage their conditions, and optimizing access to care. Virtually all AI applications aligned both positively and negatively with specific medical ethics principles. Summary: This review highlights the potential of AI to enhance patient outcomes and physicians' experiences in managing chronic pain and headache. We emphasize the importance of carefully considering the advantages, disadvantages, and unintended consequences of utilizing AI tools in chronic pain and headache, and propose the four core principles of medical ethics as an evaluation framework. [ABSTRACT FROM AUTHOR]

Abstract Background Headache disorders are among the most prevalent neurological disorders worldwide. However, whether groups differing in socioeconomic position (SEP) are disproportionately affected by headache disorders has not yet been adequately clarified. Our aim was to analyse (1) the headache prevalence by socioeconomic position (SEP) and (2) the attack frequency by SEP in a German population-based adult sample. Methods Cross-sectional data from a random general population were used. The sample included N = 2,189 participants aged ≥ 18 years. SEP was measured using net equivalised income (NEI) and education. A binary logistic regression model tested the effect of SEP in predicting the prevalence of headache in general. Ordinal logistic regressions were modeled to predict the effect of SEP on the likelihood of attack frequency. Attack frequency was categorized in low frequency episodic headache (LFEH: 0–3 days per month), moderate frequency episodic headache (MFEH: 4–14 days per month) and chronic headache (CH: ≥ 15 days per month). Results Of the 2,189 participants, 891 reported headache in the last six months. Neither income nor education was associated with headache prevalence. However, significant differences between income groups were found for attack frequency. Compared to participants with NEI > 150%, those with NEI

Abstract Introduction Headache is an illness with high prevalence and adverse effects on quality of life. As oral or dental problems such as pain can trigger or aggravate it, we aimed to investigate and compare oral and dental health status in patients affected with chronic headaches and healthy individuals. Methods The present case-control study included 60 patients with chronic headaches (case) and 60 healthy individuals (control) in Rasht, Iran. The demographic characteristics and clinical examinations, including decayed/missing/filled teeth (DMF-T) and community periodontal index of treatment needs (CPITN) indices, as well as bruxism, frequency of tooth brushing and flossing, and maxillary and mandibular tooth wear were recorded in a checklist. Data analysis was performed using the IBM SPSS version 28 at a significance level of 0.05. Results The case group consisted of 25 men (41.7%) and 35 women (58.3%) with an average age of 32.55 ± 6.62 years, while the control group had 27 men (45%) and 33 women (55%) with an average age of 30.95 ± 6.33 years. The study groups were not significantly different in bruxism, frequency of tooth brushing and flossing, DMFT, CPTIN, and maxillary and mandibular tooth wear. Conclusion It seems that chronic headaches do not significantly affect the oral and dental health of the sufferers. Moreover, it appears that these patients are well aware of the role of oral and dental hygiene in triggering or aggravating the episodes of headaches.

Abstract Background Between 2015 and 2019 the Chronic Headache Education and Self-management Study (CHESS) developed and tested a supportive self-management approach that aimed to improve outcomes for people with chronic migraine or chronic tension type headache with/without episodic migraine. However, a paucity of qualitative research which explored the lived experiences of people with chronic headache was evidenced. In response, we undertook to explore the experiences of living with chronic headaches of people who participated in the CHESS study. Methods We adopted qualitative methodologies, inviting participants in the CHESS study to participate in semi-structured interviews. In phase 1 (feasibility study), a thematic analysis was conducted. In phase 2 (main CHESS trial), interviews were informed by topic guides developed from our learning from the phase 1 interviews. Pen portrait methodology and thematic analysis was employed allowing us to explore the data longitudinally. Results Phase 1, 15 interviews (10 female) age range 29 to 69 years (median 47 years) revealed the complexities of living with chronic headache. Six overarching themes were identified including the emotional impact and the nature of their headaches. Phase 2, included 66 interviews (26 participants; median age group 50s (range 20s-60s); 20 females. 14 were interviewed at three points in time (baseline, 4 and 12 months) Through an iterative process four overlapping categories of headache impact emerged from the data and were agreed: i) ‘I will not let headaches rule my life’; ii) ‘Headaches rule my life’; iii) ‘Headaches out of control—something needs to change’; and iv) ‘Headaches controlled—not ruling my life’. One of these categories was assigned to each pen portrait at each timepoint. The remaining 12 participants were interviewed at two time points during a year; pen portraits were again produced. Analysis revealed that the headache impact categories developed above held true in this sample also providing some validation of the categories. Conclusions These data give an insight into the complexities of living with chronic headache. Chronic headache is unpredictable, permeating all aspects of an individual’s life; even when an individual feels that their headache is controlled and not interfering, this situation can rapidly change. It shows us that more work needs to be done both medically and societally to help people living with this often-hidden condition. Trial registration ISRCTN79708100

Abstract Medication overuse headache (MOH) is a chronic headache disorder that results from excessive use of acutely symptomatic headache medications, leading to more frequent and severe headaches. This study aims to assess the 3-month treatment outcomes in MOH patients, focusing on the types and usage of overused medications, as well as preventive treatments. This prospective cross-sectional study analyzed the treatment outcomes of 309 MOH patients from April 2020 to March 2022. Patients were advised to discontinue overused medications immediately and offered preventive treatments based on clinical judgment. Data on headache characteristics, medication use, and impact on daily life were collected at baseline and 3 months. Results showed overall significant improvements in headache-related variables in patients completing the 3-month treatment follow-up. The median number of headache days per month decreased from 15 days at baseline to 8 days after 3 months (p

Medication overuse headache (MOH) is a chronic headache disorder that results from excessive use of acutely symptomatic headache medications, leading to more frequent and severe headaches. This study aims to assess the 3-month treatment outcomes in MOH patients, focusing on the types and usage of overused medications, as well as preventive treatments. This prospective cross-sectional study analyzed the treatment outcomes of 309 MOH patients from April 2020 to March 2022. Patients were advised to discontinue overused medications immediately and offered preventive treatments based on clinical judgment. Data on headache characteristics, medication use, and impact on daily life were collected at baseline and 3 months. Results showed overall significant improvements in headache-related variables in patients completing the 3-month treatment follow-up. The median number of headache days per month decreased from 15 days at baseline to 8 days after 3 months (p < 0.001). Patients who overused multiple drug classes demonstrated increased disability levels (mean Headache Impact Test-6 score: 62 at baseline vs. 56 at 3 months, p < 0.01). Those who continued overusing medications reported more days of severe headache (mean 18 days at baseline vs. 14 days at 3 months, p < 0.05) and greater impact (mean Migraine Disability Assessment score: 35 at baseline vs. 28 after 3 months, p < 0.05) compared to the baseline. Differences in headache outcomes were evident across different preventive treatment groups, with generalized estimating equation analyses highlighting significant associations between clinical characteristics, overused medication classes, and preventive treatments. Most MOH clinical features significantly improved after 3 months of treatment. However, notable interactions were observed with certain clinical presentations, suggesting possible influences of overused medication classes, usage patterns, and preventive treatment types on MOH treatment outcomes. This study underscores the importance of individualized treatment strategies and the potential benefits of discontinuing overused medications. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between chronic headache outcome and aneurysmal wall enhancement (AWE) on high-resolution vessel wall imaging (HR-VWI) in patients with unruptured intracranial aneurysms (UIAs) who underwent microsurgical clipping. Methods: Two hundred seventy-four UIA patients were retrospectively analyzed. Patients were grouped according to presence of AWE. AWE was subclassified as focal or uniform. Clinical and imaging data were recorded. Headache was evaluated using the 10-point numerical rating scale and Headache Impact Test-6 before and 6 months after surgery. Results: The proportions of patients reporting chronic headache in the no AWE, focal wall enhancement (FWE), and uniform wall enhancement (UWE) groups were 5.7%, 24.8%, and 41.8%, respectively. All patients in the UWE group who reported headache before surgery experienced headache improvement after surgery. Decrease in headache severity was greater in the UWE group than in the FWE group. Multivariate binary logistic regression showed that FWE (odds ratio (OR) 0.490; 95% confidence interval (CI), 0.262–0.917; p = 0.026) and small intraluminal thrombus (OR 0.336; 95% CI, 0.142–0.795; p = 0.013) were independent factors protective against preoperative headache. FWE (OR 0.377; 95% CI, 0.195–0.728; p = 0.004) and small intraluminal thrombus (OR 0.235; 95% CI, 0.088–0.630; p = 0.004) were independent predictors of no headache relief after surgery. Conclusions: AWE on HR-VWI is associated with relief of chronic headache after surgical clipping in patients with UIAs. Incidence of chronic headache was highest in patients exhibiting UWE. These patients also experienced the greatest improvement in headache after surgical clipping. Clinical relevance statement: This study revealed that high-resolution vessel wall imaging can demonstrate aneurysmal wall plaque and intraluminal thrombus, which may be prognostic imaging markers for chronic headache in patients with unruptured intracranial aneurysms. Key Points: • Aneurysmal wall enhancement may be associated with chronic headache. • Incidence of chronic headache was highest in patients with aneurysms exhibiting uniform wall enhancement. • Patients with aneurysms exhibiting uniform wall enhancement experienced the greatest improvement in headache after clipping. [ABSTRACT FROM AUTHOR]

Background: Central Sensitivity (CS) is defined as an increased responsiveness of nociceptive neurons in the central nervous system to normal or subthreshold inputs. CS has been linked to the psychological burden associated with suffering from various chronic pain (CP) conditions, including fibromyalgia (FM) and chronic headache (CH). The present study aims to investigate whether CS can distinguish between CP conditions and healthy controls (HCs), as well as among different CP conditions, specifically CH, FM, and FM with CH. Methods: A total of 737 women (n=220 CH; n=200 FM; n=209 FM with CH; n=108 HCs) completed an online self-administered protocol consisting of the Central Sensitivity Inventory (CSI) and socio-anamnestic information. A general linear model ANCOVA was performed to test differences in CSI scores, covarying for sociodemographic variables showing a significant different distribution among groups (age, social and working status and educational level). Results: Data analysis showed a good fit for the model (R2 Adjusted=.407; df=7; F=73.172; p.001) and a significant difference between groups in CSI scores (p.001). The only covariate included in the model showing a significant effect was educational level (F= 32.208; p.001). Post hoc tests using the Bonferroni method revealed that all clinical groups scored significantly higher than HCs (all p .001). Additionally, FM with comorbid CH showed CSI scores significantly higher than all other clinical groups. Conclusions: CS appears to have a discriminating role among CP conditions, particularly in FM associated with CH. Including this dimension in the clinical evaluation of CP patients seems relevant to better understand the complex connection between CP and mental health.

Abstract Background A lack of safety data on postpartum medication use presents a potential barrier to breastfeeding and may result in infant exposure to medications in breastmilk. The type and extent of medication use by lactating women requires investigation. Methods Data were collected from the CHILD Cohort Study which enrolled pregnant women across Canada between 2008 and 2012. Participants completed questionnaires regarding medications and non-prescription medications used and breastfeeding status at 3, 6 and 12 months postpartum. Medications, along with self-reported reasons for medication use, were categorized by ontologies [hierarchical controlled vocabulary] as part of a large-scale curation effort to enable more robust investigations of reasons for medication use. Results A total of 3542 mother-infant dyads were recruited to the CHILD study. Breastfeeding rates were 87.4%, 75.3%, 45.5% at 3, 6 and 12 months respectively. About 40% of women who were breastfeeding at 3 months used at least one prescription medication during the first three months postpartum; this proportion decreased over time to 29.5% % at 6 months and 32.8% at 12 months. The most commonly used prescription medication by breastfeeding women was domperidone at 3 months (9.0%, n = 229/2540) and 6 months (5.6%, n = 109/1948), and norethisterone at 12 months (4.1%, n = 48/1180). The vast majority of domperidone use by breastfeeding women (97.3%) was for lactation purposes which is off-label (signifying unapproved use of an approved medication). Non-prescription medications were more often used among breastfeeding than non-breastfeeding women (67.6% versus 48.9% at 3 months, p

Abstract Clinical studies have shown that there may be a certain relationship between pathological changes of the myodural bridge complex (MDBC) and chronic headaches of unknown cause. But there is still a lack of experimental evidence to explain the possible mechanism. This study aims to further confirm this relationship between MDBC and chronic headaches and explore its potential occurrence mechanism in rats. Bleomycin (BLM) or phosphate-buffered saline (PBS) was injected into the myodural bridge fibers of rats to establish the hyperplastic model of MDBC. After 4 weeks, the occurrence of headaches in rats was evaluated through behavioral scores. The immunohistochemistry staining method was applied to observe the expression levels of headache-related neurotransmitters in the brain. Masson trichrome staining results showed that the number of collagen fibers of MDBC was increased in the BLM group compared to those of the other two groups. It revealed hyperplastic changes of MDBC. The behavioral scores of the BLM group were significantly higher than those of the PBS group and the blank control group. Meanwhile, expression levels of CGRP and 5-HT in the headache-related nuclei of the brain were increased in the BLM group. The current study further confirms the view that there is a relationship between pathological changes of MDBC and chronic headaches of unknown cause. This study may provide anatomical and physiological explanations for the pathogenesis of some chronic headaches of unknown cause.

Background: A lack of safety data on postpartum medication use presents a potential barrier to breastfeeding and may result in infant exposure to medications in breastmilk. The type and extent of medication use by lactating women requires investigation. Methods: Data were collected from the CHILD Cohort Study which enrolled pregnant women across Canada between 2008 and 2012. Participants completed questionnaires regarding medications and non-prescription medications used and breastfeeding status at 3, 6 and 12 months postpartum. Medications, along with self-reported reasons for medication use, were categorized by ontologies [hierarchical controlled vocabulary] as part of a large-scale curation effort to enable more robust investigations of reasons for medication use. Results: A total of 3542 mother-infant dyads were recruited to the CHILD study. Breastfeeding rates were 87.4%, 75.3%, 45.5% at 3, 6 and 12 months respectively. About 40% of women who were breastfeeding at 3 months used at least one prescription medication during the first three months postpartum; this proportion decreased over time to 29.5% % at 6 months and 32.8% at 12 months. The most commonly used prescription medication by breastfeeding women was domperidone at 3 months (9.0%, n = 229/2540) and 6 months (5.6%, n = 109/1948), and norethisterone at 12 months (4.1%, n = 48/1180). The vast majority of domperidone use by breastfeeding women (97.3%) was for lactation purposes which is off-label (signifying unapproved use of an approved medication). Non-prescription medications were more often used among breastfeeding than non-breastfeeding women (67.6% versus 48.9% at 3 months, p < 0.0001), The most commonly used non-prescription medications were multivitamins and Vitamin D at 3, 6 and 12 months postpartum. Conclusions: In Canada, medication use is common postpartum; 40% of breastfeeding women use prescription medications in the first 3 months postpartum. A diverse range of medications were used, with many women taking more than one prescription and non-prescription medicines. The most commonly used prescription medication by breastfeeding women were domperidone for off-label lactation support, signalling a need for more data on the efficacy of domperidone for this indication. This data should inform research priorities and communication strategies developed to optimize care during lactation. [ABSTRACT FROM AUTHOR]

Background and objectives: Chronic headaches are a frequent cause of pain and disability. The purpose of this randomized trial was to examine whether transcranial direct current stimulation (tDCS) applied to the primary motor cortex, reduces pain and increases daily function in individuals suffering from primary chronic headache. Materials and methods: A prospective, randomized, controlled trial, where participants and assessors were blinded, investigated the effect of active tDCS vs. sham tDCS in chronic headache sufferers. Forty subjects between 18 and 70 years of age, with a diagnosis of primary chronic headache were randomized to either active tDCS or sham tDCS treatment groups. All patients received eight treatments over four consecutive weeks. Anodal stimulation (2 mA) directed at the primary motor cortex (M1), was applied for 30 min in the active tDCS group. Participants in the sham tDCS group received 30 s of M1 stimulation at the start and end of the 30-minute procedure; for the remaining 29 min, they did not receive any stimulation. Outcome measures based on data collected at baseline, after eight treatments and three months later included changes in daily function, pain levels, and medication. Results: Significant improvements in both daily function and pain levels were observed in participants treated with active tDCS, compared to sham tDCS. Effects lasted up to 12 weeks post-treatment. Medication use remained unchanged in both groups throughout the trial with no serious adverse effects reported. Conclusion: These results suggest that tDCS has the potential to improve daily function and reduce pain in patients suffering from chronic headaches. Larger randomized, controlled trials are needed to confirm these findings. Trial registration: The study was approved by the local ethics committee (2018/ 2514) and by the Norwegian Centre for Research Data (54483). [ABSTRACT FROM AUTHOR]

Clinical studies have shown that there may be a certain relationship between pathological changes of the myodural bridge complex (MDBC) and chronic headaches of unknown cause. But there is still a lack of experimental evidence to explain the possible mechanism. This study aims to further confirm this relationship between MDBC and chronic headaches and explore its potential occurrence mechanism in rats. Bleomycin (BLM) or phosphate-buffered saline (PBS) was injected into the myodural bridge fibers of rats to establish the hyperplastic model of MDBC. After 4 weeks, the occurrence of headaches in rats was evaluated through behavioral scores. The immunohistochemistry staining method was applied to observe the expression levels of headache-related neurotransmitters in the brain. Masson trichrome staining results showed that the number of collagen fibers of MDBC was increased in the BLM group compared to those of the other two groups. It revealed hyperplastic changes of MDBC. The behavioral scores of the BLM group were significantly higher than those of the PBS group and the blank control group. Meanwhile, expression levels of CGRP and 5-HT in the headache-related nuclei of the brain were increased in the BLM group. The current study further confirms the view that there is a relationship between pathological changes of MDBC and chronic headaches of unknown cause. This study may provide anatomical and physiological explanations for the pathogenesis of some chronic headaches of unknown cause. [ABSTRACT FROM AUTHOR]

Background and Objectives Headache is one of the most common patient complaints which makes it difficult for sufferers to concentrate at work and during other daily activities. Given the importance of this condition, the present study was conducted to evaluate the prevalence of chronic headache and its related factors in the Shahrekord cohort study population. Subjects and Methods This cross-sectional study included 594 patients with headache (the case group) and 594 age- and gender-matched people without headache (the control group). Patient information was collected using a checklist and analyzed by Stata statistical software. Results The results of the study showed that the prevalence of chronic headache was 5.9%, which was 2.6% in men and 8.8% in women (P<0.001). The prevalence of headache in city residents was 6.4% higher from that in rural areas (4.7%), and it had the highest prevalence among illiterate people (7.3%) (P=0.061). As far as underlying diseases were concerned, the prevalence of chronic headache was 0.1% in patients with diabetes, 7.7% in patients with hypertension, 1.8% in patients with ischemic heart disease, and 15% in patients with depression. Conclusion In the present study, the prevalence of headache was higher in women, city residents, unemployed people, smokers, and people who consumed drugs and alcohol. Also, the prevalence of chronic non-communicable diseases such as diabetes, hypertension, ischemic heart disease and depression was higher in patients with headache. These findings reflect the importance of the effects of headache and the need to devise strategies for the treatment and prevention of headache. [ABSTRACT FROM AUTHOR]

Introduction An area of emerging interest in chronic pain populations concerns fear of pain and associated fear of movement (kinesiophobia)—a cognitive appraisal pattern that is well-validated in non-headache chronic pain. However, there is limited research on whether this construct can be measured in a similar manner in headache populations. Methods The current project details a confirmatory factor analysis of the 12-Item Tampa Scale of Kinesiophobia (TSK-12) using a clinical data set from 210 adults with diverse headache diagnoses presenting for care at a multidisciplinary pain clinic. One item (concerning an "accident" that initiated the pain condition) was excluded from analysis. Results Results of the confirmatory factor analysis for the remaining 12 items indicated adequate model fit for the previously established 2-factor structure (activity avoidance and bodily harm/somatic focus subscales). In line with previous literature, total TSK-12 scores showed moderate correlations with pain severity, pain-related interference, positive and negative affect, depressive and anxious symptoms, and pain catastrophizing. Discussion The current study is the first to examine the factor structure of the TSK-12 in an adult headache population. The results support the relevance of pain-related fear to the functional and psychosocial status of adults with chronic headache, although model fit of the TSK-12 could be characterized as adequate rather than optimal. Limitations of the study include heterogeneity in headache diagnosis and rates of comorbid non-headache chronic pain in the sample. Future studies should replicate these findings in more homogenous headache groups (eg, chronic migraine) and examine associations with behavioral indices and treatment response. [ABSTRACT FROM AUTHOR]

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Objective: To determine the medication adherence rates of patients with chronic headaches to prophylaxis and the factors affecting this rate, including internet and social media use. Methods: This study was conducted in two hospitals between May and September 2021. Adult patients with chronic headaches requiring prophylaxis were recruited for this study. Demographic data, headache types/features, prophylactic drugs, Hospital Anxiety and Depression scale scores, and duration of internet/social media use (hours/day) were recorded. Medication Adherence Report scale scores, changes in headache characteristics, and drug-related adverse effects were assessed during the first month. Results: In total, 113 patients were recruited. Most patients had migraines (69%). The medication adherence rate in the first month was 72.6%. Patients with a longer duration of internet/social media use and adverse drug effects were more likely to show poor adherence (p=0.005). Decreasing baseline maximum headache severity increased the likelihood of medication non-adherence (p=0.005). Public hospital patients (p=0.036) and married patients (p=0.048) were more prone to non-adherence. Conclusion: Internet/social media use, headache severity, and medication-related side effects are the most important factors associated with medication adherence. Non-profit healthcare professionals/organizations should use the internet and social media as communication channels to increase medication adherence. Health policies need to be adjusted to allow more time for the healthcare worker-patient communication. [ABSTRACT FROM AUTHOR]

Objective: Although headache (HA) is a common sequela of traumatic brain injury (TBI), early predictors of chronic HA after moderate to severe TBI are not well established, and the relationship chronic HA has with psychosocial functioning is understudied. Thus, we sought to (1) determine demographic and injury predictors of chronic HA 1 or more years after moderate to severe TBI and (2) examine associations between chronic HA and psychosocial outcomes. Setting: Community. Participants: Participants in the TBI Model System (TBIMS) with moderate to severe TBI who consented for additional chronic pain questionnaires at the time of TBIMS follow-up. Design: Multisite, observational cohort study using LASSO (least absolute shrinkage and selection operator) regression for prediction modeling and independent t tests for psychosocial associations. Main Outcome Measure(s): Chronic HA after TBI at year 1 or 2 postinjury and more remotely (5 or more years). Results: The LASSO model for chronic HA at 1 to 2 years achieved acceptable predictability (cross-validated area under the curve [AUC] = 0.70). At 5 or more years, predictability was nearly acceptable (cross-validated AUC = 0.68), but much more complex, with more than twice as many variables contributing. Injury characteristics had stronger predictive value at postinjury years 1 to 2 versus 5 or more years, especially sustained intracranial pressure elevation (odds ratio [OR] = 3.8) and skull fragments on head computed tomography (CT) (OR = 2.5). Additional TBI(s) was a risk factor at both time frames, as were multiple socioeconomic characteristics, including lower education level, younger age, female gender, and Black race. Lower education level was a particularly strong predictor at 5 or more years (OR up to 3.5). Emotional and participation outcomes were broadly poorer among persons with chronic HA after moderate to severe TBI. Conclusions: Among people with moderate to severe TBI, chronic HA is associated with significant psychosocial burden. The identified risk factors will enable targeted clinical screening and monitoring strategies to enhance clinical care pathways that could lead to better outcomes. They may also be useful as stratification or covariates in future clinical trial research on treatments. [ABSTRACT FROM AUTHOR]

Chronic idiopathic hypertrophic pachymeningitis (IHP) is a rare inflammatory entity with unknown etiopathogenesis, resulting in dural thickening and fibrosis. This mimics the illuminated night view of the Eiffel tower on contrast-enhanced MRI. The authors report a characteristic MRI sign of chronic IHP on contrast-enhanced MRI. The authors present a case of a 30-year-old male presenting with a headache for the past 3 years with recent aggravation of symptoms. Laboratory and imaging results were reviewed. Follow-up imaging with ongoing treatment was also reviewed. The etiology could not be determined even after extensive investigations. Contrast-enhanced MRI revealed diffuse enhancing thickening of the pachymeninges along the posterior cerebral hemispheres, falx cerebri, and tentorium cerebelli, giving the typical ‘Night view of the Eiffel tower’ appearance on coronal images. There was cerebral venous sinus thrombosis secondary to IHP. The patient was treated with corticosteroids and anticoagulants. The follow-up scan revealed reduced thickness and enhancement of the meninges.

Background: Acupuncture is a spreading and promising intervention, which has proven to be very useful in the treatment and prevention of chronic pain, in particular chronic headaches, in adults; the literature about the treatment of pediatric chronic headaches is scarce. In addition, few guidelines advise its use in children. The aim of this review is to collect all relevant studies with available data about the use, effect, and tolerability of acupuncture as a treatment for pediatric primary headaches. Methods: This is a narrative review based on eight studies selected from 135 papers including pediatric cases treated with acupuncture for headache. Results: Despite the differences in tools, procedures, and application sites, acupuncture demonstrated a positive effect on both the frequency and intensity of headaches and was well tolerated. There are no studies considering the long-term efficacy of acupuncture. Conclusion: Further additional studies are needed on acupuncture in children and adolescents, with larger series and standardized procedures, in order to better assess efficacy, tolerability, and long-term prognosis and to define guidelines for the use of this promising and safe treatment. It is particularly relevant to identify safe and well-tolerated treatment options in pediatric patients affected by recurrent and debilitating headaches. [ABSTRACT FROM AUTHOR]

Purpose of Review: Chronic migraine (CM) is a chronic form of migraine that differs from episodic migraine (EM) in terms of prevalence, comorbidities, response to treatment, and biomarkers. The aim of this review was to summarize the recent findings on serological biomarkers of CM. Recent Findings: Neuronal, inflammatory, and vascular markers have been investigated to assess their diagnostic and prognostic ability and treatment effectiveness. Several markers showed significant alterations according to disease status and treatment response in CM. Calcitonin gene-related peptide (CGRP), glutamate, and adiponectin appear to be the most promising blood biomarkers for CM. Most studies have shown altered ictal and interictal levels of these markers in CM compared with those in EM and controls. Additionally, they showed a significant association with treatment outcomes. Total adiponectin and high-molecular-weight adiponectin levels were less studied as biomarkers of CM than CGRP and glutamate levels but showed promising results. Summary: The development of suitable biomarkers could revolutionize the diagnosis and treatment of CM and ultimately decrease the disability and societal costs of the disease. [ABSTRACT FROM AUTHOR]

Objective: Migraine is a common primary headache disease. Studies have supported the presence of neurogenic inflammation in the pathophysiology of migraine. The neutrophil/lymphocyte ratio (NLR) has been used as a marker of inflammation in recent years. Although it has been shown that NLR increases during migraine attacks, there are limited data on chronic migraine (CM) patients. We aimed to evaluate the inflammatory status in CM patients using NLR as a biomarker for inflammation. Methods: Twenty three migraine patients without aura and 18 age-matched control participants were included. The migraine patients who had more than 15 headache days/month were grouped as having CM. The episodic migraine group included migraine patients who had less than 15 headache days/month. Another grouping was performed according to the total duration of migraine-type headaches. Patients having headaches over 10 years were grouped as long-term (LM) migraine patients, and those having headaches under 10 years were grouped as short-term (SM) migraine patients. The patients were in an interictal state during the evaluations. Demographic information, laboratory results, and definite diagnosis of the headache type of the participants were retrospectively collected from the files. NLR was calculated using the total counts of neutrophils and lymphocytes. Results: The NLR was similar between the control, episodic, and CM groups. No correlation was found between NLR and the frequency of headaches. The NLR was similar between the SM and LM migraine patients. Conclusion: There is no evidence of ongoing inflammation, which was evaluated by NLR, in the interictal state of patients with both episodic and CM. [ABSTRACT FROM AUTHOR]

• Chronic headaches lead to a considerable reduction of daily function in all aspects of life, especially in women. • Health professionals should be aware that common everyday negative events can cause chronic headaches. • Systems of prevention and early treatment need to be implemented. • Intimate relationships often suffer; multidisciplinary teams addressing chronic pain should include experts in sexual relations. Although headache is considered a frequently experienced type of pain, the challenges, experiences, and perceptions of people suffering from chronic headaches are poorly understood. The aim of this study was to gain subjective information regarding these aspects in daily life, in order to answer the research question "What is life like with a chronic headache?" Semi-structured, in-depth interviews were conducted with 16 patients who suffered from chronic headaches. Five main domains were explored: emotions related to headaches; trauma/stressful events; behavioural changes, relationships, and coping mechanisms. Participants reported that pain restricted their lives in many ways, including not being able to work, loss of status, identity, freedom, intimate relationships and friends. The majority believed that psychological and/or physiological trauma was the reason for their headaches. New information that emerged from this study was how common life events not usually considered major traumas, initiated and maintained symptoms. Shame and feelings of stigmatization appeared to be strongly associated with chronic pain, leading to a scenario where thriving, contentment and enjoyment were often lacking. This study provided an in-depth understanding of how chronic headache adversely affects the lives of sufferers. Chronic headaches restrict sufferers' lives, resulting in emotional and behavioural changes and a high level of disability. The complexity of chronic headaches in clinical practice is hugely underestimated, and poorly understood by society in general. [ABSTRACT FROM AUTHOR]

Copyright of Eastern Mediterranean Health Journal is the property of World Health Organization and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Objective/ background Chronic headaches and sports-related concussions are among the most common neurological morbidities in adolescents and young adults. Given that the two can overlap in presentation, studying the effects of one on another has proven difficult. In this longitudinal study, we sought to assess the relationship between chronic headaches and concussions, analyzing the role of historic concussions on chronic headaches, as well as that of premorbid headaches on future concussion incidence, severity, and recovery. Methods This multi-center, longitudinal cohort study followed 7,453 youth athletes who were administered demographic and clinical surveys as well as a total of 25,815 Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) assessments between 2009 and 2019. ImPACT was administered at baseline. Throughout the season concussions were examined by physicians and athletic trainers, followed by re-administration of ImPACT post-injury (PI), and at follow-up (FU), a median of 7 days post-concussion. Concussion incidence was calculated as the total number of concussions per patient years. Concussion severity and recovery were calculated as standardized deviations from baseline to PI and then FU in Symptom Score and the four neurocognitive composite ImPACT scores: Verbal Memory, Visual Memory, Processing Speed, and Reaction Time. Data were collected prospectively in a well-organized electronic format supervised by a national research-oriented organization with rigorous quality assurance. Analysis was preformed retrospectively. Results Of the eligible athletes, 1,147 reported chronic headaches (CH) at the start of the season and 6,306 reported no such history (NH). Median age of the cohort was 15.4 ± 1.6 years, and students were followed for an average of 1.3 ± 0.6 years. A history of concussions (OR 2.31, P

Abstract Background The Chronic Headache Education and Self-Management Study (CHESS) multicentre randomised trial evaluated the impact a group education and self-management support intervention with a best usual care plus relaxation control for people living with chronic headache disorders (tension type headaches or chronic migraine, with or without medication overuse headache). Here we report the process evaluation exploring potential explanations for the lack of positive effects from the CHESS intervention. Methods The CHESS trial included 736 (380 intervention: 356 control) people across the Midlands and London UK. We used a mixed methods approach. Our extensive process evaluation looked at context, reach, recruitment, dose delivered, dose received, fidelity and experiences of participating in the trial, and included participants and trial staff. We also looked for evidence in our qualitative data to investigate whether the original causal assumptions underpinning the intervention were realised. Results The CHESS trial reached out to a large diverse population and recruited a representative sample. Few people with chronic tension type headaches without migraine were identified and recruited. The expected ‘dose‘of the intervention was delivered to participants and intervention fidelity was high. Attendance (“dose received”) fell below expectation, although 261/380 (69%) received at least at least the pre-identified minimum dose. Intervention participants generally enjoyed being in the groups but there was little evidence to support the causal assumptions underpinning the intervention were realised. Conclusions From a process evaluation perspective despite our extensive data collection and analysis, we do not have a clear understanding of why the trial outcome was negative as the intervention was delivered as planned. However, the lack of evidence that the intervention causal assumptions brought about the planned behaviour change may provide some insight. Our data suggests only modest changes in managing headache behaviours and some disparity in how participants engaged with components of the intervention within the timeframe of the study. Moving forwards, we need a better understanding of how those who live with chronic headache can be helped to manage this disabling condition more effectively over time. Trial registration ISRCTN79708100 .

Objective: To investigate whether medication-overuse headache patients have differential DNA-methylation pattern. Methods: We collected blood samples from 120 medication-overuse headache-patients, 57 controls (29 episodic migraine patients and 28 healthy controls) in a hypothesis-generating cross-sectional case-control pilot study; 100 of the medication-overuse headache-patients were followed for six months and samples were collected at two and six months for the longitudinal methylation analyses. Blood cell proportions of leucocytes (neutrophils, NK-cells, monocytes, CD8+ and CD4+ T-cells, and B-cells) and the neutrophile-lymphocyte ratio were estimated using methylation data as a measure for immunological analysis and a cell type-specific epigenome wide association study was conducted between medication-overuse headache-patients and controls, and longitudinally for reduction in headache days/month among medication-overuse headache-patients. Results: We found a higher neutrophile-lymphocyte ratio in medication-overuse headache-patients compared to controls, indicating a higher immunological response in medication-overuse headache-patients (false discovery rate (adjusted p-value)<0.001). Reduction in headache days/month (9.8; 95% CI 8.1-11.5) was associated with lower neutrophile-lymphocyte ratio (false discovery rate adjusted p-value=0.041). Three genes (CORIN, CCKBR and CLDN9) were hypermethylated in specific cell types in medication-overuse headachepatients compared to controls. No methylation differences were associated with reduction in headache days in medication-overuse headache-patients after six months. Conclusion: This pilot study was consistent with higher immunological response in medication-overuse headachepatients which decreased with a reduction in headache days in longitudinal analysis. medication-overuse headachepatients exhibited differential methylation in innate immune cells but did not exhibit longitudinal differences with alterations in headache days. Our study creates hypotheses for further biomarker searches. [ABSTRACT FROM AUTHOR]

Extensive literature reports an increase in physical disorders (pain, pathologies, dysfunctions) and mental malaise/uneasiness (stress, burnout) affecting dental professionals in relation to fast and pressing rhythms of work, long working hours, increasingly demanding patients, ever-evolving technologies, etc. This project has been conceived to bring the science of yoga around the world to dental professionals as a preventive (occupational) medicine and to provide knowledge and means for self-care. Yoga is a concentrative self-discipline of the mind, senses, and physical body, that requires regular daily exercise (or meditation), attention, intention, and disciplined action. M&M: The study aimed to design a Yoga protocol specifically devised for dental professionals (dentists, dental hygienists, and dental assistants) including positions (asanā) to be practiced/used in the dental office. The protocol is targeted for the upper body, namely neck, upper back, chest, shoulder girdle, and wrists, being areas greatly affected by work-related musculoskeletal disorders. This paper represents a yoga-based guideline for the self-cure of musculoskeletal disorders among dental professionals. Results: The protocol includes both sitting (Upavistha position) and standing (Utthana or Sama position) asanā, with twisting (Parivrtta), side bending (Parsva), flexion and forward bending (Pashima), and extension and arching (Purva) asanā to mobilize and decompress, and to provide nourishment and oxygen to the musculo-articular system. The paper delivers different concepts and theories developed and deepened by the authors and introduces and spreads yoga as a medical science among dental professionals for the prevention and treatment of work-related musculoskeletal disorders. We articulate notions ranging from stretching out using the vinyasā method (breath-driven movement) and inward-focused attention to contemplative/concentrative science, interoceptive attention, self-awareness, the mind–body connection, and receptive attitude. The theory of “muscles are bone ties” is coined and delivered with regard to tensegrity musculoskeletal fascial structures connecting, pulling together, and nearing the bone segments where they are anchored. The paper describes over 60 asanā envisaged to be performed on dental stools or using the walls of a dental office or a dental unit chair. A detailed guideline on the work-related disorders that can find relief with the protocol is provided, including the description of breath control for the practice of asanā in vinyasā. The foundations of the technique reside in the Iyengar Yoga method and Parinama Yogā method. Conclusions: This paper represents a guideline for self-cure in the prevention or treatment of musculoskeletal disorders affecting dental professionals. Yoga is a powerful concentrative self-discipline able to provide physical and mental well-being, representing great help and support in daily life and business for dental professionals. Yógasanā restores retracted and stiff muscles, giving relief to the strained and tired limbs of dental professionals. Yoga is not intended for flexible or physically performing persons but for people who decide to take care of themselves. The practice of specific asanā represents a powerful tool for the prevention or treatment of MSDs related to poor posture, forward head, chronic neck tension (and related headache), depressed chest, compressive disorders on wrists and shoulders as carpal tunnel, impingement syndromes, outlet syndrome, subacromial pain syndrome and spinal disc pathologies. Yoga, as an integrative science in medicine and public health, represents a powerful tool for the prevention and treatment of occupational musculoskeletal disorders and an extraordinary path for the self-care of dental professionals, sitting job workers, and healthcare providers suffering from occupational biomechanical stresses and awkward postures. [ABSTRACT FROM AUTHOR]

Objective/ background: Chronic headaches and sports-related concussions are among the most common neurological morbidities in adolescents and young adults. Given that the two can overlap in presentation, studying the effects of one on another has proven difficult. In this longitudinal study, we sought to assess the relationship between chronic headaches and concussions, analyzing the role of historic concussions on chronic headaches, as well as that of premorbid headaches on future concussion incidence, severity, and recovery. Methods: This multi-center, longitudinal cohort study followed 7,453 youth athletes who were administered demographic and clinical surveys as well as a total of 25,815 Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) assessments between 2009 and 2019. ImPACT was administered at baseline. Throughout the season concussions were examined by physicians and athletic trainers, followed by re-administration of ImPACT post-injury (PI), and at follow-up (FU), a median of 7 days post-concussion. Concussion incidence was calculated as the total number of concussions per patient years. Concussion severity and recovery were calculated as standardized deviations from baseline to PI and then FU in Symptom Score and the four neurocognitive composite ImPACT scores: Verbal Memory, Visual Memory, Processing Speed, and Reaction Time. Data were collected prospectively in a well-organized electronic format supervised by a national research-oriented organization with rigorous quality assurance. Analysis was preformed retrospectively. Results: Of the eligible athletes, 1,147 reported chronic headaches (CH) at the start of the season and 6,306 reported no such history (NH). Median age of the cohort was 15.4 ± 1.6 years, and students were followed for an average of 1.3 ± 0.6 years. A history of concussions (OR 2.31, P < 0.0001) was associated with CH. Specifically, a greater number of past concussions (r2 = 0.95) as well as concussions characterized by a loss of consciousness (P < 0.0001) were associated with more severe headache burden. The CH cohort had a greater future incidence of concussion than the NH cohort (55.6 vs. 43.0 per 100 patient-years, P < 0.0001). However, multivariate analysis controlling for demographic, clinical, academic, and sports-related variables yielded no such effect (OR 0.99, P = 0.85). On multivariable analysis the CH cohort did have greater deviations from baseline to PI and FU in Symptom Score (PI OR per point 1.05, P = 0.01, FU OR per point 1.11, P = 0.04) and Processing Speed (OR per point 1.08, P = 0.04), suggesting greater concussion severity and impaired symptomatic recovery as compared to the NH cohort. Conclusion: A history of concussions was a significant contributor to headache burden among American adolescents and young adults. However, those with chronic headaches were not more likely to be diagnosed with a concussion, despite presenting with more severe concussions that had protracted recovery. Our findings not only suggest the need for conservative management among youth athletes with chronic headaches, they also indicate a potential health care gap in this population, in that those with chronic headaches may be referred for concussion diagnosis and management at lower rates than those with no such comorbidity. [ABSTRACT FROM AUTHOR]

Background: The Chronic Headache Education and Self-Management Study (CHESS) multicentre randomised trial evaluated the impact a group education and self-management support intervention with a best usual care plus relaxation control for people living with chronic headache disorders (tension type headaches or chronic migraine, with or without medication overuse headache). Here we report the process evaluation exploring potential explanations for the lack of positive effects from the CHESS intervention. Methods: The CHESS trial included 736 (380 intervention: 356 control) people across the Midlands and London UK. We used a mixed methods approach. Our extensive process evaluation looked at context, reach, recruitment, dose delivered, dose received, fidelity and experiences of participating in the trial, and included participants and trial staff. We also looked for evidence in our qualitative data to investigate whether the original causal assumptions underpinning the intervention were realised. Results: The CHESS trial reached out to a large diverse population and recruited a representative sample. Few people with chronic tension type headaches without migraine were identified and recruited. The expected 'dose'of the intervention was delivered to participants and intervention fidelity was high. Attendance ("dose received") fell below expectation, although 261/380 (69%) received at least at least the pre-identified minimum dose. Intervention participants generally enjoyed being in the groups but there was little evidence to support the causal assumptions underpinning the intervention were realised. Conclusions: From a process evaluation perspective despite our extensive data collection and analysis, we do not have a clear understanding of why the trial outcome was negative as the intervention was delivered as planned. However, the lack of evidence that the intervention causal assumptions brought about the planned behaviour change may provide some insight. Our data suggests only modest changes in managing headache behaviours and some disparity in how participants engaged with components of the intervention within the timeframe of the study. Moving forwards, we need a better understanding of how those who live with chronic headache can be helped to manage this disabling condition more effectively over time. Trial registration: ISRCTN79708100. [ABSTRACT FROM AUTHOR]

Background: Acupuncture is a spreading and promising intervention, which has proven to be very useful in the treatment and prevention of chronic pain, in particular chronic headaches, in adults; the literature about the treatment of pediatric chronic headaches is scarce. In addition, few guidelines advise its use in children. The aim of this review is to collect all relevant studies with available data about the use, effect, and tolerability of acupuncture as a treatment for pediatric primary headaches. Methods: This is a narrative review based on eight studies selected from 135 papers including pediatric cases treated with acupuncture for headache. Results: Despite the differences in tools, procedures, and application sites, acupuncture demonstrated a positive effect on both the frequency and intensity of headaches and was well tolerated. There are no studies considering the long-term efficacy of acupuncture. Conclusion: Further additional studies are needed on acupuncture in children and adolescents, with larger series and standardized procedures, in order to better assess efficacy, tolerability, and long-term prognosis and to define guidelines for the use of this promising and safe treatment. It is particularly relevant to identify safe and well-tolerated treatment options in pediatric patients affected by recurrent and debilitating headaches.

Background: Literature suggests that non-pharmacological treatments like non-invasive brain stimulation and cognitive behavioural therapy (CBT) may be used as augments in the management of Tension-Type Headache (TTH). Aims and Objectives: To assess the efficacy of Transcranial Direct Current Stimulation (tDCS) and Cognitive Behavioral Therapy (CBT) compared to treatment as usual (TAU) on headache-related disability and the psychological impact of headache on life of patients suffering from TTH. Materials and Methods: Thirty right-handed TTH patients HDI (headache disability index) > 30 were randomly allocated to group A (tDCS + TAU), group B (CBT + TAU), and group C (TAU). While the primary outcome measure was headache related disability (Headache Disability Index(HDI)), somatic symptoms (Somatic Symptom Severity (SSS-8)), anxiety & depression (Hospital Anxiety and Depression Scale (HADS)) and sleep quality (Pittsburgh Sleep Quality Index (PSQI). Assessments were done at baseline, end of the third and sixth month. Results: We found a statistically significant reduction in HDI (F=12.419, p

Background. The abuse of headache medications is an important factor in the formation of drug-induced headache. Aim. To determine the prevalence and nature of drug use among patients with migraine and chronic cephalgic syndrome. Materials and methods. An Internet survey was conducted among 1598 Internet users, as well as through social networks (Instagram, Facebook, VK) using Google Forms. Results. 60% of respondents with chronic headache and migraine symptoms did not have a reliable diagnosis. More than 70% of patients choose a drug for pain relief on their own and 62.7% take the drug in every headache attack. Conclusion. Among patients with chronic headaches and migraines, there is a high percentage of people abusing symptomatic drugs, which indicates a high risk of drug-induced headache formation.

Not available for the section "Images in Emergency".

(1) Background: Patients diagnosed with chronic pain suffer from long-term pain, which negatively affects their daily lives and mental health. Virtual reality (VR) technologies are considered a therapeutic tool to manage pain perception and mental health conditions. This systematic review aimed to appraise the efficacy of VR in improving pain intensity, anxiety, depression and mood among patients with chronic pain; (2) Methods: Five electronic databases were systematically searched using the terms representing VR and chronic pain. Quality assessment was conducted using Cochrane Collaboration's tool and Newcastle-Ottawa scale; (3) Results: Seventeen peer-reviewed articles were included in this review. It was found that VR was able to reduce pain intensity in patients with phantom limb pain, chronic headache, chronic neck pain and chronic low-back pain. The effects of VR on the improvement of anxiety, depression and mood were not determined due to the inadequate amount of clinical evidence; (4) Conclusions: VR, especially immersive VR, improves pain outcomes and its effects may vary depending on the approach and study design. More research is still needed to investigate the clinical use of VR in patients with chronic pain. [ABSTRACT FROM AUTHOR]

Objective The objective of this study is to document pain scores during withdrawal of abortive medication in patients diagnosed with medication overuse headache. Design Cross-sectional study. Setting Children's National Hospital's Headache Program. Subjects Patients 6–18 years of age who presented to the Headache Clinic at Children's National Hospital with presumed medication overuse headache between March 2017 and March 2019 were invited to participate. Methods Patients were instructed to abruptly discontinue overused medications and record their headache characteristics daily in a diary for 8 weeks. Results Fourteen diaries were returned and analyzed at a 4-week follow-up visit. Ninety-three percent of the patients were females, with a median age of 14.9 years (standard deviation [SD] = 2.0). The average headache intensity upon study entry was 4.7 out of 10 (SD = 2.5), and the average headache intensity upon study completion was 3.1 (SD = 2.5). Of the patients, 57% had daily headaches upon study entry, 71% had improved pain intensity from the first diary entry to the last diary entry, and 57% had complete headache resolution at an average of 7.6 days from medication discontinuation (SD = 5.1). Ibuprofen was the most overused medication (71%). Conclusions Our findings suggest that medication overuse headache will improve in the majority of pediatric patients who abruptly stop the offending medication(s) in an average of 8 days from withdrawal. Average pain intensity was reduced by more than one point among all patients who stopped taking abortive medications. Further larger-scale studies on medication withdrawal in pediatric patients with medication overuse headache could help us better understand whether this management strategy is effective. [ABSTRACT FROM AUTHOR]

BACKGROUND: Headache is one of the most common complaints that lead the patient to seek medical advice however only a few patients with recurrent headaches have a secondary cause like intracranial mass. The appropriate utilization of neuroimaging is important to rule-out secondary cause of headache in resourcelimited regions. The objective of this study is to describe the patterns of MRI findings in the evaluation of patients with chronic headache and to determine the clinical variables helpful in identifying patients with intracranial lesions. MATERIALS AND METHODS: This cross sectional study was conducted among 590 selected patients who underwent an MRI scan of the head from September 2016 to January 2018 at Wudassie Diagnostic center in Addis Ababa, Ethiopia. Siemens Magnetom 0.35T MRI was used. RESULTS: Out of 590 patients, 372 (63.1%) were females and 218 (36.9%) were males; 300 (50.8%) patients with the mean age of 38.6 + 0.5 years and a median of 37 + 16.7years have normal brain MRI and 290(49.2%) have abnormal brain MRI reports. The abnormal findings further divided into non-significant findings were 166(28%) that did not alter patient management and clinically significant findings were 124 (21%) which included by decreasing order of frequency tumors, infection, hydrocephalus, hemorrhage, and vascular abnormalities. CONCLUSION: It was 1.3 times higher rate of positive brain MR findings in patients who had headaches plus abnormal neurologic findings as compared to patients without neurologic abnormality (P-value = 0.01). There is a high rate of significant abnormal MRI findings in this study as compared to studies from developed nations. [ABSTRACT FROM AUTHOR]

Background: Literature suggests that non-pharmacological treatments like non-invasive brain stimulation and cognitive behavioural therapy (CBT) may be used as augments in the management of Tension-Type Headache (TTH). Aims and Objectives: To assess the efficacy of Transcranial Direct Current Stimulation (tDCS) and Cognitive Behavioral Therapy (CBT) compared to treatment as usual (TAU) on headache-related disability and the psychological impact of headache on life of patients suffering from TTH. Materials and Methods: Thirty right-handed TTH patients HDI (headache disability index) > 30 were randomly allocated to group A (tDCS + TAU), group B (CBT + TAU), and group C (TAU). While the primary outcome measure was headache related disability (Headache Disability Index(HDI)), somatic symptoms (Somatic Symptom Severity (SSS-8)), anxiety & depression (Hospital Anxiety and Depression Scale (HADS)) and sleep quality (Pittsburgh Sleep Quality Index (PSQI). Assessments were done at baseline, end of the third and sixth month. Results: We found a statistically significant reduction in HDI (F=12.419, p <0.001), SSS-8 (F=4.587, p=0.010), and HADS-anxiety (F=4.810, p=0.002). tDCS showed better efficacy than CBT, while these two were significantly better than TAU on HDI and SSS-8. On HADS-A also both tDCS and CBT were better than TAU, but showed no significant difference between them. Conclusion: Supplementing non-pharmacological techniques like tDCS and CBT will be effective in reducing headache-related disability and associated psychological symptoms. [ABSTRACT FROM AUTHOR]

Migraine significantly impacts individuals from all walks of life and from all around the globe. Chronic or high-frequency episodic migraine has similar disability and burden on the healthcare system and can be challenging to manage. The focus of this article is to provide an outline of the available pharmacological and nonpharmacological evidence-based strategies that clinicians can employ to build a "toolbox" for their patients. [ABSTRACT FROM AUTHOR]

Chronic post-traumatic headache (CPTH) after a mild traumatic brain injury (mTBI) has been reported in up to 60% of patients and can be extremely debilitating. While pharmacological treatments are typically used for CPTH, they frequently cause side effects and have limited effectiveness, leading individuals with CPTH to be unsatisfied with current treatment options and to seek nonpharmacological options. Acupuncture has been identified as a potential treatment option; however, the evidence in this population remains limited. The overall goal of this study was to examine the effect of a once weekly (e.g., low dose) versus twice weekly (e.g., high dose) of acupuncture treatment on CPTH in individuals with mTBI. Thirty-eight individuals were randomized to receive either 5 or 10 acupuncture treatments using a standard protocol over 5 weeks. The protocol consisted of 14 points using traditional acupuncture and 4 points using electroacupuncture. Headache outcomes, safety, treatment adherence, sleep quality, and quality of life (QOL) were assessed. The results showed that while there were no differences between dose groups for any of the outcomes assessed, acupuncture significantly reduced the number of headache days and headache pain intensity in individuals with CPTH. There were no significant changes in acute medication use or sleep quality. While there were some QOL improvements identified, these results should be interpreted with caution. Overall, acupuncture was shown to be safe and well-tolerated in people with CPTH after mTBI, and five acupuncture treatments using a standardized protocol shows promise in providing headache relief for this population.