Comparison of patients with migraine and tension-type headache in terms of somatosensory amplification and health anxiety / Estudo comparativo de pacientes com enxaqueca e cefaleia do tipo tensional em relação à amplificação somatossensorial e à ansiedade associada à saúde

ABSTRACT Although it is known that anxiety and depressive disorders frequently accompany migraine and TTH, the role of somatic amplification (SSA) and health anxiety in these diseases is not adequately known. Objective: The aim of this study is to compare SSA and health anxiety in patients with migraine or TTH, and healthy controls and to investigate the relationships between SSA, health anxiety, headache characteristics, anxiety and depressive symptoms. Methods: Fifty-four migraine, 50 TTH patients from the outpatient unit of the neurology department and 53 healthy volunteers were recruited for the study. The somatosensory amplification scale (SSAS), health anxiety inventory, Beck depression (BDI) and anxiety inventory (BAI) were administered to all participants. Results: The SSAS scores were significantly higher in migraineurs compared with the healthy controls. The health anxiety scores were significantly higher in both migraine and TTH groups. The BDI and BAI scores were also significantly higher in migraine and TTH groups compared with the controls. A significant positive correlation was found between headache frequency and BAI scores, the visual analogue scale scores and SSAS and BDI scores in migraineurs. The SSAS scores were also significantly correlated with the BDI and BAI scores in both of the headache groups. A similar correlation was determined with the health anxiety scores. Conclusions: While patients with migraine and TTH evalute, taking into account the SSA and health anxiety may contribute to the prognosis and treatment of these diseases.

RESUMO Embora se saiba que os distúrbios de ansiedade e depressão frequentemente acompanhem a enxaqueca e a TTH, o papel da amplificação somatossensorial (somatosensory amplification, SSA) e da hipocondria nessas doenças ainda não é bem conhecido. Objetivo: O presente estudo faz uma comparação entre pacientes que sofrem de enxaqueca e TTH com um grupo de controle saudável em termos de SSA e hipocondria e investiga a relação entre os achados e as características da cefaleia, a ansiedade e os sintomas depressivos. Métodos: O estudo incluiu 54 pacientes com enxaqueca, 50 pacientes com TTH e 53 voluntários saudáveis que se cadastraram na clínica de neurologia. A escala de amplificação somatossensorial (somatosensory amplification scale, SSAS), o inventário de hipocondria, o Inventário de Depressão de Beck (Beck Depression Inventory, BDI) e o Inventário de Ansiedade de Beck (Beck Anxiety Inventory, BAI) foram aplicados aos participantes. Resultados: Quando comparados com os controles saudáveis, as pontuações da SSAS dos pacientes com enxaqueca foram significativamente maiores, enquanto as pontuações de hipocondria foram significativamente maiores em ambos os grupos de enxaqueca e TTH. As pontuações do BAI e do BDI foram significativamente maiores em ambos os grupos de pacientes que no grupo de controle. No grupo da enxaqueca, foi identificada uma correlação positiva entre frequência de cefaleia e ansiedade, bem como entre a Escala Analógica Visual (EVA), a SSAS e a depressão. Em ambos os grupos de pacientes, a SSA foi correlacionada positivamente com a depressão e a ansiedade, e uma correlação semelhante foi encontrada entre a SSA e a hipocondria. Conclusão: Em avaliações dessas doenças, a hipocondria e a SSA devem ser levadas em consideração, pois se acredita que essa abordagem possa contribuir positivamente para o prognóstico e tratamento da doença.

A prevalência de cefaleia e fatores psicossociais associados em estudantes de medicina no Ceará / The prevalence of headache and psychosocial factors associated among medical students in a university of northeast Brazil

Introdução: A cefaleia é uma afecção que impacta negativamente a qualidade de vida da pessoa. O curso de medicina é reconhecidamente um gerador de esgotamento e, de acordo com a literatura, fatores estressantes são mais comuns em alunos de medicina que na população em geral, podendo desencadear a cefaleia. Esses fatores estressores podem ser intensificados em períodos que antecedem as provas devido a mudanças nos hábitos de sono e de estudo, havendo uma possível relação com o surgimento de cefaleias primárias. Objetivo: Avaliar a prevalência de cefaleia primária nos estudantes de medicina (EM) em períodos de provas e relacionar com fatores psicossociais. Métodos: Trata-se de um estudo transversal, baseado na aplicação de dois questionários a uma amostra de 219 EM do 1º ao 8º semestre de uma universidade no interior do Ceará. Um questionário relacionou a cefaleia com fatores psicossociais em períodos de provas. O segundo questionário: HSQ-DV, foi utilizado para o diagnóstico de enxaqueca e cefaleia do tipo tensional (CTT). Resultados: 98% dos EM relataram já ter sentido cefaleia. A prevalência de CTT e enxaqueca encontradas foi de 61,9% e 18,1%, respectivamente, dados maiores que a média para a população geral. Estudantes com enxaqueca têm mais crises antes de provas, se automedicam mais, ingerem mais psicoestimulantes, são mais ansiosos, mais depressivos, mais sedentários, mais estressados e dormem menos que aqueles com CTT. Conclusão: De fato, os EM são um grupo de risco para o desenvolvimento de cefaleias, merecendo, portanto, uma maior ênfase de pesquisas científicas sobre as cefaleias primárias neste grupo.

Introduction: Headache is a condition that impacts negatively the patients' quality of life. The medical course is a known generator of exhaustion and, according to the literature, stressors are more common in medical students (MS) than in the general population, which can trigger a headache. These stressors can be intensified in periods that precede the tests due to changes in sleep and in study habits, with a possible relation with the appearance of primary headache. Objective: To associate the presence of primary headache in MS during periods of tests and to relate to psychosocial factors. Methods: This is a cross-sectional study based on the application of two questionnaires to a sample of 219 MS from the 1st to the 8th semester of a university in Northeast Brazil. The first questionnaire related headache with psychosocial factors in periods of tests. The second questionnaire: HSQ-DV, was used for the diagnosis of migraine and tension-type headache (TTH). Results: 98% of MS reported having experienced headache. The prevalence of TTH and migraine was 61.9% and 18.1%, respectively, higher than the average for the general population. Students with migraine have more attacks before tests, self-medicate more, ingest more psychostimulants, are more anxious, more depressed, more sedentary, more stressed, and sleep less than those with TTH. Conclusion: In fact, MS are a risk group for the development of headache, thus deserving a greater emphasis of scientific research on primary headaches in this group

Evaluation of the signs and symptoms of temporomandibular disorders in children with headaches

PURPOSE: The purpose of this study was to evaluate the presence of signs and symptoms of temporomandibular disorders (TMD) in children with headaches in a neuropediatric ambulatory. METHOD: Fifty patients between 4 and 18 years of age were examined: 31 had headaches (24 migraine, 4 tension type and 3 unspecific headache) and 19 formed the control group. The data collection was comprised of a structured questionnaire answered by the children's parents, and a subjective evaluation about the childrenÆs emotional state. A specific questionnaire for TMD was applied, followed by a clinical dental examination of the children. As signs of TMD, mouth opening limitation, mandibular trajectory deviation in opening mouth, and joint noise were considered. As symptoms, pain on palpation of masseter and temporal muscles and on the poromandibular joint. RESULTS: A significant increase in signs and symptoms of TMD was found in patients with headaches when compared to the control group. There was also a significant difference in signs and symptoms of TMD according to age (increased with age) and emotional state (tense> calm). CONCLUSION: There is a higher frequency of TMD in pediatric patients with headaches; thus, it is important to look for TMD signs and symptoms in this population.

OBJETIVO: Avaliar a presença de sinais e sintomas de disfunção temporomandibular (DTM) em crianças com cefaléias em um ambulatório de neuropediatria. MÉTODO: Foram examinados 50 pacientes com idade entre 4 e 18 anos, 31 com cefaléias (24 com enxaqueca, 4 com cefaléia tensional e 3 com cefaléia inespecífica) e 19 do grupo controle. Os dados compreenderam um questionário estruturado respondido pelos pais e uma avaliação subjetiva sobre o estado emocional das crianças. Foi aplicado um questionário específico para DTM e realizado um exame clínico dental. Foram considerados como sinais de DTM: limitação da abertura bucal, desvio da trajetória ao abrir a boca e ruído articular. Quanto aos sintomas, foram considerados: dor à palpação dos músculos masseter e temporal e na articulação temporomandibular. RESULTADOS: Foi encontrado um aumento significante de sinais e sintomas de DTM em pacientes com cefaléias quando comparados com o grupo controle. Houve, também, uma diferença significante de sinais e sintomas de DTM de acordo com a idade (aumento com a idade) e estado emocional (tenso>calmo). CONCLUSÃO: Há maior freqüência de sinais e sintomas de DTM no grupo de pacientes pediátricos com cefaléias, sendo importante avaliar essa patologia nessa população.

Chronic daily headache: medications overuse and psychiatric morbidity

The objectives of the study were: [i] To assess the frequency of different chronic daily headaches in patients using ICHD-2 criteria [ii] To find out the frequency and type of medication overuse and psychiatric morbidity in chronic daily headache subjects. Cross sectional observational study. The study was conducted in the psychiatry outpatient department of a teaching medical institution during January to September 2005. Subjects suffering from chronic daily headache were recruited from a specialized headache clinic in a tertiary care hospital's Psychiatry department. The diagnoses were made according to ICHD-2. Medication overuse was defined according to ICHD-2 criteria and psychiatric illness was diagnosed following ICD-10 criteria in CDH patients. In subjects fulfilling the criteria for 'medication overuse', the culprit drug was stopped immediately and prophylactic therapy was started. Frequency of chronic daily headache was 37% in this sample. Females outnumbered males [1:1.52] and formed higher number of migraine cases [p=0.02]. Tension Type Headache [TTH] was most frequent headache [48.5%]. According to ICHD-2 criteria, probable medication overuse headache could be diagnosed in all patients, which precluded the diagnosis of chronic migraine and chronic TTH. Psychiatric morbidity was seen in 70.3% subjects and mild to moderate depression was the most common illness [53%]. TTH subjects showed predisposition for anxiety disorders [OR= 6.41; p= 0.004]. TTH is the most common subtype of CDH when ICHD-2 is followed. Medication overuse is common in this group of patients and these probably should be discontinued according to substance dependence de-addiction model for better compliance, and even more slowly in subjects with chronic migraine headache. Psychiatric morbidity is prevalent in CDH patients and requires special attention

[Study of relative distribution of depression and anxiety in suffering from migraine and Tension Type Headache and comparison with those who are not suffering from headache]

It has been proved that most of chronic headaches are accompanied with psychological and moral affairs. This study was aimed at evaluating the prevalence of depression and anxiety in patients having migraine and tension headaches and compared to similar people who are not suffering from headaches. This case- control study assessed one hundred and twenty five patients who were suffering from Migraine and tension headache by International Headache Societay [IHS] criteria that to Ishanan medical - training clinics and one hundred and twenty five control group have been studied in, terms of depression and anxiety. Beck Depression Inventory [BDI] and Catel Anxiety Inventory [CAI] were used in this study and the results have been analysed by chi-square, t-test statistical surveys using SPSS statistical software. The Moderate depression in case groups was 2.35 times of control group [P=0.001].Moderote Anxiety in case group was 2.67 time of control group [P=0.001],and sever anxiets was 207 times of control group [P=0.002]. In case group the rate of anxiety and depression was more noticeable [P<0001]. In regard to significant correlation between migraine and Tension Type Headache [TTH] with Anyiet and Depression evaluation of psychological aspect of these patients is necessary for quick treatment and avoids to chronicity of headache and reduce remedical costs

Effect of episodic tension-type headache on the health-related quality of life in employees of a Brazilian public hospital

OBJETIVO: Avaliar o Impacto de CTTE na QVRS em funcionários de um hospital brasileiro. MÉTODO: Trezentos e sessenta empregados do Hospital Mário Gatti, foram entrevistados. O questionário para avaliação da QVRS SF-36 foi aplicado e a ocorrência de cefaléia nos últimos seis meses foi avaliada. O impacto da dor nas atividades diárias, de lazer, sociais e eficiência no trabalho foi estimado(escala de zero a dez). RESULTADOS: Foram estudados dois grupos: 1. Cefaléia do tipo tensional episódica: 127 empregados - 81 (63,8%) mulheres e 46 (36,2%), homens. 2. Grupo Controle: 124 funcionários, 71 (57,3%) mulheres e 53 (42,7%) homens. As médias do grupo CTTE foram menores que as do grupo controle nos oito aspectos avaliados pelo SF-36. Nos aspectos vitalidade e dor a diferença foi estatisticamente significativa. CONCLUSÃO: os indivíduos com CTTE apresentaram pior QVRS, predominantemente no aspecto vitalidade. É possível que fatores psicológicos associados à dor possam explicar este achado.

A clinical study of chronic headaches: clinical characteristics and depressive trends in migraine & tension-type headaches

Chronic headache is commonly encountered in the neurology outpatient clinic and it is often associated with depression. In Korea, however, chronic headache has not yet been systematically investigated. We conducted this study to investigate this clinical characteristics and level of depression in patients who presented migraine, tension-type headache, or transformed migraine. METHOD: Among those with chronic headache during the period from January 1, 1994 through December 31, 1994, 131 patients were diagnosed to have either migraine, tension-type headache (by IHS classification), or transformed migraine: migraine in 60 patients, tension-type headache in 49 patients, and transformed migraine in 22 patients. Beck Depression Inventory (BDI) was performed in 116 of the 131 patients. RESULTS & CONCLUSION: There was no significant difference in the age of onset, duration of headache, and family history among the three groups. However, patients with migraine had a more severe, unilateral, and throbbing characteristic pain than those with a tension-type headache. The mean BDI scores in the transformed migraine and the tension-type headache patients were significantly higher than those of migraine, but the level of depression did not correlate with the patient's age, duration, character, severity, and frequency of headache. These findings suggest that migraine, tension-type headache and transformed migraine may be considered clinically distinct entities in viewing their different clinical characteristics and level of depression.