Diagnosis of migraine: empirical analysis of a large clinical sample of atypical migraine (IHS 1.7) patients and proposed revision of the IHS criteria.

The International Headache Society (IHS) diagnostic criteria for headache improved the accuracy of primary headache diagnoses, including migraine. However, many migraineurs receive an 'atypical migraine' diagnosis according to the IHS nosology (IHS 1.7), indicating that they approximate but do not fully meet all IHS criteria. This study characterized and sub-classified patients with atypical migraine. Within a clinical sample of 382 headache sufferers, 83 patients met IHS criteria for 'atypical migraine'. Patients receiving the IHS 1.7 designation did not converge to form a homogeneous group. Rather, distinct and clinically relevant subgroups were empirically derived (e.g. migraine with atypical pain parameters, brief migraine, chronic migraine). The results call for revisions of the IHS diagnostic criteria for migraine that would minimize the number of patients receiving an atypical diagnosis. Revisions would include decreasing the minimum headache duration criteria from 4 h to 2 h, and developing a classification for 'chronic migraine' for migraine greater than 15 days per month. The proposed revision provides a means of diagnosing the daily and near-daily headache commonly observed in clinical populations.

Treatment of obstructive sleep apnea in pediatric patients. Behavioral intervention for compliance with nasal continuous positive airway pressure.

This study evaluated the efficacy of behavioral techniques (i.e., parent training, modeling, and desensitization) to facilitate use of nasal continuous positive airway pressure (CPAP) in four children with obstructive sleep apnea (OSA) secondary to anatomic disorder of the upper airway. All patients tolerated CPAP with training: Polysomnographic data revealed improvement in sleep architecture, apnea, and oxygenation, and patients were discharged on CPAP units. All patients continued to use CPAP throughout the 3-month follow-up period and none required additional treatment for OSA. Three of four patients continued to use CPAP at the 9-month follow-up visit. Treatment resulted in improvements in alertness, attention/concentration, and behavior/temperament. Children generally have been considered poor candidates for nasal CPAP, and historically they have been offered instead more invasive procedures. This study suggests that CPAP is a viable treatment for such children when paired with behavioral interventions that facilitate its use.

Development of a computer application for headache diagnosis: the Headache Diagnostic System.

A computer-assisted decision support system for headache classification and diagnosis is presented. The system provides: structured headache data collection, automated data quality control and management, and automated headache classification. The system is based upon headache classification and diagnostic criteria recently developed by the International Headache Society. Development, logical structure and validation of the system are discussed. The system is shown to provide a general improvement in headache classification reliability and has utility for validation and improvement of present headache classification criteria.

Group cognitive and contextual therapies in treatment of depression.

Depressed subjects (N = 31) were treated with three different group therapies: (a) complete cognitive therapy (CCT); (b) partial cognitive therapy (PCT); or (c) comprehensive distancing (CD). All three groups showed significant, but equivalent, reductions in depression over 12 weeks of treatment and 2-month follow-up. However, significant reductions in dysfunctional attitudes obtained for CCT and PCT were not found for CD, which suggests different underlying therapeutic processes. Comparisons with other studies noted no differences in the efficacy of CT as a function of treatment format, but a trend toward reduced effectiveness for group vs. individual CD. Suggestions for further research in CT and CD are presented.