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I don't have this section very well developed. The migraine section is somewhat better. Blood Pressure Meds Cut Headaches 33%: In a meta-analysis the 94 DB studies of 2-14 weeks including 23,599 adults of thiazides, Fasting Headaches: Fasting is frequently mentioned by patients and in textbooks as a trigger for headache. In this study, we attempted to define the role of fasting as a possible precipitator of headache. Headache history was documented in 370 hospital employees (60% female) before and immediately after a 25-hour fast for the 1993 Day of Atonement (Yom Kippur). The population included 211 who fasted; 39% of fasters developed headache, compared with only 7% of nonfasters (p < 0.000001). Headache was usually of a nonpulsating quality, mild to moderate in intensity, and bilateral and frontal in location. Subjects with a history of headache were more likely to develop fasting-induced headache than were those without such history (66% vs. 29%, p < 0.000002). The number of headache sufferers increased in direct relation to the duration of the fast. Caffeine and nicotine withdrawal and oversleeping did not appear to have an influence on headache development. We conclude that fasting is a strong headache precipitator, especially among chronic headache sufferers. It is usually nonpulsating and nonlateralized. Neurology 1995 Nov;45(11):1953-5 Histamine Headache Diet: Histamine-induced food intolerance is not IgE-mediated. Skin-prick testing and specific IgE to food allergens are typically negative. Food rich in histamine or red wine may cause allergy-like symptoms such as sneezing, flush, skin itching, diarrhea and even shortness of breath. The suspected reason is a diminished histamine degradation based on a deficiency of diamine oxidase. As diamine oxidase cannot be supplemented, a histamine-free diet was implemented to reduce histamine intake. Forty-five patients with a history of suffering from intolerance to food or wine (n = 17) and chronic headache (n = 28) were put on the diet over months to years. Fish, cheese, hard cured sausages, pickled cabbage and alcoholic beverages had to be avoided. Complaint intensity and drug-use per week prior to and 4 weeks after a histamine-free diet were compared. After 4 weeks on the diet 33/45 patients improved considerably (P < 0.01), eight of them had total remission. In 12/45 patients, however, no changes in symptoms were observed. Symptoms of food or wine intolerance significantly decreased (P < 0.02; treatment of choice), headaches decreased in frequency (P < 0.001), duration and intensity. After eating histamine-rich food symptoms were reproducible and could be eliminated by anti-histamines in most patients. These data indicate the role of histamine in food and wine intolerance and that histamine-rich food causes a worsening of symptoms in patients suffering from chronic headaches. Results obtained support the hypothesis of a deficiency of diamine oxidase in patients with intolerance to food or wine. Clin Exp Allergy 1993 Dec;23(12):982-5 Snoring Linked to Doubling of Chronic Headaches: 206 people ages 18 to 65 with chronic daily headache (15/mo) for five years or less and 507 people with occasional headache (2-104/yr) were studied. Those with chronic headache had an average of 260 days with headaches per year. Those with occasional headache had an average of 24 headache days per year. NIA Ann Scher Neurology 4/22/03 Spontaneous Intracranial Hypotension (SIH) is often Misdiagnosed: Wouter I. Schievink, Cedars-Sinai, Archives of Neurology 12/03. An important cause of 'new daily persistent headaches. 18 consecutive patients with SIH were evaluated for definitive surgical treatment of spontaneous spinal cerebrospinal fluid (CSF) leak. The initial diagnosis was incorrect in 17 patients with a diagnostic delay ranging from four days to 13 years (median, five weeks). Migraine, meningitis, and psychogenic disorder were the most common misdiagnoses. Procedures performed for conditions mimicking SIH included cerebral arteriography in two patients, craniotomy for Chiari malformation in two patients and for evacuation of subdural hematoma in one patient, and brain biopsy in one patient. Management includes bed rest, oral hydration, caffeine, and steroids, with placement of one or more lumbar epidural blood patches, followed by directed epidural blood patch or percutaneous placement of fibrin glue if there is still no relief. If this fails, surgical patch is done. Arch Neurol. 2003;60:1713-1718; Cerebral spinal fluid leak due to dural dents or fragile arachnoid cysts, in the presence of a previously unrecognized condition such as connective tissue disorder, is the most likely cause. Headache, and particularly positional headache that worsens on upright posture, is the most common presenting symptom. MRI for diagnosis. Treatment Acupuncture No Better for Tension Headaches than Random Superficial Needling: Tension-type headache is a bilateral headache of a pressing or tightening quality without a known medical cause. It is episodic if it occurs on less than 15 days a month and as chronic if it occurs more often. A survey from the United States found a one year prevalence of 38% for episodic tension-type headache and 2% for chronic tension-type headache. In a 12-week DB PC study of 270 adults with tension headaches, the number of headaches decreased similarly for both the actually acupuncture 12-session treatments and the superficial needling at non-acupuncture sites control group vs. the waiting list control group (7.2 vs. 6.6 vs. 1.5). Acupuncture in patients with tension-type headache: randomised controlled trial. Dieter Melchart, et al. Technische Universitat Muenchen, Germany. BMJ 2005;331:376-382 (13 August). The authors noted that 3 previous sham controlled studies for no difference for acupunture, where as two others did find acupunture benefit. The authors note that acupunture is likely to have high placebo value due to it being exotic, complex, with doctor-patient contact, and a detailed ritual.Aspirin+Paracetamol+Caffeine Better than Individual Components: In a huge 1743-patient DB PC study, two tablets of the fixed combination of 250 mg acetylsalicylic acid (ASA) + 200 mg paracetamol + 50 mg caffeine did better than two tablets of 250 mg ASA + 200 mg paracetamol, two tablets of 500 mg ASA, two tablets of 500 mg paracetamol, two tablets of 50 mg caffeine, or placebo in patients who were used to treating their episodic tension-type headache or migraine attacks with non-prescription analgesics. For 'time to 50% pain relief', the fixed combination of ASA, paracetamol and caffeine was superior to the combination without caffeine (P = 0.0181), the mono-substances ASA (P = 0.0398), paracetamol (P = 0.0016), caffeine (P < 0.0001) and placebo (P < 0.0001). All active treatments except caffeine differed significantly (P < 0.0001) from placebo. The fixed combination of acetylsalicylic acid, paracetamol and caffeine is more effective than single substances and dual combination for the treatment of headache: a multicentre, randomized, double-blind, single-dose, placebo-controlled parallel group study. Diener H, et al. University of Essen, Germany. Cephalalgia. 2005 Oct;25(10):776-87. Botox Helps in DB: A 12-week DB PC study of 60 patients with chronic tension and chronic migraine headaches of 200 units of botox found considerable subjective benefit and 24 vs. 33 headache days. Improvement seemed cumulative with second open trial injection. Botulinum toxin A for chronic daily headache: a randomized, placebo-controlled, parallel design study. Ondo W, Vuong K, Derman H. Cephalalgia. 2004 Jan;24(1):60-65 Botox No Benefit for Chronic Tension Headaches: In a 12-week DB PC study of chronic tension-type headache chronic tension-type headache, botulinum toxin was not proven effective in treatment of chronic tension-type headache. Increased muscle tenderness might not be as important in pathophysiology of chronic tension-type headache as commonly believed. Padberg M, de Bruijn SFTM, de Haan RJ & Tavy DLJ. Treatment of chronic tension-type headache with botulinum toxin: a double-blind, placebo-controlled clinical trial. Cephalalgia. 2004 Aug;24(8):675-680 Mirtazepine Helps Chronic Headaches: In an 8-week, 24-patient DB PC crossover study, mirtazepine reduced headaches by 34%. Mirtazapine is effective in the prophylactic treatment of chronic tension-type headache. Bendtsen L, Jensen R. Neurology. 2004 May 25;62(10):1706-11. Ed: This decrease is very similar to the much less expensive amitriptyline. Sertraline Helps Tension HA: DB PC 50 pt India. Analgesic use decreased from 4.3 to 1.1 tabs/week with sertraline vs. 4 to 3 in placebo. Acceptable alternative to amitriptyline. J Assoc Physicians India 2002 Jul;50:873-8 Headache: 5-HTP Slight Help for Tension Headaches: In a 78-patient, 8-week DB PC study of 5-HTP 300 mg/day, there was no statistically significant change in the number of days with headache or in headache intensity in the group treated with 5-HTP. There was a significant decrease in the consumption of analgesics. During the 2 weeks after treatment, there was a significant decrease in the number of days with headache. Subjective opinion during this latter period was also favorable to 5-HTP. Five patients dropped out (1 with placebo and 4 with 5-HTP), 1 was excluded due to noncompliance, and in 7 treatment was suspended due to adverse events (3 with placebo and 4 with 5-HTP). L-5-Hydroxytryptophan in the prophylaxis of chronic tension-type headache: a double-blind, randomized, placebo-controlled study. For the Portuguese Head Society. Ribeiro CA., University of Coimbra, Portugal. Headache. 2000 Jun;40(6):451-6 |
blockers, angiotensin converting enzyme inhibitors, or angiotensin II receptor antagonists for hypertension, active treatment lowered systolic and diastolic blood pressures by 9.4 and 5.5 mm Hg compared to placebo. Those on the antihypertensive drugs were a third less likely to report headache than on placebo (8% v 12%; odds ratio 0.67, P < 0.001).