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Richard B. Lipton - One of the best experts on this subject based on the ideXlab platform.
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major life changes before and after the onset of Chronic Daily Headache a population based study
Cephalalgia, 2008Co-Authors: Ann I Scher, Walter F. Stewart, Dawn C Buse, D S Krantz, Richard B. LiptonAbstract:Chronic Daily Headache (CDH), when defined as ≥ 15 Headache days per month, affects 3-5% of the adult population. Major life changes are putative precipitating events for onset of Chronic pain, including Chronic Headache. This study compared the occurrence of specific life events between CDH cases and episodic Headache controls in a community sample. CDH cases (180+ Headache days per year: n = 206) and episodic Headache controls (2-104 Headache days per year: n = 507) were identified from a randomly selected adult US population. Subjects were interviewed about the occurrence of certain major life changes or events (change of residence, employment status, marital status, related to their children, deaths of relatives or close friends, and ‘extremely stressful’ ongoing situations) occurring in a defined time period. Events that occurred during the same year or year before frequent Headache onset in cases or in an equivalent time period in controls were considered to be antecedent events. Those that occurred...
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obesity and Chronic Daily Headache
Current Pain and Headache Reports, 2008Co-Authors: Marcelo E. Bigal, Richard B. LiptonAbstract:Obesity may be the greatest epidemic of modern times. It leads to diabetes and heart disease and shortens lifespan. Although not a risk factor for migraine, it is associated with an increased frequency and intensity of migraine. Obesity is also comorbid with Chronic Daily Headache and is a major risk factor for chronification of episodic migraine in adults and children. Although obesity is not a factor in the effectiveness of migraine treatment, it does increase the peripheral and central events in migraine, ultimately increasing the neurologic potential for migraine. Although evidence suggests that obesity is a modifiable risk factor for migraine progression, it is unknown if weight loss is related to decrease in Headache frequency. Recent surgical results suggest that this is true. We suggest all possible effective techniques aimed at weight loss be undertaken for migraineurs, especially obese migraineurs, and that carefully monitoring weight changes should be routinely done as part of their migraine care.
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head or neck injury increases the risk of Chronic Daily Headache a population based study
Neurology, 2007Co-Authors: JAY ROBERT COUCH, Richard B. Lipton, Walter F. Stewart, Ann I ScherAbstract:Objective: To evaluate the extent to which head and neck injury (HANI) contributes to Chronic Daily Headache (CDH). Background: In prospective studies, head injury is associated with Headache (HA) that remains a problem at 12 to 24 months post-head injury in 20 to 30% of patients. Of these, up to 30 to 50% manifest CDH. The degree to which head injury contributes to CDH has not been evaluated in a non-clinical population. We evaluate the relationship between lifetime occurrence of HANI and CDH in a randomly chosen population sample. Methods: Study participants are from the Frequent Headache Epidemiology Study. Cases with CDH (≥180 HA/year) and a comparison group with episodic Headache (EH, 2 to 102 HA/year) were identified from the general population. Subjects were asked about lifetime occurrence of HANI. HANI were further classified as potentially precipitating injuries (PPI) if they occurred within 2 years of CDH onset for cases or in an equivalent 2-year period for EH controls. Results: Lifetime occurrence of HANI was more frequent in cases than controls for men (adjusted OR = 3.1 [1.3 to 7.2]), women (OR = 1.5 [0.97 to 2.3]), and overall (OR = 1.7 [1.1 to 2.4]). The attributable risk was 15% (36% men, 11% women). Results were similar for PPI. The odds of CDH increased with the number of lifetime HANI in all groups (p Conclusions: Results suggest that head and neck injury (HANI) accounts for approximately 15% of Chronic Daily Headache (CDH) cases in this non-clinical population. The relationship between HANI and CDH was not limited to injuries proximate to CDH onset. The lifetime risk of CDH increases with increasing number of HANI.
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caffeine as a risk factor for Chronic Daily Headache a population based study
Neurology, 2004Co-Authors: Ann I Scher, Walter F. Stewart, Richard B. LiptonAbstract:Objective: To investigate the possible association of dietary caffeine consumption and medicinal caffeine use with Chronic Daily Headache (CDH). Methods: Population-based cases and controls were recruited from the Baltimore, MD, Philadelphia, PA, and Atlanta, GA, metropolitan areas. Controls (n = 507) reported 2 to104 Headache days/year, and cases (n = 206) reported ≥180 Headache days/year. Current and past dietary caffeine consumption and medication use for Headache were based on detailed self-report. High caffeine exposure was defined as being in the upper quartile of dietary consumption or using a caffeine-containing over-the-counter analgesic as the preferred Headache treatment. Results: In comparison with episodic Headache controls, CDH cases were more likely overall to have been high caffeine consumers before onset of CDH (odds ratio [OR] = 1.50, p = 0.05). No association was found for current caffeine consumption (i.e., post CDH) (OR = 1.36, p = 0.12). In secondary analyses, associations were confined to younger (age Conclusion: Dietary and medicinal caffeine consumption appears to be a modest risk factor for Chronic Daily Headache onset, regardless of Headache type.
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primary Chronic Daily Headache and its subtypes in adolescents and adults
Neurology, 2004Co-Authors: Marcelo E. Bigal, Richard B. Lipton, Alan M. Rapoport, Stewart J Tepper, Fred D SheftellAbstract:Objectives: To determine the relative frequency of Chronic Daily Headache (CDH) subtypes in adolescents and to compare the distribution of CDH subtypes in adolescents and adults of various ages. Methods: Adolescents (13 to 17 years, n = 170) and adults (18 or older, n = 638) were recruited during the same time frame. CDH subtypes were classified according the criteria proposed by Silberstein and Lipton (1996) as transformed migraine (TM), Chronic tension-type Headache (CTTH), new Daily persistent Headache (NDPH), and hemicrania continua (HC). Results: Among adolescents and adults there were substantial differences in the distribution of CDH subtypes. The relative frequency of TM was lower in adolescents (68.8% vs 87.4%, p p p p p p Conclusions: In adolescents with CDH, TM usually develops without medication overuse. Adolescents with the early onset form of TM may develop the disorder in the absence of medication overuse because they are at increased biologic risk.
Shuujiun Wang - One of the best experts on this subject based on the ideXlab platform.
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Chronic migraine and Chronic Daily Headache in the asia pacific region a systematic review
Cephalalgia, 2013Co-Authors: Richard J Stark, Shuujiun Wang, K Ravishankar, Hua Chiang Siow, Kwang Soo Lee, Rachael PepperleAbstract:Background:Data on the prevalence and characteristics of Chronic migraine (CM) and Chronic Daily Headache (CDH) in the Asia-Pacific region are limited.Methods:We performed a systematic review on th...
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Chronic Daily Headache in children and adolescents: a multi-faceted syndrome.
The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques, 2010Co-Authors: Shashi S. Seshia, Shuujiun Wang, Ishaq Abu-arafeh, Andrew D. Hershey, Vincenzo Guidetti, Paul Winner, Çiçek Wöber-bingölAbstract:Chronic Daily Headache (CDH) is a multi-faceted, often complex pain syndrome in children and adolescents. Chronic Daily Headache may be primary or secondary. Chronic migraine and Chronic tension-type are the most frequent subtypes. Chronic Daily Headache is co-morbid with adverse life events, anxiety and depressive disorders, possibly with other psychiatric disorders, other pain syndromes and sleep disorders; these conditions contribute to initiating and maintaining CDH. Hence, early management of episodic Headache and treatment of associated conditions are crucial to prevention. There is evidence for the benefit of psychological therapies, principally relaxation and cognitive behavioral, and promising information on acupuncture for CDH. Data on drug treatment are based primarily on open label studies. The controversies surrounding CDH are discussed and proposals for improvement presented. The multifaceted nature of CDH makes it a good candidate for a multi-axial classification system. Such an approach should facilitate biopsychosocial management and enhance consistency in clinical research.
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Chronic Daily Headache in adolescents an 8 year follow up study
Neurology, 2009Co-Authors: Shuujiun Wang, Jongling FuhAbstract:Objective: To assess the long-term outcome of a community-based adolescent cohort with Chronic Daily Headache (CDH). Methods: A field sample of 122 adolescents aged 12–14 years with CDH was established in 2000 (baseline) with short-term follow-up studies in 2001 and 2002. In 2008, the cohort was re-interviewed by physicians via telephone to determine the Headache profile for the past year, including Migraine Disability Assessment (MIDAS), a Headache disability questionnaire. Presence of CDH was defined as ≥15 Headache days/month, average ≥4 hours/day for >3 months. Outcome measures included Headache frequency, MIDAS score, and presence of CDH in 2008. Results: A total of 103 subjects (26 male/77 female, mean age 21.6 ± 0.9 years) completed the study (response rate 84.4%). The average monthly Headache frequency was 4.7 ± 6.0 (0–30) days. Twenty-eight (27.2%) subjects had moderate or severe Headache disability (MIDAS ≥11). Twelve (12%) subjects met CDH criteria, with Chronic migraine (n = 10, 83%) as the most common subtype. Two (2%) subjects overused medications. From 2000 to 2008, the frequencies of migraine diagnoses were fairly consistent in this cohort. Presence of migraine at baseline predicted poorer outcome of all 3 measures. Additionally, CDH onset Conclusions: This long-term follow-up study revealed a marked decline in the frequency of Chronic Daily Headache (CDH). However, one fourth of patients still had significant Headache disability. Migraine history was a major factor in evolution of CDH into young adulthood. Early onset and longer duration of CDH implied a protracted disease course.
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psychiatric comorbidity and suicide risk in adolescents with Chronic Daily Headache
Neurology, 2007Co-Authors: Shuujiun Wang, Kaidih Juang, Jongling FuhAbstract:OBJECTIVES: To investigate the prevalence and correlates of comorbid psychiatric disorders and suicidal risk in community-based adolescents with Chronic Daily Headache (CDH). METHODS: We identified and recruited 122 adolescents with CDH from a non-referral student sample (n = 7,900). CDH subtypes were classified according to the most updated criteria of the International Classification of Headache Disorders, 2nd edition (ICHD-2). An in-person psychiatric interview was performed with each subject with CDH to assess depressive and anxiety disorders and suicidal risk based on the Mini-International Neuropsychiatric Interview-Kid (MINI-Kid). Clinical correlates and impacts were investigated. RESULTS: A total of 121 subjects (31 male/90 female, mean age 13.8 years) finished the psychiatric interview. Fifty-seven subjects (47%) had > or =1 assessed psychiatric comorbidity with major depression (21%) and panic disorder (19%) as the two most common diagnoses. Current suicidal risk was assessed as high (score > or = 10) in 20% of subjects. Female gender and older age were associated with depressive disorders. Presence of migraine was associated with psychiatric comorbidities (OR = 3.5, p = 0.002). The associations with psychiatric disorders were stronger for migraine with aura than for migraine without aura. Migraine with aura also independently predicted a high suicidal risk (score > or = 10) (adjusted OR = 6.0, p = 0.028). In contrast, CDH subtypes, Headache frequencies, or medication overuse were not correlated. Comorbid psychiatric disorders were not related to physician consultations or more days of sick leave. CONCLUSIONS: This community-based study showed high comorbidity of psychiatric disorders and suicidal risk in adolescents with Chronic Daily Headache. The presence of migraine attacks, especially migraine with aura, was the major predictor for these associations. Language: en
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outcomes and predictors of Chronic Daily Headache in adolescents a 2 year longitudinal study
Neurology, 2007Co-Authors: Shuujiun Wang, Jongling Fuh, Kaidih JuangAbstract:Objectives: To assess the outcomes and predictors of Chronic Daily Headache (CDH) in a community-based cohort of adolescents. Methods: We established a field sample of 122 adolescents (32 M/90 F, ages 12 to 14) with CDH in 2000. These adolescents received annual follow-up by neurologists for 2 years via a semistructured telephone interview. CDH was defined as ≥15 Headache days/month, average ≥2 h/day for >3 months; subtypes were classified based on the original and appendix criteria of the International Classification of Headache Disorders (2nd ed.; ICHD-2). Poor outcome was defined as persistence of CDH at 2 years. Results: Follow-up response rates were 92% in 2001 and 84% in 2002. Average monthly Headache frequency was 11.0 ± 9.7 days in 2001 and 7.7 ± 6.5 days in 2002. CDH persistence rates were 40% in 2001 and 25% in 2002. Medication overuse declined from 20% (baseline) to 6% at 2 years. The prevalence of migraine did not change throughout the follow-up (67 to 60%), whereas that of tension-type Headache deceased from 86 to 46% ( p Conclusions: Most adolescents with Chronic Daily Headache (CDH) continued to have frequent Headaches, although the incidence of CDH declined at follow-up. Migraine diagnosis gained prominence as Headache frequency decreased. The percentages of Chronic migraine in adolescents with CDH increased obviously if the appendix criteria were applied.
Jongling Fuh - One of the best experts on this subject based on the ideXlab platform.
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Chronic Daily Headache in adolescents an 8 year follow up study
Neurology, 2009Co-Authors: Shuujiun Wang, Jongling FuhAbstract:Objective: To assess the long-term outcome of a community-based adolescent cohort with Chronic Daily Headache (CDH). Methods: A field sample of 122 adolescents aged 12–14 years with CDH was established in 2000 (baseline) with short-term follow-up studies in 2001 and 2002. In 2008, the cohort was re-interviewed by physicians via telephone to determine the Headache profile for the past year, including Migraine Disability Assessment (MIDAS), a Headache disability questionnaire. Presence of CDH was defined as ≥15 Headache days/month, average ≥4 hours/day for >3 months. Outcome measures included Headache frequency, MIDAS score, and presence of CDH in 2008. Results: A total of 103 subjects (26 male/77 female, mean age 21.6 ± 0.9 years) completed the study (response rate 84.4%). The average monthly Headache frequency was 4.7 ± 6.0 (0–30) days. Twenty-eight (27.2%) subjects had moderate or severe Headache disability (MIDAS ≥11). Twelve (12%) subjects met CDH criteria, with Chronic migraine (n = 10, 83%) as the most common subtype. Two (2%) subjects overused medications. From 2000 to 2008, the frequencies of migraine diagnoses were fairly consistent in this cohort. Presence of migraine at baseline predicted poorer outcome of all 3 measures. Additionally, CDH onset Conclusions: This long-term follow-up study revealed a marked decline in the frequency of Chronic Daily Headache (CDH). However, one fourth of patients still had significant Headache disability. Migraine history was a major factor in evolution of CDH into young adulthood. Early onset and longer duration of CDH implied a protracted disease course.
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psychiatric comorbidity and suicide risk in adolescents with Chronic Daily Headache
Neurology, 2007Co-Authors: Shuujiun Wang, Kaidih Juang, Jongling FuhAbstract:OBJECTIVES: To investigate the prevalence and correlates of comorbid psychiatric disorders and suicidal risk in community-based adolescents with Chronic Daily Headache (CDH). METHODS: We identified and recruited 122 adolescents with CDH from a non-referral student sample (n = 7,900). CDH subtypes were classified according to the most updated criteria of the International Classification of Headache Disorders, 2nd edition (ICHD-2). An in-person psychiatric interview was performed with each subject with CDH to assess depressive and anxiety disorders and suicidal risk based on the Mini-International Neuropsychiatric Interview-Kid (MINI-Kid). Clinical correlates and impacts were investigated. RESULTS: A total of 121 subjects (31 male/90 female, mean age 13.8 years) finished the psychiatric interview. Fifty-seven subjects (47%) had > or =1 assessed psychiatric comorbidity with major depression (21%) and panic disorder (19%) as the two most common diagnoses. Current suicidal risk was assessed as high (score > or = 10) in 20% of subjects. Female gender and older age were associated with depressive disorders. Presence of migraine was associated with psychiatric comorbidities (OR = 3.5, p = 0.002). The associations with psychiatric disorders were stronger for migraine with aura than for migraine without aura. Migraine with aura also independently predicted a high suicidal risk (score > or = 10) (adjusted OR = 6.0, p = 0.028). In contrast, CDH subtypes, Headache frequencies, or medication overuse were not correlated. Comorbid psychiatric disorders were not related to physician consultations or more days of sick leave. CONCLUSIONS: This community-based study showed high comorbidity of psychiatric disorders and suicidal risk in adolescents with Chronic Daily Headache. The presence of migraine attacks, especially migraine with aura, was the major predictor for these associations. Language: en
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outcomes and predictors of Chronic Daily Headache in adolescents a 2 year longitudinal study
Neurology, 2007Co-Authors: Shuujiun Wang, Jongling Fuh, Kaidih JuangAbstract:Objectives: To assess the outcomes and predictors of Chronic Daily Headache (CDH) in a community-based cohort of adolescents. Methods: We established a field sample of 122 adolescents (32 M/90 F, ages 12 to 14) with CDH in 2000. These adolescents received annual follow-up by neurologists for 2 years via a semistructured telephone interview. CDH was defined as ≥15 Headache days/month, average ≥2 h/day for >3 months; subtypes were classified based on the original and appendix criteria of the International Classification of Headache Disorders (2nd ed.; ICHD-2). Poor outcome was defined as persistence of CDH at 2 years. Results: Follow-up response rates were 92% in 2001 and 84% in 2002. Average monthly Headache frequency was 11.0 ± 9.7 days in 2001 and 7.7 ± 6.5 days in 2002. CDH persistence rates were 40% in 2001 and 25% in 2002. Medication overuse declined from 20% (baseline) to 6% at 2 years. The prevalence of migraine did not change throughout the follow-up (67 to 60%), whereas that of tension-type Headache deceased from 86 to 46% ( p Conclusions: Most adolescents with Chronic Daily Headache (CDH) continued to have frequent Headaches, although the incidence of CDH declined at follow-up. Migraine diagnosis gained prominence as Headache frequency decreased. The percentages of Chronic migraine in adolescents with CDH increased obviously if the appendix criteria were applied.
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Chronic Daily Headache in adolescents prevalence impact and medication overuse
Neurology, 2006Co-Authors: Shuujiun Wang, Jongling Fuh, Kaidih JuangAbstract:Objectives: To examine the prevalence, impact, and related medication use or overuse of primary Chronic Daily Headache (CDH) among adolescents in a field sample. Methods: The authors conducted a two-phase CDH survey of all students from ages 12 to 14 years in five selected middle schools in Taiwan. Subjects with CDH in the past year were identified and interviewed by neurologists. CDH was defined as Headache occurring at a frequency of 15 days/month or more, average of 2 hours/day or more, for more than 3 months, and its subtypes were classified on the basis of the International Classification of Headache Disorders , 2nd edition. Results: Of the 7,900 participants, 122 (1.5%) fulfilled the criteria for primary CDH in the past year. Girls had a higher prevalence (2.4%) than boys (0.8%) ( p Conclusions: Chronic Daily Headache (CDH) was common in a large nonreferred adolescent sample. Based on the International Classification of Headache Disorders , 2nd edition, criteria, Chronic tension-type Headache was the most common subtype; however, a majority of adolescents with CDH had Headaches with features of migraine.
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Chronic Daily Headache in taipei taiwan prevalence follow up and outcome predictors
Cephalalgia, 2001Co-Authors: Jongling Fuh, Kaidih Juang, Weita Chen, Shuujiun WangAbstract:We conducted a two-stage population-based Headache survey among subjects aged > or = 15 in Taipei, Taiwan. Subjects with Chronic Daily Headache (CDH) in the past year were identified, interviewed and followed-up. CDH was defined as a Headache frequency > 15 days/month, with a duration > 4 h/day. Of the 3377 participants, 108 (3.2%) fulfilled the criteria for CDH, with a higher prevalence in women (4.3%) than men (1.9%). TM was the most common subtype (55%), followed by CTTH (44%). Thirty-four per cent of the CDH subjects overused analgesics. At the 2-year follow-up, 35% of the CDH subjects still had CDH. The significant predictors for persistent CDH at follow-up included: older age ( > or = 40 years) (RR = 2.4), CDH onset after 32 years (RR = 1.8), CDH duration > or = 6 years (RR = 2.0), medication overuse (RR = 1.8), and "Daily" Headache (RR = 2.1). We found that CDH is not uncommon in the community and its prevalence is similar among different populations. Older subjects and those with medication overuse may have a more protracted course of illness.
Kaidih Juang - One of the best experts on this subject based on the ideXlab platform.
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psychiatric comorbidity and suicide risk in adolescents with Chronic Daily Headache
Neurology, 2007Co-Authors: Shuujiun Wang, Kaidih Juang, Jongling FuhAbstract:OBJECTIVES: To investigate the prevalence and correlates of comorbid psychiatric disorders and suicidal risk in community-based adolescents with Chronic Daily Headache (CDH). METHODS: We identified and recruited 122 adolescents with CDH from a non-referral student sample (n = 7,900). CDH subtypes were classified according to the most updated criteria of the International Classification of Headache Disorders, 2nd edition (ICHD-2). An in-person psychiatric interview was performed with each subject with CDH to assess depressive and anxiety disorders and suicidal risk based on the Mini-International Neuropsychiatric Interview-Kid (MINI-Kid). Clinical correlates and impacts were investigated. RESULTS: A total of 121 subjects (31 male/90 female, mean age 13.8 years) finished the psychiatric interview. Fifty-seven subjects (47%) had > or =1 assessed psychiatric comorbidity with major depression (21%) and panic disorder (19%) as the two most common diagnoses. Current suicidal risk was assessed as high (score > or = 10) in 20% of subjects. Female gender and older age were associated with depressive disorders. Presence of migraine was associated with psychiatric comorbidities (OR = 3.5, p = 0.002). The associations with psychiatric disorders were stronger for migraine with aura than for migraine without aura. Migraine with aura also independently predicted a high suicidal risk (score > or = 10) (adjusted OR = 6.0, p = 0.028). In contrast, CDH subtypes, Headache frequencies, or medication overuse were not correlated. Comorbid psychiatric disorders were not related to physician consultations or more days of sick leave. CONCLUSIONS: This community-based study showed high comorbidity of psychiatric disorders and suicidal risk in adolescents with Chronic Daily Headache. The presence of migraine attacks, especially migraine with aura, was the major predictor for these associations. Language: en
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outcomes and predictors of Chronic Daily Headache in adolescents a 2 year longitudinal study
Neurology, 2007Co-Authors: Shuujiun Wang, Jongling Fuh, Kaidih JuangAbstract:Objectives: To assess the outcomes and predictors of Chronic Daily Headache (CDH) in a community-based cohort of adolescents. Methods: We established a field sample of 122 adolescents (32 M/90 F, ages 12 to 14) with CDH in 2000. These adolescents received annual follow-up by neurologists for 2 years via a semistructured telephone interview. CDH was defined as ≥15 Headache days/month, average ≥2 h/day for >3 months; subtypes were classified based on the original and appendix criteria of the International Classification of Headache Disorders (2nd ed.; ICHD-2). Poor outcome was defined as persistence of CDH at 2 years. Results: Follow-up response rates were 92% in 2001 and 84% in 2002. Average monthly Headache frequency was 11.0 ± 9.7 days in 2001 and 7.7 ± 6.5 days in 2002. CDH persistence rates were 40% in 2001 and 25% in 2002. Medication overuse declined from 20% (baseline) to 6% at 2 years. The prevalence of migraine did not change throughout the follow-up (67 to 60%), whereas that of tension-type Headache deceased from 86 to 46% ( p Conclusions: Most adolescents with Chronic Daily Headache (CDH) continued to have frequent Headaches, although the incidence of CDH declined at follow-up. Migraine diagnosis gained prominence as Headache frequency decreased. The percentages of Chronic migraine in adolescents with CDH increased obviously if the appendix criteria were applied.
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Chronic Daily Headache in adolescents prevalence impact and medication overuse
Neurology, 2006Co-Authors: Shuujiun Wang, Jongling Fuh, Kaidih JuangAbstract:Objectives: To examine the prevalence, impact, and related medication use or overuse of primary Chronic Daily Headache (CDH) among adolescents in a field sample. Methods: The authors conducted a two-phase CDH survey of all students from ages 12 to 14 years in five selected middle schools in Taiwan. Subjects with CDH in the past year were identified and interviewed by neurologists. CDH was defined as Headache occurring at a frequency of 15 days/month or more, average of 2 hours/day or more, for more than 3 months, and its subtypes were classified on the basis of the International Classification of Headache Disorders , 2nd edition. Results: Of the 7,900 participants, 122 (1.5%) fulfilled the criteria for primary CDH in the past year. Girls had a higher prevalence (2.4%) than boys (0.8%) ( p Conclusions: Chronic Daily Headache (CDH) was common in a large nonreferred adolescent sample. Based on the International Classification of Headache Disorders , 2nd edition, criteria, Chronic tension-type Headache was the most common subtype; however, a majority of adolescents with CDH had Headaches with features of migraine.
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Chronic Daily Headache in taipei taiwan prevalence follow up and outcome predictors
Cephalalgia, 2001Co-Authors: Jongling Fuh, Kaidih Juang, Weita Chen, Shuujiun WangAbstract:We conducted a two-stage population-based Headache survey among subjects aged > or = 15 in Taipei, Taiwan. Subjects with Chronic Daily Headache (CDH) in the past year were identified, interviewed and followed-up. CDH was defined as a Headache frequency > 15 days/month, with a duration > 4 h/day. Of the 3377 participants, 108 (3.2%) fulfilled the criteria for CDH, with a higher prevalence in women (4.3%) than men (1.9%). TM was the most common subtype (55%), followed by CTTH (44%). Thirty-four per cent of the CDH subjects overused analgesics. At the 2-year follow-up, 35% of the CDH subjects still had CDH. The significant predictors for persistent CDH at follow-up included: older age ( > or = 40 years) (RR = 2.4), CDH onset after 32 years (RR = 1.8), CDH duration > or = 6 years (RR = 2.0), medication overuse (RR = 1.8), and "Daily" Headache (RR = 2.1). We found that CDH is not uncommon in the community and its prevalence is similar among different populations. Older subjects and those with medication overuse may have a more protracted course of illness.
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comorbidity of depressive and anxiety disorders in Chronic Daily Headache and its subtypes
Headache, 2000Co-Authors: Jongling Fuh, Kaidih Juang, Shuujiun WangAbstract:Objective.—To investigate the frequency of depressive and anxiety disorders in patients with Chronic Daily Headache. Background.—There is a lack of data in the literature on the extent of psychiatric comorbidity in patients with different subtypes of Chronic Daily Headache. Methods.—We recruited consecutive patients with Chronic Daily Headache seen in a Headache clinic from November 1998 to December 1999. The subtypes of Chronic Daily Headache were classified according to the criteria proposed by Silberstein et al. A psychiatrist evaluated the patients according to the structured Mini-International Neuropsychiatric Interview to assess the comorbidity of depressive and anxiety disorders. Results.—Two hundred sixty-one patients with Chronic Daily Headache were recruited. The mean age was 46 years, and 80% were women. Transformed migraine was diagnosed in 152 patients (58%) and Chronic tension-type Headache in 92 patients (35%). Seventy-eight percent of patients with transformed migraine had psychiatric comorbidity, including major depression (57%), dysthymia (11%), panic disorder (30%), and generalized anxiety disorder (8%). Sixty-four percent of patients with Chronic tension-type Headache had psychiatric diagnoses, including major depression (51%), dysthymia (8%), panic disorder (22%), and generalized anxiety disorder (1%). The frequency of anxiety disorders was significantly higher in patients with transformed migraine after controlling for age and sex (P = .02). Both depressive and anxiety disorders were significantly more frequent in women. Conclusion.—Psychiatric comorbidity, especially major depression and panic disorders, was highly prevalent in patients with Chronic Daily Headache seen in a Headache clinic. These results demonstrate that women and patients with transformed migraine are at higher risk of psychiatric comorbidity.
Stewart J Tepper - One of the best experts on this subject based on the ideXlab platform.
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primary Chronic Daily Headache and its subtypes in adolescents and adults
Neurology, 2004Co-Authors: Marcelo E. Bigal, Richard B. Lipton, Alan M. Rapoport, Stewart J Tepper, Fred D SheftellAbstract:Objectives: To determine the relative frequency of Chronic Daily Headache (CDH) subtypes in adolescents and to compare the distribution of CDH subtypes in adolescents and adults of various ages. Methods: Adolescents (13 to 17 years, n = 170) and adults (18 or older, n = 638) were recruited during the same time frame. CDH subtypes were classified according the criteria proposed by Silberstein and Lipton (1996) as transformed migraine (TM), Chronic tension-type Headache (CTTH), new Daily persistent Headache (NDPH), and hemicrania continua (HC). Results: Among adolescents and adults there were substantial differences in the distribution of CDH subtypes. The relative frequency of TM was lower in adolescents (68.8% vs 87.4%, p p p p p p Conclusions: In adolescents with CDH, TM usually develops without medication overuse. Adolescents with the early onset form of TM may develop the disorder in the absence of medication overuse because they are at increased biologic risk.
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Chronic Daily Headache in a tertiary care population correlation between the international Headache society diagnostic criteria and proposed revisions of criteria for Chronic Daily Headache
Cephalalgia, 2002Co-Authors: Marcelo E. Bigal, Fred D Sheftell, Richard B. Lipton, Alan M. Rapoport, Stewart J TepperAbstract:The International Headache Society (IHS) has been criticized for its approach to classification of Chronic Daily Headache (CDH); Silberstein and Lipton criteria provide an alternative to this approach. The aim of this study is to apply the alternative diagnostic approaches to a sample of CDH patients consulting in specialty care. Our sample consisted of 638 patients with CDH. Patients were classified according to both classification systems. Patients were predominantly female (65.0%), with ages ranging from 11 to 88 years. According to the Silberstein and Lipton classification, we found eight different diagnoses. The most common diagnosis was Chronic migraine (87.4%), followed by new Daily persistent Headache (10.8%). Just six patients had Chronic tension-type Headache (CTTH). Applying the IHS criteria we found 14 different diagnoses. Migraine was found in 576 (90.2%) patients. CTTH occurred in 621 (97.3%), with only 10 (1.57%) having this as the sole diagnosis. We conclude that both systems allow for the classification of most patients with CDH when Daily Headache diaries are available. The main difference is that the IHS classification is cumbersome and requires multiple diagnoses. The Silberstein and Lipton system is easier to apply, and more parsimonious. These findings support revision of the IHS classification system to include Chronic migraine.
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nefazodone for Chronic Daily Headache prophylaxis an open label study
Headache, 2001Co-Authors: Joel R Saper, Alvin E Lake, Stewart J TepperAbstract:Objective.—To assess effectiveness, tolerability, and safety of nefazodone as a prophylactic agent for Chronic Daily Headache. Background.—Nefazodone is a potent, selective 5-HT2 antagonist with a distinct and atypical mechanism of action. The evolution of intermittent migraine to Chronic Daily Headache has been linked to up-regulation of 5-HT2 receptors as well as other factors. Other effective migraine prophylactic medications are also 5-HT2 antagonists. Although research has shown nefazodone to be an effective antidepressant with a good tolerability and safety profile, its potential role in Headache prophylaxis has not been tested. Design.—This was a two-center, open-label study with a 4-week baseline, followed by 12 weeks of treatment with nefazodone at a median dose of 300 mg (mean, 303.66 ± 65.57 mg; range, 100 to 450 mg depending on tolerability). Potential patients were required to report more than 15 days of Headache per month for at least 3 months prior to screening. Only patients with at least 15 days of recorded Headache during baseline were included in the final sample (N=52). Most patients (n=48) had a history of migraine based on International Headache Society criteria; 4 had primarily Chronic tension-type Headache, but with more migrainous features than permitted by International Headache Society criteria for a primary Chronic tension-type Headache diagnosis. Results.—Significant improvement was demonstrated for all Headache diary measures, with significance levels ranging from P<.00001 for average intensity, duration, Headache index (intensity × duration), peak intensity, Headache days per week, and peak impairment, to P<.0033 for severe Headache days per week, and P<.0051 for rescue medication days. During the last month of treatment, 71% of the patients completing the study showed at least a 50% reduction in Headache index compared to baseline, and 59% had at least a 75% improvement. Visual analog scales completed at 4-week intervals showed significant improvement in patient ratings of overall Headache status, quality of life, sleep, mood (P<.00001), and sexual function (P<.00053). Significant improvements were also observed in the Pain Disability Index (P<.00007), Beck Depression Inventory-II (P<.00001), Hamilton Rating Scale for Depression (P<.0008), and Hamilton Psychiatric Rating Scale for Anxiety (P<.00007). Headache indices for patients in the top quartile on the depression and anxiety scales (clinical depression/anxiety) did not differ from the other patients during baseline. However, patients who were depressed or anxious showed significantly more improvement over the course of 12 weeks of treatment (P<.0006 or less for the depression scales, P<.026 for anxiety). Common mild to moderate adverse events reported by 10% or more of the patients included fatigue, nausea, dry mouth, dizziness, sleep disturbance, blurred vision, irritability/nervousness, and sedation. Only 5 of the 52 patients discontinued the study due to adverse events: Headache (2 patients), and nausea, sleep disturbance, and a drugged feeling (1 patient each). Conclusions.—These results provide preliminary support for the efficacy of nefazodone in the prophylaxis of Chronic Daily Headache. In this sample, nefazodone was safe and generally well tolerated. Patient ratings of sexual function improved over the course of treatment, in contrast to what is generally observed with most antidepressants. Nefazodone may be particularly beneficial for patients with Chronic Daily Headache and comorbid depression. Further research is indicated.