Daiva Rastenyte

The cost of headache disorders in Europe: the Eurolight project.

Background and purpose:u2002 Headache disorders are very common, but their monetary costs in Europe are unknown. We performed the first comprehensive estimation of how economic resources are lost to headache in Europe.

The impact of headache in Europe: principal results of the Eurolight project

BackgroundEuropean data, at least from Western Europe, are relatively good on migraine prevalence but less sound for tension-type headache (TTH) and medication-overuse headache (MOH). Evidence on impact of headache disorders is very limited. Eurolight was a data-gathering exercise primarily to inform health policy in the European Union (EU). This manuscript reports personal impact.MethodsThe study was cross-sectional with modified cluster sampling. Surveys were conducted by structured questionnaire, including diagnostic questions based on ICHD-II and various measures of impact, and are reported from Austria, France, Germany, Italy, Lithuania, Luxembourg, Netherlands, Spain and United Kingdom. Different methods of sampling were used in each. The full methodology is described elsewhere.ResultsQuestionnaires were analysed from 8,271 participants (58% female, mean age 43.4 y). Participation-rates, where calculable, varied from 10.6% to 58.8%. Moderate interest-bias was detected. Unadjusted lifetime prevalence of any headache was 91.3%. Gender-adjusted 1-year prevalences were: any headache 78.6%; migraine 35.3%; TTH 38.2%, headache on ≥15 d/mo 7.2%; probable MOH 3.1%. Personal impact was high, and included ictal symptom burden, interictal burden, cumulative burden and impact on others (partners and children). There was a general gradient of probable MOHu2009>u2009migraineu2009>u2009TTH, and most measures indicated higher impact among females. Lost useful time was substantial: 17.7% of males and 28.0% of females with migraine lost >10% of days; 44.7% of males and 53.7% of females with probable MOH lost >20%.ConclusionsThe common headache disorders have very high personal impact in the EU, with important implications for health policy.

Clinical Assessment of Noninvasive Intracranial Pressure Absolute Value Measurement Method

Objective: To assess prospectively the accuracy and precision of a method for noninvasive intracranial pressure (ICP) measurement compared with invasive gold standard CSF pressure measurement. Methods: Included were 62 neurologic patients (37 idiopathic intracranial hypertension, 20 multiple sclerosis, 1 Guillain-Barré syndrome, 1 polyneuropathy, and 3 hydrocephalus). The average age was 40 ± 12 years. All patients had lumbar puncture indicated as a diagnostic procedure. ICP was measured using a noninvasive ICP measurement method, which is based on a two-depth high-resolution transcranial Doppler insonation of the ophthalmic artery (OA). The OA is being used as a natural pair of scales, in which the intracranial segment of the OA is compressed by ICP and the extracranial segment of the OA is compressed by extracranial pressure (Pe) applied to the orbit. The blood flow parameters in both OA segments are approximately the same in the scales balance case when Pe = ICP. All patients had simultaneous recording of noninvasive ICP values and invasive gold standard CSF pressure values. Results: Analysis of the 72 simultaneous paired recordings of noninvasive ICP and the gold standard CSF pressure showed good accuracy for the noninvasive method as indicated by the low mean systematic error (0.12 mm Hg; confidence level [CL] 0.98). The method also showed high precision as indicated by the low SD of the paired recordings (2.19 mm Hg; CL 0.98). The method does not need calibration. Conclusion: The proposed noninvasive ICP measurement method is precise and accurate compared with gold standard CSF pressure measured via lumbar puncture.

Headache, depression and anxiety: associations in the Eurolight project

BackgroundHeadache disorders and psychiatric disorders are both common, while evidence, mostly pertaining to migraine, suggests they are comorbid more often than might be expected by chance. There are good reasons for establishing whether they are: symptoms of comorbid illnesses may summate synergistically; comorbidities hinder management, negatively influencing outcomes; high-level comorbidity indicates that, where one disease occurs, the other should be looked for. The Eurolight project gathered population-based data on these disorders from 6624 participants.MethodsEurolight was a cross-sectional survey sampling from the adult populations (18–65 years) of 10 EU countries. We used data from six. The questionnaire included headache-diagnostic questions based on ICHD-II, the Headache-Attributed Lost Time (HALT) questionnaire, and HADS for depression and anxiety. We estimated odds ratios (ORs) to show associations between migraine, tension-type headache (TTH) or probable medication-overuse headache (pMOH) and depression or anxiety.ResultspMOH was most strongly associated with both psychiatric disorders: for depression, ORs (vs no headache) were 5.5 [2.2–13.5] (pu2009<u20090.0001) in males, 5.5 [2.9–10.5] (pu2009<u20090.0001) in females; for anxiety, ORs were 10.4 [4.9–21.8] (pu2009<u20090.0001) and 7.1 [4.5–11.2] (pu2009<u20090.0001). Migraine was also associated with both: for depression, ORs were 2.1 [1.3–3.4] (pu2009=u20090.002) and 1.8 [1.1–3.1] (pu2009=u20090.030); for anxiety 4.2 [2.8–6.3] (pu2009<u20090.0001) and 2.4 [1.7–3.4] (pu2009<u20090.0001). TTH showed associations only with anxiety: ORs 2.5 [1.7–3.7] (pu2009<u20090.0001) for males, 1.5 [1.1–2.1] (pu2009=u20090.021) for females. Participants with migraine carried 19.1xa0% probability of comorbid anxiety, 6.9xa0% of depression and 5.1xa0% of both, higher than the representative general-population sample (14.3, 5.6 and 3.8xa0%). Probabilities in those with MOH were 38.8, 16.9 and 14.4xa0%; in TTH, they did not exceed those of the whole sample. Comorbid psychiatric disorder did not add to headache-attributed productive time losses, but weak associations existed (R2u2009=u20090.020–0.082) for all headache types between lost productive time and probabilities of depression and, less so, anxiety.ConclusionIn this large study we confirmed that depression and especially anxiety are comorbid more than by chance with migraine, and showed the same is true, but more strongly, with MOH. Arguably, migraine patients and, more certainly, MOH patients should be screened with HADS in pursuit of best outcomes.

Improved diagnostic value of a TCD-based non-invasive ICP measurement method compared with the sonographic ONSD method for detecting elevated intracranial pressure

Abstract Objectives: To compare the diagnostic reliability of optic nerve sheath diameter (ONSD) ultrasonography with a transcranial Doppler (TCD)-based absolute intracranial pressure (ICP) value measurement method for detection of elevated ICP in neurological patients. The ONSD method has been only tested previously on neurosurgical patients. Methods: A prospective clinical study of a non-invasive ICP estimation method based on ONSD correlation with ICP and an absolute ICP value measurement method based on a two-depth TCD technology has recruited 108 neurological patients. Ninety-two of these patients have been enrolled in the final analysis of the diagnostic reliability of ONSD ultrasonography and 85 patients using the absolute ICP value measurement method. All non-invasive ICP measurements were compared with ‘Gold Standard’ invasive cerebrospinal fluid (CSF) pressure measurements obtained by lumbar puncture. Receiver-operating characteristic (ROC) analysis has been used to investigate the diagnostic value of these two methods. Results: The diagnostic sensitivity, specificity, and the area under the ROC curve (AUC) of the ONSD method for detecting elevated intracranial pressure (ICP >14·7 mmHg) were calculated using a cutoff point of ONSD at 5·0 mm and found to be 37·0%, 58·5%, and 0·57, respectively. The diagnostic sensitivity, specificity, and AUC for the non-invasive absolute ICP measurement method were calculated at the same ICP cutoff point of 14·7 mmHg and were determined to be 68·0%, 84·3%, and 0·87, respectively. Conclusions: The non-invasive ICP measurement method based on two-depth TCD technology has a better diagnostic reliability on neurological patients than the ONSD method when expressed by the sensitivity and specificity for detecting elevated ICP >14·7 mmHg.

The Eurolight project: the impact of primary headache disorders in Europe. Description of methods

The Eurolight project is the first at European Union level to assess the impact of headache disorders, and also the first of its scale performed by collaboration between professional and lay organizations and individuals. Here are reported the methods developed for it. The project took the form of surveys, by structured questionnaire, conducted in ten countries of Europe which together represented 60% of the adult population of the European Union. In Lithuania, the survey was population-based. Elsewhere, truly population-based studies were impractical for reasons of cost, and various compromises were developed. Closest to being population-based were the surveys in Germany, Luxembourg, the Netherlands, Italy and Spain. In Austria, France and UK, samples were taken from health-care settings. In addition in the Netherlands, Spain and Ireland, samples were drawn from members of national headache patient organizations and their relatives. Independent double data-entry was performed prior to analysis. Returned questionnaires from 9,269 respondents showed a moderate female bias (58%); of respondents from patients’ organizations (nxa0=xa0992), 61% were female. Mean age of all respondents was 44xa0years; samples from patients’ organizations were slightly older (mean 47xa0years). The different sampling methods worked with differing degrees of effectiveness, as evidenced by the responder-rates, which varied from 10.8 to 90.7%. In the more population-based surveys, responder-rates varied from 11.3 to 58.8%. We conclude that the methodology, although with differences born of necessity in the ten countries, was sound overall, and will provide robust data on the public ill-health that results from headache in Europe.

Interictal burden attributable to episodic headache: findings from the Eurolight project.

BackgroundMost primary headaches are episodic, and most estimates of the heavy disability burden attributed to headache derive from epidemiological data focused on the episodic subtypes of migraine and tension-type headache (TTH). These disorders give rise directly but intermittently to symptom burden. Nevertheless, people with these disorders may not be symptom-free between attacks. We analysed the Eurolight dataset for interictal burden.MethodsEurolight was a cross-sectional survey using modified cluster sampling from the adult population (18–65 years) in 10 countries of the European Union. We used data from nine. The questionnaire included headache-diagnostic questions based on ICHD-II and several question sets addressing impact, including interictal and cumulative burdens.ResultsThere were 6455 participants with headache (male 2444 [37.9xa0%]). Interictal symptoms were reported by 26.0xa0% of those with migraine and 18.9xa0% with TTH: interictal anxiety by 10.6xa0% with migraine and avoidance (lifestyle compromise) by 14.8xa0%, both much more common than in TTH (3.1xa0% [OR 3.8] and 4.7xa0% [OR 3.5] respectively). Mean time spent in the interictal state was 317xa0days/year for migraine, 331xa0days/year for TTH. Those who were “rarely” or “never” in control of their headaches (migraine 15.2xa0%, TTH 9.6xa0%) had significantly raised odds of interictal anxiety, avoidance and other interictal symptoms. Among those with migraine, interictal anxiety increased markedly with headache intensity and frequency, avoidance less so but still significantly. Lost productive time was associated with high ORs (up to 5.3) of anxiety and avoidance.A third (32.9xa0%) with migraine and a quarter (26.7xa0%) with TTH (difference: pu2009<u20090.0001) were reluctant to tell others of their headaches. About 10xa0% with each disorder felt families and friends did not understand their headaches. Nearly 12xa0% with migraine reported their employers and colleagues did not.Regarding cumulative burden, 11.8xa0% reported they had done less well in education because of headache, 5.9xa0% reported reduced earnings and 7.4xa0% that their careers had suffered.ConclusionsInterictal burden in those with episodic headache is common, more so in migraine than TTH. Some elements have the potential to be profoundly consequential. New methodology is needed to measure interictal burden if descriptions of headache burden are to be complete.

The importance of HLA DRB1 gene allele to clinical features and disability in patients with multiple sclerosis in Lithuania

BackgroundThe association of HLA DRB1 alleles with susceptibility to multiple sclerosis (MS) has been consistently reported although its effect on the clinical features and disability is still unclear probably due to diversity in ethnicity and geographic location of the studied populations. The aim of the present study was to investigate the influence of HLA DRB1 alleles on the clinical features and disability of the patients with MS in Lithuania.MethodsThis was a prospective study of 120 patients with MS. HLA DRB1 alleles were genotyped using the polymerase chain reaction.ResultsThe first symptoms of MS in patients with HLA DRB1*15 allele manifested at younger age than in those without this allele (28.32 +/− 5.49 yrs vs. 30.94 +/− 8.43 yrs, respectively, pu2009=u20090.043). HLA DRB1*08 allele was more prevalent among relapsing-remitting (RR) MS patients than among patients with progressive course of MS (25.0% vs. 8.3%, respectively, chi^2u2009=u20096.000, pu2009=u20090.05). MS patients with this allele had lower relapse rate than those without this allele (1.00 +/− 0.97 and 1.44 +/− 0.85, respectively, pu2009=u20090.043). Degree of disability during the last visit was lower among the patients with HLA DRB1*08 allele (EDSS score 3.15 +/− 1.95 vs. 4.49 +/− 1.96, pu2009=u20090.006), and higher among those with HLA DRB1*15 allele (EDSS score 4.60 +/− 2.10 vs.4.05 +/− 1.94, pu2009=u20090.047) compared to patients without these alleles but there were no significant associations between these alleles and the duration of the disease to disability. HLA DRB1*08 allele (ORu2009=u20090.18, 95% CI 0,039-0,8, pu2009=u20090.029) was demonstradet to be independent factor to take a longer time to reach an EDSS of 6, while HLA DRB1*01 allele (ORu2009=u20095.92, 95% CI 1,30-26,8, pu2009=u20090.021) was related in a shorter time to reach and EDSS of 6. Patients with HLA DRB1*08 allele had lower IgG index compared to patients without this allele (0.58 +/− 0.17 and 0.73 +/− 0.31, respectively, pu2009=u20090.04), and HLA DRB1*15 allele was more often found among MS patients with oligoclonal bands (OCBs) in cerebrospinal fluid than among those without OCBs (OR 2.3, CI 95% 1.017-5.301; pu2009=u20090.043).ConclusionsHLA DRB1*15 allele was related with an earlier manifestation of the first MS symptoms, progressive course of the disease and higher degree of disability. HLA DRB1*08 allele was more prevalent among the RR MS patients and was associated with the lower rate of relapse, degree of disability and IgG index.

Diverging trends in the incidence and mortality of stroke during the period 1986—2002: A study from the Stroke register in Kaunas, Lithuania

Aims: The aim of the present study was to explore the longitudinal stroke trends in the middle-aged Lithuanian population. Methods: All stroke events in the studied population were ascertained and validated according to the standardized criteria outlined by the WHO MONICA Project. The study included all patients aged 25 to 64 years who experienced a stroke between 1986 and 2002. Results: A flat trend was observed in both the incidence and the attack rates of stroke among men during the 17-year study period, while among women, the incidence of stroke increased by 1.7%/year, and the attack rates by 2.3%/year. The 28-day case fatality and mortality rates of stroke decreased significantly in both sexes. The decline in case fatality explained 100% of the decline in mortality. Among the types of stroke, cerebral infarction contributed most to the decline in the mortality in men. In women, the mortality from cerebral infarction and intracerebral haemorrhage declined similarly to that from all types of strokes. Conclusions: Findings from our study indicating no positive changes in the incidence of stroke but instead an increase among middle-aged women in Kaunas are disturbing. These results suggest a need for the intensification of appropriate strategies for stroke prevention by the public health officials in Lithuania.

Headache yesterday in Europe

BackgroundSurveys enquiring about burden of headache over a prior period of time (eg, 3xa0months) are subject to recall bias. To eliminate this as far as possible, we focused on presence and impact of headache on the preceding day (“headache yesterday”).MethodsAdults (18-65 years) were surveyed from the general populations of Germany, Italy, Lithuania, Luxembourg and the Netherlands, from a work-force population in Spain and from mostly non-headache patient populations of Austria, France and UK. A study of non-responders in some countries allowed detection of potential participation bias where initial participation rates were low.ResultsParticipation rates varied between 11% and 59% (mean 27%). Non-responder studies suggested that, because of participation bias, headache prevalence might be overestimated in initial responders by up to 2% (absolute). Across all countries, 1,422 of 8,271 participants (15-17%, depending on correction for participation bias) had headache yesterday lasting on average for 6xa0hours. It was bad or very bad in 56% of cases and caused absence from work or school in 6%. Among those who worked despite headache, 20% reported productivity reduced by >50%. Social activities were lost by 24%. Women (21%) were more likely than men (12%) to have headache yesterday, but impact was similar in the two genders.ConclusionsWith recall biases avoided, our findings indicate that headache costs at least 0.7% of working capacity in Europe. This calculation takes into account that most of those who missed work could make up for this later, which, however, means that leisure and social activities are even more influenced by headache.