Karin Zebenholzer

Migraine and weather: A prospective diary-based analysis

Aims: Weather is mentioned as a trigger factor by migraine patients most frequently. We examined the impact of meteorological factors and the impact of their day-to-day change on the risk of occurrence and persistence of headache and migraine and the correlation of subjective weather perception with objective weather data. Methods: We performed a prospective, diary-based cohort study in 238 patients suffering from migraine with or without aura. Patients had to live within 25 km of the Vienna meteorological station and were required to keep a diary for 90 days. We analysed 11 meteorological parameters and 17 synoptic weather situations. For evaluating the hazard of occurrence and persistence of migraine and headache, we performed a univariate and a stepwise multivariate Cox regression analysis. We calculated correlations between subjective weather perception and meteorological data. Results: In the uni- and multivariate analysis, a ridge of high pressure increased the risk of headache occurrence, lower mean daily wind speed increased the risk of migraine occurrence and a day-to-day change of daily sunshine duration increased the risk of migraine occurrence. A day-to-day change of the daily minimum temperature decreased the risk of migraine persistence. After correction for multiple testing, none of these findings remained statistically significant. Subjective weather perceptions did not correlate with the occurrence or persistence of migraine or headache. Subjective perception of cold and too-cold weather and of too-warm weather correlated with daily minimum, mean and maximum temperature. Conclusion: The influence of weather factors on migraine and headache is small and questionable.

Facial Pain and the Second Edition of the International Classification of Headache Disorders

Background.—Recurrent or chronic facial pain may be a diagnostic challenge. Applying the diagnostic criteria of the second edition of the International Classification of Headache Disorders (ICHD‐II) leaves a considerable number of patients unclassifiable.

Posturographic findings in patients with idiopathic cervical dystonia before and after local injections with botulinum toxin.

In this posturographic study, whole-body postural control was impaired in more than 75% of patients with idiopathic cervical dystonia (ICD) before local injections with botulinum toxin type A (BTX-A) and the impairment was independent of the direction of the torticollis. Six weeks after therapy with BTX-A, the number of pathological posturographic parameters had decreased by almost 30%, and the improvement reached statistical significance for sway path, sway area and anteroposterior sway during stance on foam with eyes closed. From a pathophysiological point of view, this improvement may be explained – at least in part – by a reduction of abnormal proprioceptive input from the neck. Accordingly, it seems possible that neck proprioceptive input plays a role in whole-body postural control in ICD patients, even though previous studies suggested that the neck input is relatively ignored in these patients.

Quality of Life, Depression, and Anxiety 6 Months After Inpatient Withdrawal in Patients With Medication Overuse Headache: An Observational Study

Objectives:Patients with medication overuse headache (MOH) experience decreased quality of life (QoL) and increased psychiatric comorbidity. We performed an observational study in patients with MOH to assess whether QoL (primary outcome parameter), depression, and anxiety (secondary outcome parameters) improve after inpatient withdrawal therapy. Methods:Forty-two patients undergoing the usual regimen established for inpatient withdrawal therapy at our department completed a structured questionnaires (the Short Form-36 health survey, Self-Rating Depression Scale, and Self-Rating Anxiety Scale) immediately before inpatient withdrawal. Six months after withdrawal, they were examined again with the same questionnaires. Results:Thirty-two patients (27 female) aged 46.8±9.4 years could be interviewed twice. At baseline, QoL was decreased compared with normative data (z-scores ranging from −1.2 to −2.0). Depression was present in 65.6% and anxiety disorder in 71.9% of the patients. At follow-up, physical QoL (P<0.001) and mental QoL (P=0.019) had improved, but QoL was still impaired (z-scores ranging from −0.3 to −1.3). Depression and anxiety scores had decreased significantly. Poor mental QoL and high scores of depression and anxiety at baseline correlated with frequent headaches at follow-up (P=0.013, P=0.024, and P=0.008, respectively). Discussion:QoL is impaired in patients with MOH, and many patients are depressed and anxious. Inpatient withdrawal therapy lead to a statistically significant improvement of QoL, depression, and anxiety. Poor baseline mental QoL as well as depression and anxiety are associated with poor outcome in terms of headache frequency.

Replication study of multiple sclerosis (MS) susceptibility alleles and correlation of DNA-variants with disease features in a cohort of Austrian MS patients

We performed a replication study in 883 Austrian multiple sclerosis (MS) patients and 972 control individuals for 25 previously risk-associated loci (39 SNPs). Two loci, rs1109670 (DDEF2/MBOAT2, p < 0.02) and rs16914086 (TBC1D2, p < 0.05), are replicated here for the first time. Furthermore, we tested all 39 SNPs for association with age at disease onset and measures of disease severity. We observed a trend for association of rs3135388 (HLA-DRB1*1501, p < 0.01), rs7090530 (IL2RA, p < 0.026) and rs1841770 (ZIC1, p < 0.017) with a younger age at MS onset and of rs12044852 (CD58, p < 0.035) with shorter time to reach EDSS6.

Reliability of assessing lifestyle and trigger factors in patients with migraine--findings from the PAMINA study.

Numerous lifestyle factors are blamed for triggering migraine attacks. The reliability of assessing these factors retrospectively is unknown. Therefore, retrospective and prospective assessments of lifestyle in general and of migraine triggers in particular were compared in patients with migraine.

A neuropsychological rehabilitation program for patients with Multiple Sclerosis based on the model of the ICF

BACKGROUND Forty to sixty percent of MS patients suffer from cognitive impairments. Cognitive deficits are a great burden for patients affected. In particular they may lead to a reduced quality of life, loss of work and problems with the social environment. OBJECTIVE The aim of this study was to evaluate a specific neuropsychological rehabilitation program for MS patients according to the ICF to be able to meet more properly individual requirements on the therapy level of function as well as of activities and participation. METHODS Forty patients with MS were randomised in an intervention (IG) - and a control group (CG). The outcome measure of the IG, who started an intensive computer based home training of attention and attended psychological counselling was compared to the untrained CG. RESULTS In specific domains of attention (simple and cued alertness and divided attention) significant group differences between CG and IG could be found. The IG reported an improvement of mental fatigue and retardation. CONCLUSION These findings support the idea that a neuropsychological rehabilitation program, which based on the model of ICF, could improve cognitive impairment and could also have a positive influence of activities and participation.

Accurate Diagnosis of Facial Pain: Reply from the Authors

Dear Sir We read with interest the timely article published by Zebenholzer et al. (1). Their findings should alert us all to the need for further study regarding the diagnosis and classification of facial pain. Applying the most recent classification of the International Headache Society (IHS) (2) to the 97 patients studied they found that about 21% were diagnosed with persistent idiopathic facial pain and about 29% were unclassifiable. As a tertiary pain centre the patients such as those reported (1) are usually complex, whilst it is reasonable to assume that straightforward cases such as temporomandibular disorders (TMD) are commonly diagnosed and treated efficiently at primary care centres. However, the finding that 50% of cases are essentially labelled as idiopathic or undiagnosable (1) according to IHS criteria is disturbing. In the 20– 30 years that we have been involved in the care of chronic orofacial pain patients we have similar (3, 4) although largely unpublished observations. We have persistently applied the IHS classifications for both research and clinical activities but have found these insufficient in orofacial pain patients, particularly those with TMDs or with facial pain accompanied by atypical features. For example, clinical differences between tension-type headache (TTH) and regional masticatory muscle myofascial pain (MMP) justify separate classification. MMP is viewed by orofacial pain specialists as a primary facial pain (5), not secondary to temporomandibular joint disease (6, 7), and has been shown to be largely unrelated to muscle hyperactivity (8). Although MMP may share pathophysiological mechanisms with TTH, it seems to be a distinct entity justifying separate classification (7). In such cases we are forced to rely on alternative classifications that detail orofacial pain syndromes, most recently the classification published by the American Academy of Orofacial Pain (5), conveniently modelled on the IHS classification. Analysing the cases presented by Zebenholzer et al. (1), one could argue that in cases with pain beginning after surgery accompanied by sensory deficit, a diagnosis of post-traumatic neuropathic pain may reasonably be applied (5, 9). Similarly, a patient with long-lasting paroxysmal pain accompanied by autonomic signs could be suffering from vascular orofacial pain (3) or a trigeminal autonomic cephalgia (TAC) variant, i.e. probable TAC (2). However, the aim of this letter is not to criticize the diagnoses presented in this excellent publication, rather to utilize its findings as a platform to encourage the IHS to cooperate more extensively with orofacial pain specialties so as to expand its classification of orofacial pain syndromes. This will no doubt expand our abilities to diagnose such pain entities accurately and limit inconclusive diagnoses such as idiopathic persistent facial pain and atypical facial pain.

Migräne und Schlaganfall

Immer wieder wurde ein moglicher Zusammenhang zwischen Migrane und Schlaganfall postuliert und versucht zu erforschen, ob das Vorliegen einer Migrane ein unabhangiger oder additiver Risikofaktor fur einen ischamischen Infarkt ist, ob Migrane einen ischamischen Infarkt auslosen beziehungsweise ob Migrane durch einen Infarkt induziert werden kann.