Ksenija Willheim

Migraine and tension-type headache in Croatia : A population-based survey of precipitating factors

The careful monitoring of the trigger factors of headache could be an important step in treatment, because their avoidance may lessen the frequency and severity of attacks. Furthermore, they may provide a clue to the aetiology of headache. The aim of the present study was to estimate the prevalence of tension-type headache (TTH) and to establish the frequency of precipitating factors in subjects with migraine and TTH in the adult population of Bakar, County of the Coast and Gorski Kotar, Croatia. Another important purpose of the study was to examine the relationship of the precipitating factors with migraine and TTH, and with migraine subtypes: migraine with aura (MA) and migraine without aura (MO). We performed a population-based survey using a ‘face-to-face door-to-door’ interview method. The surveyed population consisted of 5173 residents aged between 15 and 65 years. The 3794 participants (73.3%) were screened for headache history according to the International Headache Society (IHS) criteria. Headache screen-positive responders, 2475 (65.2%), were interviewed by trained medical students with a structured detailed interview focused on the precipitating factors. The following precipitating factors in lifetime migraineurs and tension-type headachers have been assessed: stress, sleep disturbances, eating habits, menstrual cycle, oral contraceptives, food items, afferent stimulation, changes in weather conditions and temperature, frequent travelling and physical activity. A total of 720 lifetime migraineurs and 1319 tension-type headachers have been identified. The most common precipitants for both migraine and TTH were stress and frequent travelling. Stress (odds ratio (OR) 1.4, 95% confidence interval (CI) 1.17, 1.69) was associated with migraine, whereas physical activity (OR 0.72, 95% CI 0.59, 0.87) was related to TTH. Considering MA and MO, frequent travelling (OR 2.2, 95% CI 1.59, 2.99), food items (OR 2.2, 95% CI 1.35, 3.51) and changes in weather conditions and temperature (OR 1.75, 95% CI 1.27, 2.41) exhibited a significant positive association with MA. The present study demonstrated that precipitant-dependent attacks are frequent among both migraineurs and tensiontype headachers. Lifetime migraineurs experienced headache attacks preceded by triggering factors more frequently than tension-type headachers. MA was more frequently associated with precipitating factors than MO. We suggest that some triggering factors may contribute to the higher occurrence of precipitant-dependent headache attacks in susceptible individuals.

Prevalence of migraine in Croatia: a population-based survey.

Objectives.—The aim of the present study was to estimate the prevalence of migraine among Croatian adults. This is the first epidemiological study of migraine in Croatia in which the operational diagnostic criteria of the International Headache Society have been applied.

Incidence and Prevalence of Myasthenia gravis in the County of the Coast and Gorski kotar, Croatia, 1976 through 19961

For the period 1976 through 1996, we carried out an incidence and prevalence study of myasthenia gravis in the County of the Coast and Gorski kotar, Croatia. This was the first epidemiological study of myasthenia gravis in Croatia. A total of 43 incident cases were identified. Overall the average crude annual incidence rate was 6.52 per 1,000,000 person-years; 5.59 per 1,000,000 person-years for men and 7.41 per 1,000,000 person-years for women. The incidence rate was 6.30 (95% confidence intervals 4.56–8.51), age-adjusted to the European population and 5.17 (95% confidence intervals 3.74–6.98), age-adjusted to the world population. On 31 December 1996, there were 32 prevalent cases. The crude prevalence was 99 per 1,000,000 population (95% confidence intervals 67.7–139.6). The prevalence adjusted to the European and world populations was 101.9 (95% confidence intervals 69.7–143.7) and 75.9 (95% confidence intervals 51.9–107) per 1,000,000 population, respectively. Our incidence findings are similar to those reported in North-East Italy but lower than those in the United States. Our prevalence findings were generally higher than those in Northern European Countries but lower than those in the United States. Standardization of rates to the European or world population could facilitate comparison between different populations.

Epidemiology of primary central nervous system tumors in the Coast and Gorski Kotar County, Croatia, 1977-2000

Aim and Background To establish the incidence of primary tumors of the central nervous system (CNS) in the resident population of the Coast and Gorski Kotar County, Croatia, in the period 1977-2000. Methods A retrospective descriptive epidemiological study. Tumors were classified according to the World Health Organizations scheme. A total of 911 cases was identified. Information about patient gender and age at diagnosis, tumor location and histologic type was obtained from case histories, autopsy protocols and pathology reports. Age- and sex-adjusted incidence were determined by a direct standardization method. Results Histologic confirmation was obtained in 84.5% of cases. The most frequent tumors were glioblastoma in men (30.2%) and meningioma in women (29.5%). The average annual crude and world-standardized incidence was 11.2 (95% CI, 10.1-12.3) and 8.2/100,000/year (95% CI, 7.4-9.0), respectively. The highest specific age incidence was detected in the seventh decade of life, 24.7/100,000/year (95% CI, 21.4-28.8). The tumors occurred equally in each sex. The lowest incidence was detected on the islands, 7.4/100,000/year (95% CI, 5.9-9.2) and the highest along the coast, 12.7/100,000/year (95% CI, 11.4-14.0). The survey showed the highest incidence of these neoplasms in the coastal municipality of Senj, 14.7/100,000/year (95% CI, 10.3-20.5). Conclusion The descriptive epidemiological incidence of primary CNS tumors in the Coast and Gorski Kotar County, Croatia, especially those of neuroepithelial and meningeal origin, correspond to the data reported in similar studies elsewhere in the world. The incidence of these neoplasms in the area investigated is uneven. Limitations in study design preclude definitive conclusions about the causes of these differences.

Incidence and prevalence of motor neuron disease in Coastal and Mountainous Regions, Croatia, 1984–1993. A preliminary survey

In the period 1984–1993, we carried out an incidence and prevalence study of motor neuron disease in Coastal and Mountainous Regions, Croatia. This was the first epidemiological study on motor neuron disease in Croatia. A total of 22 incident cases were identified. The crude annual incidence rate was 0.68 (95% confidence interval 0.43‐1.03) per 100,000 person‐years; 0.95 (95% confidence interval 0.60‐1.43) per 100,000 person‐years for men and 0.42 (95% confidence interval 0.26‐0.63) per 100,000 person‐years for women. The rate adjusted to the European population was 0.63 (95% confidence interval 0.39‐0.95) per 100,000 person‐years. The age‐adjusted incidence in our population is similar to the rates, standardized to the European population, observed in Italy, but lower than recent rates in the US and northern European studies. On 31st December 1993, there were 18 prevalent cases. The prevalence adjusted to the European population was 5.24 (95% confidence interval 3.10‐8.28) per 100,000 population.