Martha S. Linet

Migraine headaches and panic attacks

&NA; Migraine headache and panic attacks are two common conditions which first occur at an early age and appear to have a number of underlying physiologic abnormalities in common. In a population‐based telephone interview survey examining headache occurrence in approximately 10,000 subjects, 12–29 years old, we assessed the prevalence of panic disorder (and a less severe entity designated as panic syndrome) using an abbreviated version of the National Institute of Mental Health Diagnostic Interview Survey. Subjects with panic disorder or panic syndrome reported more frequent occurrence of headaches during the preceding week, as well as headaches of longer duration and substantially more headaches with migraine symptoms than individuals without a history of panic attack. Males with panic disorder were 7 times more likely than those without this condition to report the occurrence of a migraine headache in the previous week. In addition, 5.5% of males and 9.5% of females with panic disorder or panic syndrome reported 25% of the total migraine headaches described by all study subjects in the one‐week recall period.

Gender differences in the experience of headache

Since 1940 numerous studies have shown that women report higher rates of symptoms, illness, disability and medical care utilization than men. The present analysis addresses gender differences in headache, with a focus on symptom frequency and associated pain and duration of each subjects most recent headache attack experienced within 4 weeks of interview. A random sample of 10,167 Washington County, Maryland residents (ages 12-29 years) were administered a standardized telephone interview in a large epidemiologic study of headache during 1986-87. Among the respondents, 6347 described one or more headaches occurring within 4 weeks of the interview. Women reported few specific symptoms more frequently than men, and the relative rankings of the symptoms were nearly identical for each gender (rs = 0.98). Estimated pain associated with each subjects headache and the duration of the attack were systematically greater for women than men. Although the relative rankings of symptoms by associated pain were very similar (rs = 0.90), the correlation for the ranking of symptoms for duration by gender was less strong (rs = 0.59). Women were significantly more likely to report recent headache-related disability and to seek health care services for their headaches, even after adjusting for headache severity. The results suggest that a strong interplay of an underlying physiological difference with socially determined role perceptions and illness orientations lead to greater reporting of symptoms by women.

Acquired disorders affecting the immune system and non-Hodgkin's lymphoma

A case-control study was undertaken to determine whether a prior history of a variety of acquired disorders affecting the immune system was associated with an increased risk of non-Hodgkins lymphoma. Cases were identified over a 4-year period (1976-1979) at the Johns Hopkins Hospital and individually matched to hospital controls on age, sex, race, and year of diagnosis. For the 109 cases and matched controls who were traced and interviewed, positive associations suggesting an increase in risk were not detected. Instead, there was a suggestion of an inverse relationship. Odds ratios (ORs) were consistently less than 1 for associations between non-Hodgkins lymphoma and several chronic infectious diseases (OR = 0.65, 95% CI = 0.35, 1.20), chronic inflammatory diseases (OR = 0.88, 95% CI = 0.43, 1.79), autoimmune disorders (OR = 0.80, 95% CI = 0.19, 3.76), and allergic disorders (OR = 0.77, 95% CI = 0.45, 1.32). A statistically significant protective association was found for surgical removal of lymphoid tissue (OR = 0.50, 95% CI = 0.27, 0.91). Adjustment for potentially confounding variables did not change these results. These findings do not support the previously anecdotally reported impression that disorders producing a chronic antigenic stimulus are associated with the development of non-Hodgkins lymphoma.

A case-control study of aplastic anemia

A case-control interview study of aplastic anemia was conducted to evaluate suspected risk factors. Cases (N = 59) newly diagnosed during 1975-82 at 25 Baltimore area hospitals were compared with 59 individually matched (on age, sex and race) controls selected by random digit dialing. The average educational level was less for cases than controls. The major job-related findings were a significant excess for occupational exposure to paint (OR = 6.1; 95% C.I. = 1.2-29.7), further substantiated by a positive dose-response relationship, although painters were not at excess risk. An increased risk of occupational exposure to viruses (OR = 9.0; 95% C.I. = 0.8-105.6) was noted. Additional evidence implicating viral factors included a significant association with prior history of hepatitis (OR = 9.0; 95% C.I. = 1.0, 84.2) and an elevated risk for pre-diagnostic receipt of blood transfusions (OR = 7.1; 95% C.I. = 0.7-68.4). Risks were not increased for other occupational, residential, personal, or medical treatment exposures or for other viral infections, medical conditions, smoking or alcohol consumption prior to diagnosis. Because of the small number of subjects studied and the multiple comparisons examined, these findings should be interpreted cautiously and confirmation should be undertaken in larger, population-based studies.

Chronic Lymphocytic Leukemia and Multiple Myeloma in Husband and Wife

Chronic lymphocytic leukemia (CLL) and multiple myeloma (MM) are rare, B-lymphocyte malignancies of unknown etiology. CLL appears to have a strong familial component; MM has also been reported in families but to a lesser extent. Clinical reports have suggested associations between each of these disorders and prior history of chronic antigenic stimulation from chronic infections, inflammatory or autoimmune diseases; chronic use of certain drugs; and various occupational exposures thought to be related to certain chemicals. Hypotheses as to possible etiologic agents or exposures are usually suggested by clinical clues from in-depth medical histories. We report four suspect exposures shared by a husband and wife who developed the rare, B-cell tumors, CLL and multiple myeloma.