Mattias Linde

EFNS guideline on the treatment of tension‐type headache – Report of an EFNS task force

Background:u2002 Tension‐type headache (TTH) is the most prevalent headache type and is causing a high degree of disability. Treatment of frequent TTH is often difficult.

Exercise as migraine prophylaxis: A randomized study using relaxation and topiramate as controls

Aim: Scientific evidence regarding exercise in migraine prophylaxis is required. Therefore this study aimed to evaluate the effects of exercise in migraine prevention. Methods: In a randomized, controlled trial of adults with migraine, exercising for 40u2009minutes three times a week was compared to relaxation according to a recorded programme or daily topiramate use, which was slowly increased to the individual’s highest tolerable dose (maximum 200u2009mg/day). The treatment period lasted for 3 months, and migraine status, quality of life, level of physical activity, and oxygen uptake were evaluated. The primary efficacy variable was the mean reduction of the frequency of migraine attacks during the final month of treatment compared with the baseline. Results: Ninety-one patients were randomized and included in the intention-to-treat analysis. The primary efficacy variable showed a mean reduction of 0.93 (95% confidence interval (CI) 0.31–1.54) attacks in the exercise group, 0.83 (95% CI 0.22–1.45) attacks in the relaxation group, and 0.97 (95% CI 0.36–1.58) attacks in the topiramate group. No significant difference was observed between the groups (pu2009=u20090.95). Conclusion: Exercise may be an option for the prophylactic treatment of migraine in patients who do not benefit from or do not want to take daily medication.

New drugs in migraine treatment and prophylaxis: telcagepant and topiramate

Although the triptan drugs provide effective relief from migraine for many patients, a substantial number of affected individuals are unresponsive to these compounds, and such therapy can also lead to a range of adverse effects. Telcagepant represents a new class of antimigraine drug-the calcitonin gene-related peptide receptor blockers. This compound exerts its effects by blocking receptors for the calcitonin-gene-related peptide at several sites in the trigeminal and central nervous systems, resulting in pain relief. Telcagepant does not cause vasoconstriction, a major limitation in the use of triptans. Comparisons with triptans in clinical trials for acute treatment of migraine attacks revealed clinical effects similar to those of triptans but better than those of placebo. Telcagepant might provide hope for those who have a poor response to, or are unable to use, older drugs. In patients who need prophylaxis because of frequent attacks of migraine, topiramate is a first-line drug for migraine prevention in many countries; it is generally safe and reasonably well tolerated. Data suggest that topiramate could aid reversion of chronic migraine to episodic migraine.

Time trends in the prevalence of headache disorders. The Nord-Trøndelag Health Studies (HUNT 2 and HUNT 3):

Earlier reports regarding secular trends of migraine are conflicting, and there is a lack of long-term follow-up studies of other headache syndromes among adults. The aim of the present study was to assess any changes in the prevalence of the major headache types in a large adult population. With an 11-year interval, all inhabitants aged ≥20 years (nu2009=u200992,566 and 94,194) in the Norwegian county of Nord-Trøndelag were invited to participate in two cross-sectional surveys. Attendance rates were 56% and 42%. The age-adjusted 1-year prevalences, according to the diagnostic criteria of the International Headache Society, sex-ratios and attack frequencies were assessed. The migraine prevalence increased from 12.1% to 13.2% (Pu2009<u20090.001), but the sex ratio did not change. The prevalence of non-migrainous headache overall decreased (26.0% vs 24.2%; Pu2009<u20090.001). The prevalences of ‘headache suffering’ (37.4%), chronic daily headache (2.5%) and medication overuse headache (1.0%) remained stable. Apart from a small increase of migraine, headache prevalences remained essentially stable among adults in a Norwegian county during an 11-year period.

Epidemiology of medication overuse headache in the general Swedish population

Aims: The aim was to estimate the prevalence of medication overuse headache (MOH) in Sweden and to analyze the occurrence of this disorder in different population groups. Methods: A total of 44,300 randomly selected individuals (55% women), aged 15 years and above, were interviewed in a national telephone survey, using a standardized questionnaire including the International Headache Society criteria for MOH and questions about sociodemographic factors, headache history and medication use. Results: In Sweden, 3.2% (95% confidence interval (CI) 3.1–3.4), nu2009=u20091428) suffer from chronic daily headache (CDH) and out of those, 56% (nu2009=u2009799) have MOH. The prevalence of MOH is 1.8% (95% CI 1.7–1.9). The mean age of onset was higher among men than women as well as among those with tension-type headache as primary headache compared to those who originally had migraine. A multivariate analysis showed that socioeconomic factors such as having a low level of education and/or a low household income were associated with MOH. Conclusions: This is the first Swedish population-based study of MOH and we conclude that MOH is a significant public health problem in Sweden, as it is in other parts of the world.

Sociodemographic differences in medication use, health-care contacts and sickness absence among individuals with medication-overuse headache

The objective of this study was to analyse sociodemographic differences in medication use, health-care contacts and sickness absence among individuals with medication-overuse headache (MOH). A cross-sectional, population survey was conducted, in which 44,300 Swedes (≥15xa0years old) were interviewed over telephone. In total, 799 individuals had MOH. Of these, 47xa0% (nxa0=xa0370) only used over-the-counter medications. During the last year, 46xa0% (nxa0=xa0343) had made a headache-related visit to their physician and 14xa0% (nxa0=xa0102) had visited a neurologist. Among individuals aged <30xa0years, the number of days/month with headache was greater than the number of days with medication use, whereas the opposite was true for those ≥30xa0years. Both the proportion using prophylactic medication and the proportion having consulted a neurologist were smaller among those who only had elementary school education than among those with higher education (pxa0=xa00.021 and pxa0=xa00.046). Those with a lower level of education also had a higher number of days/month with headache and with medication use than those with a higher educational level (pxa0=xa00.011 and pxa0=xa00.018). The MOH-sufferers have limited contacts with health-care and preventive measures thus need to include other actors as well. Particular efforts should be directed towards those with low educational levels, and more research on medication use in relation to age is required.

Migrainous infarction : a Nordic multicenter study

Background and purpose:u2002 Migrainous infarction (MI), i.e. an ischemic stroke developing during an attack of migraine with aura is rare and the knowledge of its clinical characteristics is limited. Previous case series using the International Classification of Headache Disorders (ICHD) included <10 cases which make conclusions less valid. This study aimed to describe characteristics and outcome of MI in a larger sample.

Influence of disease features on adherence to prophylactic migraine medication

Objectivesu2002–u2002 Randomized controlled trials of prophylactic treatments for migraine focus on the effects in an ideal situation and underestimate the impact of non‐adherence, which in this study was examined in a natural setting.

Holding on to the indispensable medication -A grounded theory on medication use from the perspective of persons with medication overuse headache

BackgroundMedication overuse headache (MOH) is a chronic headache disorder, caused by overuse of acute medication. To date, it remains unclear why some people overuse these medications. The aim of this qualitative study was to explore how individuals with MOH use medications and other strategies to manage headaches in their daily lives, and their thoughts about their own use of acute medication. Our intention was to develop a theoretical model about the development of MOH, from the perspective of those with MOH.MethodsData collection and analysis were conducted according to grounded theory methodology. The participants were recruited via newspaper advertisements. Fourteen persons with MOH were interviewed in individual qualitative interviews.ResultsThe basic process leading to medication overuse was holding on to the indispensable medication. The acute medication was indispensable to the participants because they perceived it as the only thing that could prevent headaches from ruining their lives. The participants perceived headaches as something that threatened to ruin their lives. As a result, they went to great lengths trying to find ways to manage it. They tried numerous strategies. However, the only strategy actually perceived as effective was the use of acute medication and they eventually became resigned to the idea that it was the only effective aid. The acute medication thus became indispensable. Their general intention was to use as little medication as possible but they found themselves compelled to medicate frequently to cope with their headaches. They did not like to think about their medication use and sometimes avoided keeping track of the amount used.ConclusionsThis qualitative study adds understanding to the process via which MOH develops from the perspective of those having MOH. Such knowledge may help bridge the gap between the perspectives of patients and health-care professionals.

It's a balance between letting it influence life completely and not letting it influence life at all--a qualitative study of migraine prevention from patients' perspective.

Purpose: The aim of this study was to elucidate migraine prevention from a patient perspective. Method: Twenty-one participants who suffered from migraine were interviewed and the data analysed by means of qualitative content analysis. Results: The analysis revealed two categories; Avoiding migraine triggers and introducing migraine inhibiting strategies. In both categories, decisions were influenced by an appraisal of the advantages versus disadvantages, attitudes, support and knowledge. An overarching theme: “migraine prevention from the patients’ perspective is a balance between letting it influence life completely and not letting it influence life at all” was identified from the interviews. Conclusions: As migraine is a chronic disorder that cannot be cured, merely relieved, prevention is of great importance. The present study highlights migraine prevention from the patients’ perspective and the important issue of how much prevention is allowed to influence life. Either of the directions involves a risk that life can be controlled by migraine. Acceptance of the disease and allowing migraine prevention to influence life to some degree can be a way of regaining control. Implications for Rehabilitation Migraine prevention from the patients’ perspective is described as a balance between letting it influence life completely and not letting it influence life at all, which in either direction can lead to a life controlled by migraine. To take the patients’ perspectives of the illness in consideration as well as finding the most suitable treatment, based on an appraisal of individual advantages versus disadvantages is important to meet the need of the patient and to improve migraine prevention. Increased knowledge about migraine prevention is imperative both in health care and for the individual patient. Support during prevention is requested by patients.