Ragnhild Berling Grande

Prevalence of Secondary Chronic Headaches in a Population-Based Sample of 30-44-Year-Old Persons. The Akershus Study of Chronic Headache

We studied secondary chronic headaches (≥ 15 days/month for at least 3 months) in a random sample of 30 000 persons aged 30-44 years. They received a mailed questionnaire. Those with self-reported chronic headache within the last month and/or year were invited to an interview and examination by a neurological resident. The criteria of the International Classification of Headache Disorders (ICHD-II) were applied. The questionnaire response rate was 71%, and the participation rate of the interview was 74%. Of the 633 participants, 298 had a secondary chronic headache. The 1-year prevalence of secondary chronic headache was 2.14%, i.e. chronic posttraumatic headache 0.21%, chronic headache attributed to whiplash injury 0.17%, post-craniotomy headache 0.02%, medication-overuse headache (MOH) 1.72%, cervicogenic headache 0.17%, headache attributed to chronic rhinosinusitis 0.33% and miscellaneous headaches 0.04%. The majority of those with ICHD-II-defined secondary chronic headache had MOH, while about one-third had other secondary headaches often in combination with MOH.

Reduction in medication-overuse headache after short information. The Akershus study of chronic headache.

Objective:  Our aim was to investigate the course of medication‐overuse headache in the general population and the effect of simple advice regarding medication overuse.

Prevalence of Primary Chronic Headache in a Population-Based Sample of 30- to 44-Year-Old Persons

Background: Prevalence data on primary chronic headache in the general population based on clinical interviews by physicians are lacking. Methods: In a cross-sectional epidemiological survey, a random sample of 30,000 persons from Akershus County, aged 30–44 years, were sent a postal questionnaire. Those with self-reported chronic headache within the last month and/or year were invited to a semi-structured diagnostic interview and a physical and neurological examination conducted by 2 neurological residents with experience in headache diagnostics. The diagnoses were made according to the International Classification of Headache Disorders, 2nd edition, 2004, and relevant revisions. Results: The questionnaire response rate was 71%, and the participation rate of the interview was 74%. The 1-year prevalence of primary chronic headache was 2.9%. Chronic tension-type headache (CTTH) and probable chronic tension-type headache (pCTTH) had 1-year prevalences of 1.6 and 1.2%, respectively. The prevalences of other primary chronic headaches were: chronic migraine (CM) 0.01%, probable CM 0.09% and other subtypes 0.04%. Co-occurrence of migraine was frequent, as 42% with CTTH and 55% with pCTTH had migraine. Conclusion: Primary chronic headache is prevalent in the general population. The majority has CTTH or pCTTH, while CM and other primary chronic headaches are rare.

Management of primary chronic headache in the general population: the Akershus study of chronic headache

BackgroundThe prevalence of secondary chronic headache in our population is 0.5%. Data is sparse on these types of headache and information about utilisation of health care and medication is missing. Our aim was to evaluate utility of health service services and medication use in secondary chronic headache in the general population.MethodsAn age and gender stratified cross-sectional epidemiological survey included 30,000 persons 30–44 years old. Diagnoses were interview-based. The International Classification of Headache Disorders 2nd ed. was applied along with supplementary definitions for chronic rhinosinusitis and cervicogenic headache. Secondary chronic headache exclusively due to medication overuse was excluded.ResultsOne hundred and thirteen participants had secondary chronic headache. Thirty % had never consulted a physician, 70% had consulted their GP, 35% had consulted a neurologist and 5% had been hospitalised due to their secondary chronic headache. Co-occurrence of migraine or medication overuse increased the physician contact. Acute headache medication was taken by 84% and 11% used prophylactic medication. Complementary and alternative medicine was used by 73% with the higher frequency among those with than without physician contact.ConclusionThe pattern of health care utilisation indicates that there is room for improving management of secondary chronic headache.

The Severity of Dependence Scale detects people with medication overuse: the Akershus study of chronic headache

Objective: To evaluate the Severity of Dependence Scale (SDS) in people with primary chronic headache and analyse the pattern of medication overuse. Design: Cross sectional epidemiological survey. A posted questionnaire screened for chronic headache. Neurological residents interviewed those with self-reported chronic headache. The International Classification of Headache Disorders was used. Split file methodology was employed for data analysis. Setting: Akershus University Hospital, Oslo, Norway. Participants: A random sample of 30 000 people, aged 30–44 years, from the general population of Akershus County, Norway. 405 people had primary chronic headache. Main outcome measure: SDS score in those with and without medication overuse. Results: The screening questionnaire response rate was 71% and the participation rate of the interview 74%. Among 405 people with primary chronic headache, 95% had chronic tension-type headache, 4% had chronic migraine and <1% had other primary chronic headaches. Of 386 persons with chronic tension-type headache, 44% had medication overuse and 47% had co-occurrence of migraine. Simple analgesics, combination analgesics, triptans, ergotamine, opioids and a combination of acute medications were overused by 65%, 27%, 4%, <1%, 1% and 2% of people, respectively. The mean SDS score was significantly higher in those with than in those without medication overuse (5.6 vs 2.7; p<0.001). Conclusion: The SDS questionnaire detects medication overuse and dependency-like behaviour in persons with primary chronic headache.

Prevalence of new daily persistent headache in the general population. The Akershus study of chronic headache.

The aim of the present study was to investigate the prevalence of new daily persistent headache (NDPH) in the general population, and compare the clinical characteristics of NDPH and chronic tension-type headache (CTTH). This is a population-based cross-sectional study. A random sample of 30 000 persons aged 30-44 years was drawn from the population of Akershus County, Norway. A postal questionnaire was screened for chronic headache. Those (n = 633) with self-reported chronic headache within the last month and/or year were invited to an interview and examination by a neurological resident. A follow-up interview was conducted after 1.5-3 years. The headaches were diagnosed according to the International Classification of Headache Disorders, 2nd edn and relevant revisions. The response rate of the questionnaire was 71% and the participation rate of the interview was 74%. Four persons, three men and one woman, had NDPH. The overall 1-year prevalence of NDPH was 0.03%. The clinical characteristics of NDPH and CTTH were similar, except for the sudden onset in NDPH. Three of the four persons with NDPH had medication overuse. Follow-up disclosed that the symptomatology of NDPH is not unchangeable, since two persons had improvement of their NDPH. NDPH is rare and occurs in one of 3500 persons from the general population of 30-44-year-olds. It is often associated with medication overuse.

The severity of dependence score correlates with medication overuse in persons with secondary chronic headaches. The Akershus study of chronic headache

&NA; The objective was to compare the Severity of Dependence Scale (SDS) score and pattern of medication use in persons with secondary chronic headache (≥15 days/month for at least 3 months) in a cross‐sectional epidemiological survey. A posted questionnaire screened for chronic headache. Neurological residents interviewed those with self‐reported chronic headache. The International Classification of Headache Disorders was used. Split file methodology was employed for data analysis. People with secondary chronic headaches were identified in an age and gender stratified sample of 30,000 30–44 year olds from the general population. The interviews and examinations were conducted at the Akershus University Hospital, Oslo, Norway. The main outcome measure was the SDS score in those with and without medication overuse. Fifty‐five (49%) of the 113 persons with secondary chronic headaches were found to have medication overuse. Fifty‐eight percent overused simple analgesics and 31% overused combination analgesics. The SDS score was significantly higher among those with than without medication overuse (5.5 vs. 1.9). The sensitivity, specificity, positive and negative predictive values were 0.82, 0.82, 0.82 and 0.83, respectively. Thus the SDS score correlates with medication overuse, and a high SDS score suggests dependency‐like behaviour in persons with secondary chronic headache. The use of SDS score in subjects with frequent pain episodes may contribute to the detection of medication overuse and better management of this group of patients.

A Vertical VAS is a Valid Instrument for Monitoring Headache Pain Intensity

Visual analogue scales (VAS) are well-validated instruments for assessing pain intensity, but have an impractical format. The aim of the study was to validate a vertical against a horizontal VAS for pain intensity registration. Out-patients with headache or non-headache pain were included. Participants completed a horizontal and a vertical VAS. Both were completed twice for test-retest. Headache was diagnosed according to the International Classification of Headache Disorders, 2nd edition. The results on vertical and horizontal VAS did not differ significantly in the different headache or chronic pain groups. For test-retest evaluation, effect sizes and Cohens δ values were < 0.029 with < 1.5% change from test to retest (P < 0.01). Correlation coefficients were > 0.95. Bland-Altman analysis showed good agreement between vertical and horizontal scores with correlation coefficients > 0.84. A vertical VAS is equally valid as a horizontal VAS for registration of pain intensity in headache and non-headache patients.

Dependence scores predict prognosis of medication overuse headache: A prospective cohort from the Akershus study of chronic headache

Summary Prognosis regarding out‐patient detoxification from medication overuse and improvement of chronic headache is predicted by Severity of Dependence Scale scores in subjects with medication overuse headache. Those with high scores at baseline are less likely to improve and may require in‐patient treatment. Abstract Medication overuse headache (MOH) is a chronic headache that is common in the general population. It has characteristics similar to drug dependence, and detoxification is established as the main treatment. The majority of MOH cases are in contact with general practitioners. Our objective was to investigate whether the Severity of Dependence Scale (SDS) score could be used as predictor for the prognosis of MOH in the general population. In a cross‐sectional epidemiological survey, an age‐ and gender‐stratified sample of 30,000 persons 30 to 44 years of age was recruited via a posted questionnaire. Those individuals with self‐reported chronic headache (⩾15 days per month) were interviewed by neurological residents at Akershus University Hospital, Oslo. The International Classification of Headache Disorders was used. Those with MOH were re‐interviewed by telephone 2 to 3 years after the initial interview. SDS scores and medication information were collected at baseline and follow‐up. The main outcomes were SDS scores, termination of MOH and chronic headache from baseline to follow‐up. We found the predominant overused analgesics in this sample to be simple analgesics. At follow‐up, 65% of participants no longer had medication overuse, and 37% had changed to episodic headache (<15 days per month). The SDS score at baseline successfully predicted improvement for primary MOH, but not secondary MOH. The SDS scores decreased slightly from baseline to follow‐up in those who stopped medication overuse, but were still significantly higher than in subjects with chronic headache without medication overuse at baseline. We conclude that the SDS score can predict successful prognosis related to detoxification of primary MOH but not in secondary MOH.

Personality traits and psychological distress in persons with chronic tension‐type headache. The Akershus study of chronic headache

Aaseth K, Grande RB, Leiknes KA, Benth JŠ, Lundqvist C, Russell MB. Personality traits and psychological distress in persons with chronic tension‐type headache. The Akershus study of chronic headache.
Acta Neurol Scand: 2011: 124: 375–382.
© 2011 John Wiley & Sons A/S.