Rigmor Jensen

Predictors of outcome of the treatment programme in a multidisciplinary headache centre.

Introduction: Despite the high prevalence of headaches, multidisciplinary headache clinics are few and their efficacy still needs validation. The objective was to characterise patients and treatment results in a tertiary headache centre. Subjects and methods: A systematic review of all referred patients in the Danish Headache Centre in a 2-year period. Outcome results were analysed with respect to diagnoses and sociodemographics. Results: A total of 1326 patients with a mean age of 43.7 years and maleu2009:u2009female ratio of 3u2009:u20097 were included. In total, frequency and absence rate from work were reduced from 20 to 11 days (Pu2009<u20090.001) and 5 to 2 days/month (Pu2009<u20090.001), respectively. Predictors for good outcome were female gender, migraine, triptan overuse and a frequency of 10 days/month, whereas tension-type headache and overuse of simple analgesics predicted a poor outcome. Conclusions: The present analysis provided support for a multidisciplinary approach in a tertiary headache centre. Further evaluation of specific treatment strategies and outcome predictors are important for future planning.

Assessment of Headache Diagnosis. A Comparative Population Study of a Clinical Interview With a Diagnostic Headache Diary

The level of agreement between headache information, attained by clinical interview and headache diary, was evaluated in subjects who frequently suffered from headache and were participating in an epidemiological study of headache. One hundred and six subjects were interviewed and asked to complete a diary for a period of 4–8 weeks; 46% completed the study. For migraine the diary and clinical diagnoses demonstrated agreement in 82%, κ value 0.57, sensitivity 90% and specificity 64%. For tension-type headache they demonstrated agreement in 87%, κ value 0.39, sensitivity 97%, specificity 29% and a good agreement of frequency of tension-type headache was also obtained. In migraine, but not in tension-type headache, accompanying symptoms tended to be overestimated in the interview. The diary was not useful for the diagnosis of migraine with aura, but proved valuable in distinguishing between migraine and tension-type headache, and in the identification of coexisting headache disorders. Combined use of a diagnostic diary and clinical interview is recommended.

Prevalence of lower urinary tract symptoms (LUTS) in stroke patients: a cross-sectional, clinical survey.

The aims of this study were primarily to investigate the prevalence, severity and impact on daily life of Lower Urinary Tract Symptoms (LUTS) in a clinical sample of stroke patients and secondly to identify factors associated with LUTS.

Can quality of life be improved by pelvic floor muscle training in women with urinary incontinence after ischemic stroke? A randomised, controlled and blinded study

The purpose of this study was to evaluate the effect of pelvic floor muscle training in women with urinary incontinence after ischemic stroke measured by quality of life (QoL) parameters. Three hundred thirty-nine medical records of stroke patients were searched. Twenty-six subjects were randomised to a Treatment Group or a Control Group in a single blinded, randomised study design. The intervention included 12xa0weeks of standardised pelvic floor muscle training. The outcome was measured by the Short Form 36 (SF-36) Health Survey Questionnaire and The Incontinence Impact Questionnaire (IIQ). Twenty-four subjects completed the study. The SF-36 and IIQ did not show significant difference between the two groups. Despite the high prevalence of stroke with urinary incontinence, it is difficult to include these patients in such studies. The samples were too small to detect any significant differences. Development of specific instruments for QoL in stroke patients with urinary incontinence can be recommended.

Is there a long-lasting effect of pelvic floor muscle training in women with urinary incontinence after ischemic stroke?

The aim of this study was to evaluate the long-lasting effect of pelvic floor muscle training (PFMT) in women with urinary incontinence after stroke measured by quality of life parameters. Twenty-four (24/24) women with urinary incontinence after stroke, who had completed a prospective, randomised controlled and single-blinded trial evaluating the effect of 12 weeks PFMT, were included in this follow-up study. The follow-up assessments were done by telephone interview 6 months after the intervention. The effect was evaluated by The Short Form 36 (SF-36) Health Survey Questionnaire and Incontinence Impact Questionnaire (IIQ). Twenty-four subjects completed the study. In the treatment group, the SF-36 showed a trend to a long-lasting effect in one of the eight domains and the IIQ showed a tendency to decreased impact of UI in two sub-scales compared to the control group. Our data indicated that PFMT may have a long-lasting effect measured by quality of life parameters.

Are activity limitations associated with lower urinary tract symptoms in stroke patients? A cross-sectional, clinical survey

Objective. To assess self-reported activity limitations in a clinical sample of stroke patients and to identify their association with prevalence, severity and impact on daily life of lower urinary tract symptoms (LUTS). Material and methods. A cross-sectional, clinical survey was initiated whereby stroke patients were invited to complete four activity limitations measurements: Barthel Index, mobility velocity, mobility distance, mobility aids and one LUTS measurement: the Danish Prostatic Symptom Score (DAN-PSS-1) questionnaire. Of 519 stroke patients, 482 subjects were eligible. Results. The response rate was 84%. The activity limitations were reported by 17–34% depending on the measurement. Mobility velocity was highly significantly associated (p=0.01) with severity of LUTS. In the LUTS incontinence symptom group, Barthel Index and mobility velocity were significantly associated with prevalence [p=0.03, odds ratio (OR) 2.08 and p=0.05, OR 1.87, respectively]. Barthel Index and mobility distance were al...

Is well-being associated with lower urinary tract symptoms in patients with stroke?

Abstract Objective. This study aimed to assess self-reported well-being in a clinical sample of stroke patients and to identify possible associations with prevalence, severity and bother of lower urinary tract symptoms (LUTS). Material and methods. A cross-sectional, clinical survey was initiated whereby stroke patients were invited to complete The WHO-Five Well-Being Index (WHO-5) and a LUTS instrument, the Danish Prostatic Symptom Score (DAN-PSS-1) questionnaire. Of 519 stroke patients invited, 482 subjects were eligible and 407 (84%) respondents answered the questionnaires. Results. Poor well-being (sum score <13) was reported by 22% of all stroke patients, for women 29% and for men 14%. Depression (sum score <8) was reported by 10%, for women 11% and for men 8%. Poor well-being was significantly (p < 0.01) associated with severity and bother of LUTS. Likewise, poor well-being was significantly (p < 0.001) associated with the prevalence of four different symptom groups of LUTS. Conclusions. The results indicate that poor well-being is present in stroke patients with LUTS, especially in women. Likewise, the data showed significant association between poor well-being and LUTS. Screening for well-being and LUTS in stroke patients is strongly recommended.

Familial Hemiplegic Migraine and Recurrent Episodes of Psychosis: A Case Report

Familial hemiplegic migraine (FHM) is a rare autosomal dominant form of migraine with motor aura. We present a case report of a father and son with very similar attacks of hemiplegic migraine and recurrent episodes of accompanying psychoses. Previously, such episodes led to hospitalization and extended clinical examinations, which further worsened the psychoses. Since the episodes were recognized as related to the hemiplegic migraine, a treatment strategy combining sleep and sedation was initiated and progression onto psychosis was almost completely avoided in both father and son. Genetic analyses found no causal gene mutation in the three known FHM genes, suggesting that the phenotype is caused by a yet unidentified mutation.