Shiang-Ru Lu

Comorbidity of Depressive and Anxiety Disorders in Chronic Daily Headache and Its Subtypes

Objective.—To investigate the frequency of depressive and anxiety disorders in patients with chronic daily headache.

Quality of life differs among headache diagnoses : analysis of SF-36 survey in 901 headache patients

&NA; This paper presents the results of health‐related quality of life (HRQoL) in 901 patients consecutively visiting a headache clinic of a national medical center in Taipei, Taiwan. HRQoL was evaluated with the Medical Outcome Study‐Short Form (SF‐36) and the Hospital Anxiety and Depression Scale (HADS). According to the classification criteria for chronic daily headache (CDH) proposed by Silberstein et al. (Neurology 47 (1996) 871) five hundred and ninety‐three (66%) patients had CDH, of whom transformed migraine (TM) was diagnosed in 310, and chronic tension‐type headache (CTTH) in 231. One hundred and ninety‐three patients had episodic migraine. All SF‐36 scale scores significantly correlated with the HADS scores and the intensity and frequency of pain. Compared with the normative data, a pervasive multi‐dimensional decline of the SF‐36 scores was noted among the headache patients except for the physical functioning scale. The decline was most remarkable in the role limitations of physical and emotional dimensions and in the bodily pain. An increasing impairment of the SF‐36 scores was noted from migraine to CTTH to TM. After controlling for the HADS, age, gender, education, and chronic illness by multiple linear regression analyses, the patients with TM had the worst SF‐36 profile; whereas, the patients with CTTH and migraine had compatible results. This study is the first to demonstrate that the SF‐36 scores differ among headache diagnoses. Psychological distress, as well as the percentages of the types of patients, greatly influenced the SF‐36 scores in hospital‐based headache samples. Our findings also suggest that improvement in the pain profile as well as psychological well‐being can predict a generalized improvement in the SF‐36 scales in headache patients.

Chronic daily headache in adolescents Prevalence, impact, and medication overuse

Objectives: To examine the prevalence, impact, and related medication use or overuse of primary chronic daily headache (CDH) among adolescents in a field sample. Methods: The authors conducted a two-phase CDH survey of all students from ages 12 to 14 years in five selected middle schools in Taiwan. Subjects with CDH in the past year were identified and interviewed by neurologists. CDH was defined as headache occurring at a frequency of 15 days/month or more, average of 2 hours/day or more, for more than 3 months, and its subtypes were classified on the basis of the International Classification of Headache Disorders, 2nd edition. Results: Of the 7,900 participants, 122 (1.5%) fulfilled the criteria for primary CDH in the past year. Girls had a higher prevalence (2.4%) than boys (0.8%) (p < 0.001). Of the CDH subjects, 88 (72%) could be classified into either chronic tension-type headache (65.6%) or chronic migraine (6.6%). None of them fulfilled the criteria of new daily-persistent headache or hemicrania continua. Twenty-four subjects (20%) overused medications. Eighty-two (67%) of all CDH subjects had migraine or probable migraine. In the past semester, most CDH subjects (65%) did not take any sick leave for headaches. Only 6 subjects consulted neurologists in the past year, and only 1 subject took headache prophylactic agents. Conclusions: Chronic daily headache (CDH) was common in a large nonreferred adolescent sample. Based on the International Classification of Headache Disorders, 2nd edition, criteria, chronic tension-type headache was the most common subtype; however, a majority of adolescents with CDH had headaches with features of migraine.

Psychometric evaluation of a Chinese (Taiwanese) version of the SF-36 health survey amongst middle-aged women from a rural community.

To test the psychometric properties of the Chinese (Taiwanese) version of the short form 36 health survey (SF-36), 1439 women, aged 40–54 years and living in Kinmen (a Taiwanese island reflecting a predominantly rural community) were recruited to participate in this survey. The rate of unavailable data points for the 36 tested items remained consistently low, and item-discriminate validity was high (95%) for all subscales. Cronbachs α coefficient remained above the 0.70 threshold criterion for all scales except for social functioning and bodily pain. Principal components analysis supported the two major dimensions of health, physical and mental, in the internal structure of the SF-36 scales, although the dimensions did not match the hypothesized association very well. Poorer health profiles were associated with physical and mental conditions. The mental health subscores in the SF-36 test correlated highly with the associated hospital anxiety and depression score (Spearman rank correlation coefficient = −0.62). In conclusion, the reliability and validity tests performed on the data collected support the cross-cultural application of the Chinese (Taiwanese) version of the SF-36 test.

Psychiatric comorbidity and suicide risk in adolescents with chronic daily headache

Objectives: To investigate the prevalence and correlates of comorbid psychiatric disorders and suicidal risk in community-based adolescents with chronic daily headache (CDH). Methods: We identified and recruited 122 adolescents with CDH from a non-referral student sample (n = 7,900). CDH subtypes were classified according to the most updated criteria of the International Classification of Headache Disorders, 2nd edition (ICHD-2). An in-person psychiatric interview was performed with each subject with CDH to assess depressive and anxiety disorders and suicidal risk based on the Mini-International Neuropsychiatric Interview–Kid (MINI-Kid). Clinical correlates and impacts were investigated. Results: A total of 121 subjects (31 male/90 female, mean age 13.8 years) finished the psychiatric interview. Fifty-seven subjects (47%) had ≥1 assessed psychiatric comorbidity with major depression (21%) and panic disorder (19%) as the two most common diagnoses. Current suicidal risk was assessed as high (score ≥ 10) in 20% of subjects. Female gender and older age were associated with depressive disorders. Presence of migraine was associated with psychiatric comorbidities (OR = 3.5, p = 0.002). The associations with psychiatric disorders were stronger for migraine with aura than for migraine without aura. Migraine with aura also independently predicted a high suicidal risk (score ≥ 10) (adjusted OR = 6.0, p = 0.028). In contrast, CDH subtypes, headache frequencies, or medication overuse were not correlated. Comorbid psychiatric disorders were not related to physician consultations or more days of sick leave. Conclusions: This community-based study showed high comorbidity of psychiatric disorders and suicidal risk in adolescents with chronic daily headache. The presence of migraine attacks, especially migraine with aura, was the major predictor for these associations.

Does medication overuse headache represent a behavior of dependence

Abstract Medication overuse is relatively common in patients with frequent headache. To explore the prevalence of patients who meet the criteria for substance dependence in Diagnostic and Statistical Manual of Mental Disorders, Edition IV (DSM‐IV), and to identify variables of substance dependence among patients with chronic daily headache, we recruited consecutive patients with chronic daily headache at a headache clinic from November 1999 to June 2004. Each patient completed a headache intake form, a dependence questionnaire modified from DSM‐IV, and the Hospital Anxiety and Depression Scale (HADS). The presence of probable medication overuse headache (pMOH) was defined on the basis of the International Classification of Headache Disorders, 2nd edition, 2004. A total of 1861 patients with chronic daily headache (1369 women, 492 men; mean age, 49.6±15.4 years) were recruited. Almost half (895/1861, 48%) met criteria of pMOH, and 606 of these patients (606/895, 68%) met three of five DSM‐IV substance dependence criteria. In contrast, only 191 of 968 patients without pMOH (20%) met the DSM‐IV criteria (OR=8.6, [7.0–10.6], chi‐square test, P<0.001). Patients who fulfilled DSM‐IV criteria of dependence had higher numbers of physician appointments in the past year. Multivariate logistic regression analyses revealed that migraine headache, frequent physician consultation, intensity of headache, and presence of a higher anxiety score were significant independent variables for substance dependence. Among patients with chronic daily headache, pMOH was associated with behaviors of substance dependence.

The kinmen women-health investigation (KIWI): a menopausal study of a population aged 40-54

OBJECTIVES This paper aims to report the methodology of a study of a cohort of middle-aged women in Taiwan, their age at menopause, and related factors and prevalence of menopausal symptoms, and to examine the relationships between symptoms and sociodemographic variables. METHODS An epidemiological study of neuropsychological change during the menopausal transition among Chinese women aged 40-54 years old on the islet of Kinmen. RESULTS Of a targeted population of 2256 individuals, 1497 (66%) participated in the study. The mean age at menarche was 15.6 years and that at menopause was 48 years. The hormone use rate at the time of study was 23% in surgical menopausal women, and 9% were past users. After excluding surgical menopausal and premenopausal women, 6% reported a current use of estrogen replacement therapy and 6% were past users. The most frequently reported discomforts for those women aged >45 were troubled sleep, backaches, and joint pain. Four symptom clusters: musculoskeletal, non-specific somatic complaints, urogenital, and vasomotor, were identified. After adjustment for age, the urogenital and vasomotor symptoms were significantly associated with menopausal status. CONCLUSIONS The age at menopause did not differ much from Western studies, but the menopausal symptoms, especially the vasomotor symptoms, were much lower in our study population. Nevertheless, vasomotor symptoms were still significantly associated with menopausal status.

Migraine prevalence during menopausal transition.

Background.—The effect of menopausal transition on the frequency of migraine has never been the focus of a community‐based study.

Comorbidity of headaches and depression in the elderly.

The comorbidity of headache and depression is rarely studied in the elderly. Confounders were seldom controlled in previous studies. From August 1993 to March 1994, we conducted a door-to-door survey to investigate the relationship of headache and depression in a Chinese elderly population (age > or = 65 years old) in two townships of Kinmen, Taiwan. A total of 1421 participants (71%) out of 2003 eligible citizens completed five measurements: a structured headache interview, Geriatric Depression Scale-short form (GDS-S), a survey of chronic medical illness. Cognitive Abilities Screening Instrument and an evaluation of activities of daily living. Headache diagnoses were made according to the criteria of the International Headache Society (IHS), 1988. Depression was defined as a GDS-S score > or = 8. After adjustment for confounding, subjects with more frequent headaches, more severe headaches, diagnoses of IHS migraine or chronic tension-type headaches in the past year, or a lifetime history of any headache including migraine were more likely to be depressed. In addition, the most relevant headache-related predictors of depression were the presence of any reported lifetime headache (odds ratio (OR) = 1.8, P < 0.01) and headache frequency > or = 7 days/month in the past year (OR = 2.0, P = 0.01). This study provided evidence that headache is independently associated with depression in the elderly. A high comorbidity of depression was found in the elderly with IHS migraine or chronic tension-type headaches. Not only the headache profile in the past year but also that in their lifetime was important in predicting current depression in the elderly. 1

Outcomes and predictors of chronic daily headache in adolescents : A 2-year longitudinal study

Objectives: To assess the outcomes and predictors of chronic daily headache (CDH) in a community-based cohort of adolescents. Methods: We established a field sample of 122 adolescents (32 M/90 F, ages 12 to 14) with CDH in 2000. These adolescents received annual follow-up by neurologists for 2 years via a semistructured telephone interview. CDH was defined as ≥15 headache days/month, average ≥2 h/day for >3 months; subtypes were classified based on the original and appendix criteria of the International Classification of Headache Disorders (2nd ed.; ICHD-2). Poor outcome was defined as persistence of CDH at 2 years. Results: Follow-up response rates were 92% in 2001 and 84% in 2002. Average monthly headache frequency was 11.0 ± 9.7 days in 2001 and 7.7 ± 6.5 days in 2002. CDH persistence rates were 40% in 2001 and 25% in 2002. Medication overuse declined from 20% (baseline) to 6% at 2 years. The prevalence of migraine did not change throughout the follow-up (67 to 60%), whereas that of tension-type headache deceased from 86 to 46% (p < 0.001). Chronic migraine prevalence increased markedly at baseline and became the most common CDH subtype at follow-up when using the ICHD-2 appendix criteria. During follow-up, seven subjects (6%) dropped out of school. Independent predictors for CDH persistence were medication overuse and major depression. Conclusions: Most adolescents with chronic daily headache (CDH) continued to have frequent headaches, although the incidence of CDH declined at follow-up. Migraine diagnosis gained prominence as headache frequency decreased. The percentages of chronic migraine in adolescents with CDH increased obviously if the appendix criteria were applied.