Background
Methods
Study design, population and variables
Inclusion criteria
Exclusion criteria
Headache classification
Anxiety, depression and psychological distress
Neuroticism
Headache-related disability
HSCL-25 and EPQ population controls
Statistical analysis
Ethical issues
Results
All secondary chronic headaches N = 95 | Post-traumatic/cervicogenic headache N = 50 | Rhinosinusitis headache N = 39 | (p-value for CPTH/CEH vs. HACRS) | |
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Age, mean (SD) | 38.7 (4.2) | 38.9 (4.2) | 38.9 (3.8) | 0.82 |
Gender, n (%) | 0.06 | |||
Female | 77 (81) | 37 (74) | 35 (90) | |
Male | 18 (19) | 13 (26) | 4 (10) | |
Education, highest attained, n (%) | 0.92 | |||
≤ 15 years | 75 (76) | 38 (76) | 30 (77) | |
> 15 years | 24 (25) | 12 (24) | 9 (23) | |
Married or cohabitant, n (%) | 60 (63) | 32 (64) | 25 (64) | 0.99 |
Body mass index (kg/m2), mean (SD) | 26.6 (5.0) | 27.4 (5.3) | 25.5 (4.5) | 0.11 |
Daily smoker, n (%) | 0.93 | |||
No | 57 (63) | 30 (63) | 24 (62) | |
Yes | 35 (37) | 18 (37) | 15 (38) | |
Concomitant migraine, n (%) | 0.15 | |||
No | 55 (58) | 32 (64) | 19 (49) | |
Yes | 40 (42) | 18 (36) | 20 (51) | |
Number of headache days past 3 months, mean (SD) | 62.0 (27.1) | 70.5 (25.4) | 52.4 (24.5) | 0.002 |
Number of medication days past month, mean (SD) | 12.8 (10.8) | 13.4 (11.5) | 13.2 (10.3) | 0.94 |
Medication-overuse, n (%) | 0.76 | |||
No | 50 (53) | 26 (52) | 19 (49) | |
Yes | 45 (47) | 24 (48) | 20 (51) | |
HSCL-25 scores, mean (SD) | ||||
Anxiety score, mean (SD) | ||||
Female | 1.80 (0.46) | 1.88 (0.43) | 1.79 (0.48) | 0.37 |
Male | 1.84 (0.49) | 1.85 (0.50) | 1.88 (0.56) | 0.94 |
Depression score, mean (SD) | ||||
Female | 1.83 (0.55) | 1.88 (0.59) | 1.87 (0.50) | 0.96 |
Male | 1.79 (0.56) | 1.76 (0.56) | 1.67 (0.49) | 0.77 |
Total score, mean (SD) | ||||
Female | 1.82 (0.48) | 1.88 (0.49) | 1.84 (0.44) | 0.70 |
Male | 1.81 (0.49) | 1.80 (0.52) | 1.75 (0.51) | 0.88 |
HSCL-25, psychological distress, n (%) | 0.40 | |||
No (< 1.67 for men and < 1.75 for women) | 48 (51) | 22 (45) | 21 (54) | |
Yes (> 1.67 for men and > 1.75 for women) | 46 (49) | 27 (55) | 18 (46) | |
EPQ N-score, mean (SD) | 11.4 (5.4) | 10.6 (5.5) | 12.9 (4.9) | 0.06 |
EPQ L-score, mean (SD) | 10.6 (3.2) | 10.4 (3.6) | 10.9 (2.6) | 0.5 |
MIDAS score, mean (SD) | 66 (60) | 80 (60) | 44 (46) | 0.005 |
MIDAS score (grade), n (%) | 0.23 | |||
0–5 Minimal | 16 (20) | 6 (14) | 9 (27) | |
6–10 Mild | 4 (5) | 2 (5) | 2 (6) | |
11–20 Moderate | 5 (6) | 1 (2) | 3 (9) | |
> 20 Severe | 55 (69) | 33 (79) | 19 (58) |
Psychological distress and neuroticism
Covariate | High psychological distress | |||||||
---|---|---|---|---|---|---|---|---|
Bivariate (n = 80–94) | Multivariable (n = 83) | |||||||
n | Odds ratio | 95% CI | p-value | n | Odds ratio | 95% CI | p-value | |
Age | 94 | 1.0 | 0.9–1.1 | 0.5 | 83 | 1.0 | 0.9–1.2 | 0.6 |
Gender | ||||||||
Male | 18 | 1 | 17 | 1 | ||||
Female | 76 | 0.5 | 0.2–1.6 | 0.3 | 66 | 0.7 | 0.2–2.2 | 0.5 |
Headache days last 3 months | ||||||||
< 80 days | 50 | 1 | 47 | 1 | ||||
≥ 80 days | 38 | 1.3 | 0.6–3.0 | 0.5 | 36 | 1.1 | 0.4–3.1 | 0.9 |
Co-occurrence of migraine | ||||||||
No | 54 | 1 | 48 | 1 | ||||
Yes | 40 | 0.6 | 0.3–1.5 | 0.3 | 35 | 0.6 | 0.2–1.4 | 0.2 |
Type of headache | ||||||||
HACRS | 39 | 1 | 36 | 1 | ||||
CPTH/CEH | 49 | 1.4 | 0.6–3.3 | 0.4 | 47 | 1.1 | 0.4–3.0 | 0.8 |
Medication overuse | ||||||||
No | 49 | 1 | 43 | 1 | ||||
Yes | 45 | 2.0 | 0.9–4.5 | 0.1 | 40 | 1.9 | 0.8–4.8 | 0.2 |
Neuroticism Eysenck N-scale | ||||||||
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Bivariate (n = 79) | Multivariable (n = 72) | |||||||
N | Unstandarized coefficient | 95% CI | p-value | N | Unstandarized coefficient | 95% CI | p-value | |
Age | 79 | 0.14 | −0.15; 0.43 | 0.3 | 72 | 0.10 | −0.23; 0.42 | 0.6 |
Gender | ||||||||
Male* | 16 | 0 | 15 | 0 | ||||
Female | 63 | 1.34 | −1.62; 4.30 | 0.4 | 57 | 0.88 | −2.53; 4.30 | 0.6 |
Headache days last 3 months | ||||||||
< 80 days* | 41 | 0 | 40 | 0 | ||||
≥ 80 days | 33 | −0.77 | −3.29; 1.76 | 0.5 | 32 | −0.34 | −3.43; 2.76 | 0.8 |
Co-occurrence of migraine | ||||||||
No* | 49 | 0 | 43 | 0 | ||||
Yes | 30 | 0.09 | −2.39; 2.55 | 0.9 | 29 | −0.34 | −3.10; 2.43 | 0.8 |
Type of headache | ||||||||
HACRS* | 32 | 0 | 30 | 0 | ||||
CPTH/CEH | 44 | −2.23 | −4.65; 0.19 | 0.07 | 42 | −2.10 | −5.27; 1.07 | 0.2 |
Medication overuse | ||||||||
No* | 42 | 0 | 37 | 0 | ||||
Yes | 37 | 1.73 | −0.64; 4.09 | 0.2 | 35 | 1.72 | −0.96; 4.39 | 0.2 |
Headache disability
Covariate | Severe disability | |||||||
---|---|---|---|---|---|---|---|---|
Bivariate (n = 74–94) | Multivariable (n = 74) | |||||||
n | Odds ratio | 95% CI | p-value | n | Odds ratio | 95% CI | p-value | |
Age | 80 | 1.0 | 0.9–1.1 | 0.7 | 74 | 1.0 | 0.9–1.2 | 1.0 |
Gender | ||||||||
Male | 18 | 1 | 17 | 1 | ||||
Female | 62 | 1.1 | 0.4–3.5 | 0.8 | 57 | 1.5 | 0.4–5.9 | 0.5 |
Headache days last 3 months | ||||||||
< 80 days | 45 | 1 | 42 | 1 | ||||
≥ 80 days | 34 | 4.2 | 1.4–13.0 | 0.01 | 32 | 4.0 | 1.1–14.5 | 0.04 |
Co-occurrence of migraine | ||||||||
No | 50 | 1 | 46 | 1 | ||||
Yes | 30 | 1.1 | 0.4–2.9 | 0.9 | 28 | 1.1 | 0.3–3.3 | 0.9 |
Type of headache | ||||||||
HACRS | 33 | 1 | 32 | 1 | ||||
CPTH/CEH | 42 | 2.7 | 1.0–7.4 | 0.05 | 42 | 1.9 | 0.6–6.4 | 0.3 |
Medication overuse | ||||||||
No | 44 | 1 | 39 | 1 | ||||
Yes | 36 | 1.3 | 0.5–3.5 | 0.5 | 35 | 1.3 | 0.4–4.0 | 0.7 |
HSCL-25 defined psychological distress | ||||||||
No | 43 | 1 | 38 | 1 | ||||
Yes | 37 | 1.5 | 0.6–3.8 | 0.5 | 36 | 1.1 | 0.4–3.4 | 0.9 |
Psychological distress, neuroticism and disability as predictors of headache prognosis
Covariate | No chronic headache | > 25% reduction in headache days | > 25% increase in headache days | Severe disability | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Multivariate (n = 63) | Multivariate (n = 61) | Multivariate (n = 61) | Multivariate (n = 46) | |||||||||||||
N | Odds Ratio | 95% CI | p-value | N | Odds Ratio | 95% CI | p-value | N | Odds Ratio | 95% CI | p-value | N | Odds Ratio | 95% CI | p-value | |
Age | 63 | 1.0 | 0.8–1.2 | 0.8 | 61 | 1.0 | 0.8–1.2 | 0.9 | 61 | 1.0 | 0.8–1.2 | 0.8 | 46 | 1.3 | 1.0–1.8 | 0.1 |
Gender | ||||||||||||||||
Male | 13 | 1.7 | 0.3–11.4 | 0.6 | 12 | 1.3 | 0.2–8.9 | 0.8 | 12 | 0.3 | 0.0–2.6 | 0.3 | 10 | 0.2 | 0.0–10.8 | 0.5 |
Female | 59 | 1 | 49 | 1 | 49 | 1 | 36 | 1 | ||||||||
Headache days last 3 months | ||||||||||||||||
< 80 days | 35 | 11.0 | 1.2–99.7 | 0.03 | 34 | 14.3 | 1.6–127.7 | 0.017 | 34 | 0.0 | 0.0–0.0 | 1.0 | 31 | 0.4 | 0.1–4.2 | 0.5 |
≥ 80 days | 28 | 1 | 27 | 1 | 27 | 1 | 15 | 1 | ||||||||
Type of headache | ||||||||||||||||
HACRS | 28 | 2.6 | 0.5–13.3 | 0.3 | 27 | 2.5 | 0.5–11.9 | 0.3 | 27 | 0.1 | 0.0–0.8 | 0.03 | 26 | 0.1 | 0.0–0.8 | 0.035 |
CPTH/CEH | 35 | 1 | 34 | 1 | 34 | 1 | 20 | 1 | ||||||||
Medication overuse | ||||||||||||||||
No | 32 | 1.6 | 0.3–7.3 | 0.6 | 30 | 1.6 | 0.4–7.0 | 0.5 | 30 | 0.2 | 0.0–1.6 | 0.2 | 24 | 0.1 | 0.0–1.6 | 0.1 |
Yes | 31 | 1 | 31 | 1 | 31 | 1 | 22 | 1 | ||||||||
HSCL-25 defined psychological distress | ||||||||||||||||
No | 34 | 1.8 | 0.4–8.5 | 0.4 | 33 | 1.5 | 0.3–6.2 | 0.6 | 33 | 0.6 | 0.1–2.9 | 0.5 | 25 | 0.7 | 0.1–6.5 | 0.8 |
Yes | 29 | 1 | 28 | 1 | 28 | 1 | 21 | 1 | ||||||||
Disability grade | ||||||||||||||||
No to moderate | 21 | 3.6 | 0.9–14.3 | 0.04 | 20 | 1.3 | 0.3–5.1 | 0.7 | 20 | 1.4 | 0.3–6.8 | 0.6 | 18 | 0.0 | 0.0–0.0 | 1.0 |
Severe | 42 | 1 | 41 | 1 | 41 | 1 | 28 | 1 |
Discussion
Methodological discussion
Psychological distress, neuroticism and disability in secondary chronic headaches
Prognosis of secondary chronic headaches
Conclusion
Major criteria | I. Symptoms and signs of neck involvement Ia. Precipitation of head pain, similar to the usually occurring one: Ia1) by neck movement and/or sustained, awkward head positioning, and/or: Ia2) by external pressure over the upper cervical or occipital region on the symptomatic side. Ib. Restriction of the range of motion (ROM) in the neck. Ic. Ipsilateral neck, shoulder or arm pain of a rather vague, non-radicular nature, or – occasionally – arm pain of a radicular nature. II. Confirmatory evidence by diagnostic anaesthetic blockades. III. Unilaterality of the head pain, without sideshift. |
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Head pain characteristics | IV. Moderate-severe, non-throbbing pain, usually starting in the neck. Episodes of varying duration, or: fluctuating, continuous pain. |
Other characteristics of some importance | V. Only marginal effect or lack of effect of indomethacin. Only marginal effect or lack of effect of ergotamine and sumatriptan. Female sex. Not infrequent occurrence of head or indirect neck trauma by history, usually of more than only medium severity. |
Other features of lesser importance | VI. Various attack-related phenomena, only occasionally present, and/or moderately expressed when present: a) nausea, b) phono- and photophobia, c) dizziness, d) ipsilateral “blurred vision”, e) difficulties swallowing, f) ipsilateral oedema, mostly in the periocular area. |
Major factors
| |
Facial pain/pressure | |
Nasal obstruction/blockage | |
Nasal discharge/purulence/discolored postnasal drainage | |
Hyposmia/anosmia | |
Purulence in nasal cavity on examination | |
Fever (acute rhinosinusitis) | |
Minor factors
| |
Headache | |
Fever (all nonacute) | |
Halitosis | |
Fatigue | |
Dental pain | |
Cough | |
Ear pain/pressure/fullness |