Document Detail

Precipitating and relieving factors of migraine versus tension type headache.
Jump to Full Text
MedLine Citation:
PMID:  22920541     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: To determine the differences of precipitating and relieving factors between migraine and tension type headache.
METHODS: This is a cross sectional study. We retrospectively reviewed the records of 250 migraine patients and 250 patients diagnosed as tension type headache from the specialized headache clinic in Dept. of Neurology, Dhaka Medical College Hospital. Data were collected through a predesigned questionnaire containing information on age, sex, social status and a predetermined list of precipitating and relieving factors.
RESULTS: In this study, the female patients predominated (67%). Most of the patients were within 21-30 years age group (58.6%). About 58% of them belonged to middle class families. The common precipitating factors like stress, anxiety, activity, journey, reading, cold and warm were well distributed among both the migraine and tension type headache (TTH) patients. But significant difference was demonstrated for fatigue (p < 0.05), sleep deprivation (p < 0.05), sunlight (p < 0.01) and food (p < 0.05), which were common among migraineurs. In consideration of relieving factors of pain, different maneuvers were commonly tried by migraineurs and significant difference were observed for both analgesic drug and massage (p < 0.05), which relieved migraine headache. But maneuvers like sleep, rest and posture were used by both groups.
CONCLUSION: The most frequent precipitating factors for headache appear to be identical for both migraine and TTH patients. Even though some factors like fatigue, sleep deprivation, sunlight and food significantly precipitate migraine and drug, massage are effective maneuver for relieving pain among migrianeurs.
Authors:
Badrul Haque; Kazi Mohibur Rahman; Azharul Hoque; A T M Hasibul Hasan; Rajib Nayan Chowdhury; Sharif Uddin Khan; Mondal Badrul Alam; Mansur Habib; Quazi Deen Mohammad
Publication Detail:
Type:  Journal Article     Date:  2012-08-25
Journal Detail:
Title:  BMC neurology     Volume:  12     ISSN:  1471-2377     ISO Abbreviation:  BMC Neurol     Publication Date:  2012  
Date Detail:
Created Date:  2012-11-22     Completed Date:  2013-05-17     Revised Date:  2013-07-12    
Medline Journal Info:
Nlm Unique ID:  100968555     Medline TA:  BMC Neurol     Country:  England    
Other Details:
Languages:  eng     Pagination:  82     Citation Subset:  IM    
Affiliation:
Department of Neurology, Dhaka Medical College Hospital, Dhaka, Bangladesh.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Age Distribution
Aged
Aged, 80 and over
Bangladesh / epidemiology
Child
Child, Preschool
Comorbidity
Fatigue / epidemiology*,  prevention & control
Female
Humans
Incidence
Male
Massage / utilization*
Middle Aged
Migraine Disorders / epidemiology*,  rehabilitation*
Risk Factors
Sex Distribution
Stress, Psychological / epidemiology*,  prevention & control
Tension-Type Headache / epidemiology*,  rehabilitation*
Young Adult
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Full Text
Journal Information
Journal ID (nlm-ta): BMC Neurol
Journal ID (iso-abbrev): BMC Neurol
ISSN: 1471-2377
Publisher: BioMed Central
Article Information
Download PDF
Copyright ©2012 Haque et al.; licensee BioMed Central Ltd.
open-access:
Received Day: 22 Month: 6 Year: 2012
Accepted Day: 22 Month: 8 Year: 2012
collection publication date: Year: 2012
Electronic publication date: Day: 25 Month: 8 Year: 2012
Volume: 12First Page: 82 Last Page: 82
PubMed Id: 22920541
ID: 3503560
Publisher Id: 1471-2377-12-82
DOI: 10.1186/1471-2377-12-82

Precipitating and relieving factors of migraine versus tension type headache
Badrul Haque1 Email: bhaque27@gmail.com
Kazi Mohibur Rahman1 Email: mohibur_68@yahoo.com
Azharul Hoque1 Email: azharul59@yahoo.com
ATM Hasibul Hasan2 Email: parag007us@gmail.com
Rajib Nayan Chowdhury1 Email: rajibchow86@yahoo.com
Sharif Uddin Khan1 Email: sharif.911@gmail.com
Mondal Badrul Alam1 Email: badrul_dmc@yahoo.com
Mansur Habib1 Email: mansur.habib@yahoo.com
Quazi Deen Mohammad1 Email: nins_dmc@yahoo.com
1Department of Neurology, Dhaka Medical College Hospital, Dhaka, Bangladesh
2Department of Medicine, Dhaka Medical College Hospital, Dhaka, Bangladesh

Background

Headache is the commonest neurological condition in terms of number of people affected [1]. A number of studies have reported that headache sufferers claim factors precipitating or triggering their headache and list is not a short one (stress, emotion, flickering light, noise, fatigue, food, season etc.) [2,3]. But studies devoted to specific triggers related to migraine and tension type headache (TTH) are rare. Henry et al. [4] evaluated these triggers among migraineurs. Rasmussen [5] used an unique structured headache interview method. Robbins [6] gathered information on triggers at first visit to headache clinic. Peatfield [7] studied the relation of food with headache. Only Larmande et al [8] evaluated the climate as a possible precipitating factor. Martin et al [9] grouped these precipitators into two major classes; the negative effect (stress, anxiety, depression) and the visual disturbance (flicker, glare, eyestrain).Attention to trigger factors plays a prominent role in the clinical management of headaches. Schulman and Silberstein [10] advise, for example, that “wherever possible, practitioners should help susceptible patients learn to avoid triggers”, and Skaer [11] states that “migraine prevention is best achieved by avoidance of known migraine triggers”. The logic of this advice is very clear and, of course, if individuals could avoid any factor that could trigger a headache then they would not get a headache. In the practice of headache management, precipitating factors are established for patients to avoid. They also provide insight into the mechanisms involved in the headaches, facilitating diagnosis. The question addressed in this study was as to see whether there are precipitating and relieving factors that separate the two most common headache conditions, ie, migraine and tension-type headache.


Methods

This is an observational study carried out in weekly Headache outdoor clinic of Department of Neurology, DMCH. We reviewed the records of 250 migraine and same number of tension type headache (TTH) patients. All the patients were diagnosed clinically following the International Classification of Headache Disorder version-2 (ICHD-II) criteria by consultant neurologists at the clinic. The clinical diagnosis was considered as gold standard, considering the detail history of headache, examination findings and the vast clinical experience of the consultant neurologist in diagnosing headache disorder with the support of ICHD classification criteria. All the subtypes of migraine (migraine with aura, without aura, chronic migraine, probable migraine) were considered under the broad terminology of migraine headache. We included only those patients in whom headache could be classified convincingly either as migraine or TTH. Any patient of headache disorder with comorbid illness or more than one type of headache (combination of migraine and TTH, medication over use) were excluded from the study. We have used a predetermined check list of 11 established precipitating factors and 5 relieving factors for headache (Table 1). The study protocol was approved by the ethical committee of Dhaka Medical College hospital. Data were collected from hospital records by preformed questionnaire containing information on age, sex, social status, precipitating and relieving factors. Data was analyzed using SPSS-16 system.


Result

In this study we divided all the 500 headache patients equally into two groups: migraine and TTH, following the international headache society criteria. All the precipitating and relieving factors we looked for are listed in (Table 1). The female patients predominated in this study (67% female and 33% male). Most of the patients were within 21–30 years age group (58.6%), followed by 18.2% patients within 11–20 years. Only 1.6% patients were below 10 years and 0.4% above 60 years of age (Table 2). About 58% of them belonged to middle class families and 40.6% from lower socioeconomic back ground (Table 2). The distribution of precipitating factors is listed in (Table 3). Most of the patients reported multiple precipitating and relieving factors. The common precipitating factors like stress (81, 96), anxiety (68, 51), activity (34, 24), journey (58, 46), reading (11, 14), cold (24, 31) and warmth (16, 24) were well distributed among both the migraine and TTH patients. But significant difference was demonstrated for fatigue (p < 0.05), sleep deprivation (p < 0.05), sunlight (p < 0.01) and food (p < 0.05). The relieving factors are enlisted in (Table 4). Significant difference were observed for both drug (152, 126) and massage (17, 6) (p < 0.05), which relieved migraine headache. But factors like sleep (146, 131), rest (25, 21) and posture (4, 1) were well distributed within both groups. Interestingly, the migraineurs tried each maneuver for headache remedy more frequently than the TTH patient except for the massage.


Discussion

Different precipitating factors for headache that we studied had been described by several authors previously [12,13]. In this study we have observed that several precipitating factors were identical among both migraineurs and TTH patients. Factors related to endogenous psychogenic mechanism like stress, anxiety were well distributed among both groups as precipitator. Rasmussen [5] also reported stress and mental tension as most frequent precipitants for both migraine and tension type of headache. In a study of 494 patients with migraine headache Robbins L [6] et al. observed similarly that stress was the most cited precipitating factor. Stress/ anxiety does so by central mechanism through direct activation of the ascending reticular pathway. Other factors like journey, physical activity, exposure to cold/warm, reading were also common in both group of patients and did not show any significant difference. Contrary to this finding, in a population based study in Croatia Zivadinov R [14] et al. showed that stress was associated with migraine whereas physical activity was related to TTH. Journey, change in weather and temperature were also associated among patient of migraine with aura in his study. The difference might account on the social and environmental variation among population. Similar to Spierings ELH et al. [15] we didn’t find any precipitating factor that was significantly reported frequently by TTH patients than the migraineurs. Instead fatigue, deprivation from sleep, sunlight and food were more frequently indicated significantly by migraineurs than the TTH patients (p <0.05 in all of the factors). Our finding is also supported by the report of Chabriat H et al. [16] who showed that fatigue, sleep difficulty and food or drinks more frequently precipitate headache among migraineurs than the nonmigraneurs. Deprivation of sleep results in fatigue which in turn, activates the sympathetic outflow to boost metabolic process for availability of energy. The sympathetic activation subsequently thought to precipitate headache.

Most of the people with headache disorders practice many nonpharmacological measures to get the relief of the pain. However, it is not known whether behavior during the attack is headache-type-specific or a general response to head pain. Martins and Prarreira [17,18] identified six maneuvers tried by the patients, most commonly the migraineurs to improve the headache during and attack. It is a common observation, by clinicians involved in the headache field that many patients use some instinctive manoeuvres, of their own accord that tend to alleviate their suffering. In our quest to identify the relieving factors we also observed that the rates of use of each maneuver were more frequent for the migraineurs, though the difference was not significant except for drug and massage. Other factors like sleep, rest and posture were well used by both groups. Both use of drug and massage was associated with relieve of pain in migraneurs. But this is quite contrary to the report of Bag B et al. [19] where massage relived pain among TTH patients. Unlike our observation, they also showed sleep, rest, change in posture were also significantly relieved pain with migraine patients.

We had some limitations in this study. Firstly, we could not match the age and sex among the two groups of patients due to wide variation of age and sex specific prevalence of headache and the retrospective nature of the study. Secondly, the chance of recall bias was minimized by the check list of precipitating and relieving factors in hospital records. Finally, the chance of observer biasness in diagnosis of headache disorder was also minimized as they followed the international headache society criteria (ICHD-II 2004) at the specialized headache clinic.


Conclusion

Most of the precipitating and relieving factors are common and similar in both migraine and TTH patients. Though some of them (fatigue, sleep deprivation, sunlight and food) are indicated significantly among migraineurs, there is no factor associated significantly with TTH. This difference is also true for relieving factors (drug and massage relived migraine headache). The careful monitoring of the precipitating factors of headache could be an important step in treatment, because their avoidance may lessen the frequency and severity of attacks. Furthermore, they may also provide a clue to the aetio-pathogenesis of headache. So the search for these precipitating and relieving factors should be continued in future.


Competing interest

The authors declare that they have no competing interests.


Author’s contributions

The first three authors were involved in patient consultation, data collection and writing the article. The corresponding author was involved in data entry, data analysis and writing the article. The rest of the authors were involved in patient consultation and data collection step of the research. All authors read and approved the final manuscript.


Funding

The study was not funded by any donor agency.


Pre-publication history

The pre-publication history for this paper can be accessed here:

http://www.biomedcentral.com/1471-2377/12/82/prepub


References
WHO report on South East Asia http://www.searo.who.int/LinkFiles/Information_and_Documents_facts.
Martin PR,Psychological management of chronic headachesYear: 1993Guilford, New York
Scopp AL,Headache triggers: Theory, research and clinical application — Part IHeadache QuarterlyYear: 199233238
Henry P,Michel P,Dartigues JF,et al. the GRIM. Epidemiology of migraine in France [in French]. In: La Migraine en FranceYear: 1993John Libbey Eurotext, Paris2748
Rasmussen BK,Migraine and tension-type headache in a general population: precipitating factors, female hormones, sleep pattern and relation to lifestylePainYear: 199353657210.1016/0304-3959(93)90057-V8316392
Robbins L,Precipitating factors in migraine: a retrospective review of 494 patientsHeadacheYear: 19943421421610.1111/j.1526-4610.1994.hed3404214.x8014037
Peatfield RC,Relationships between food, wine, and beer-precipitated migrainous headachesHeuducheYear: 19953535535710.1111/j.1526-4610.1995.hed3506355.x
Larmande P,Hubert B,Sorabella A,et al. Influence of changes in climate and the calendar on the onset of a migraine crisis [in French]Rev NeuralYear: 19961523843
Martin PR,Milech D,Nathan PR,Towards a functional model of chronic headachesHeadacheYear: 19933346147010.1111/j.1526-4610.1993.hed3309461.x8262791
Schulman EA,Silberstein SD,Symptomatic and prophylactic treatment of migraine and tension-type headacheNeurologyYear: 199242Suppl. 216211557187
Skaer TL,Clinical presentation and treatment of migraineClin TherYear: 19961822924510.1016/S0149-2918(96)80004-X8733984
Peatfield RC,Olesen J,Precipitating factors. In: Oiesen J, Tfelt-Hansen P Welch KMA, eds. The HeadachesYear: 1993Raven Press, Ltd, New York241245
Pearce JM,Blau JNNeural aspects of migraineMigraine: Clinical, Therapeutic, Conceptual and Research AspectsYear: 1987Chapman and Hall, London247263
Zivadinov R,Willheim K,Sepic-Grahovac D,et al. Migraine and tension-type headache in Croatia: a population-based survey of precipitating factorsCephalalgiaYear: 2003 Jun2353364310.1046/j.1468-2982.2003.00544.x12780762
Spierings ELH,Ranke AH,Honkoop PC,Precipitating and aggravating factors of migraine versus tension type headacheHeadacheYear: 20014155455810.1046/j.1526-4610.2001.041006554.x11437890
Chabriat H,Danchot J,Michel P,et al. Precipitating Factors of HeadacheA Prospective Study in a National Control-Matched Survey in Migraineurs and Nonmigraineurs. HeadacheYear: 199939335338
Martins IP,Parreira E,Tricks to relieve migraine attacksHeadache QYear: 2000111137
Martins IP,Parreira E,Behavioral response to headache: a comparison between migraine and tension-type headacheHeadacheYear: 2001415465310.1046/j.1526-4610.2001.041006546.x11437889
Bag B,Karabulut N,Pain relieving factors in migraine and tension type headacheInt J Clin PractYear: 200559776076310.1111/j.1368-5031.2005.00535.x15963200

Tables
[TableWrap ID: T1] Table 1 

List of headache precipitating and relieving factors


Precipitating factors:  
1. Fatigue
 
2. Stress
 
3. Anxiety
 
4. Cold
 
5. Warm
 
6. Sunlight
 
7. Sleep deprivation/Insomnia
 
8. Food
 
9. Activity
 
10. Journey
 
11. Reading
 
Relieving factors:
 
1. Sleep
 
2. Drug
 
3. Rest
 
4. Posture
 
5. Massage  

[TableWrap ID: T2] Table 2 

Socio demographic profile of the patients (n = 500)


Parameter n %
Age
 
 
  <10yr
8
1.6
  11-20yrs
91
18.2
  21-30yrs
293
58.6
  31-40yrs
69
13.8
  41-50yrs
22
4.4
  51-60yrs
15
3
  >60yrs
2
0.4
Sex
 
 
  Male
165
33
  Female
335
67
Socio-economic status
 
 
  Lower
203
40.6
  Middle
90
58
  Upper 7 1.4

[TableWrap ID: T3] Table 3 

Comparison of common precipitating factors among migraine and TTH


Precipitating factor Migraine (%) TTH (%) pvalue
Sunlight
110 (44)
70 (28)
<0.01
Fatigue
34 (13)
18 (7)
<0.05
Sleep deprivation
52 (20)
35(14)
<0.05
Stress
81 (32)
96 (38)
>0.05
Anxiety
68 (27)
51 (20)
>0.05
Cold
24 (9)
31 (12)
>0.05
Warm
16 (6)
24 (9)
>0.05
Activity
34 (14)
24 (9)
>0.05
Journey
58 (23)
46 (18)
>0.05
Food
7 (2.8)
1(0.4)
<0.05
Reading 11 (4) 14 (5) >0.05

[TableWrap ID: T4] Table 4 

Comparison of common relieving factors among migraine and TTH


Relieving factor Migraine (%) TTH (%) pvalue
Drug
152 (61)
126 (50)
<0.05
Sleep
146 (58)
131 (52)
>0.05
Massage
17 (7)
6 (2.4)
<0.05
Rest
25 (10)
21(8.4)
>0.05
Posture 4 (1.6) 1 (0.4) >0.05


Article Categories:
  • Research Article

Keywords: Headache, Tension type headache (TTH), Migraine.

Previous Document:  Bioflotation of sulfide minerals with Acidithiobacillus ferrooxidans in relation to copper activatio...
Next Document:  Trapping of p-coumaryl and coniferyl alcohol during soda-AQ treatment : A means of estimating uncond...