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TEXT BOOK REVIEW OBESITY IS A RISK FACTOR FOR TRANSFORMED MIGRAINE BUT NOT CHRONIC TENSION-TYPE HEADACHE

TEXT BOOK REVIEWOBESITY IS A RISK FACTOR FOR TRANSFORMED MIGRAINE BUT NOT CHRONIC TENSION-TYPE HEADACHETutor : dr.Untung G., Sp.S

Created By: Nurul Arsy M. G4A013038

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BACKGROUND

DEFINITION

Classification HeadacheBased on the International Classification of Headache Disorders edition 2 2013 ( ICHD - 3 )

Migrain A chronic condition characterized by episodic headache with moderate - severe intensity that ends within 4-72 hours

Migrain Without AuraDiagnostic CriteriaA. At least five attacks1 fulfilling criteria BDB. Headache attacks lasting 4-72 hours (untreated or unsuccessfully treated)2,3C. Headache has at least two of the following four characteristics:1. unilateral location2. pulsating quality3. moderate or severe pain intensity4. aggravation by or causing avoidance of routine physical activity (e.g. walking or climbing stairs)D. During headache at least one of the following:1. nausea and/or vomiting2. photophobia and phonophobiaE. Not better accounted for by another ICHD-3 diagnosis.Migrain With AuraDiagnostic Criteria A. At least two attacks fulfilling criteria B and CB. One or more of the following fully reversible aura, symptoms:: visual, sensory, speech and/or language, motor, brainstem, retinalC. At least two of the following four characteristics:1. at least one aura symptom spreads graduallyover 5 minutes, and/or two or more symptomsoccur in succession2. each individual aura symptom lasts 5-60 minutes13. at least one aura symptom is unilateral24. the aura is accompanied, or followed within 60minutes, by headacheD. Not better accounted for by another ICHD-3 diagnosis,and transient ischaemic attack has beenexcluded.

Chronic Migrain (Transformed Migrain)Headache occurring on 15 or more days per month for more than 3 months, which has the features of migraine headache on at least 8 days per month

Diagnostic Criteria :A. Headache (tension-type-like and/or migraine-like) on 15 days per month for >3 months2 and fulfilling criteria B and CB. Occurring in a patient who has had at least five attacks fulfilling criteria B-D for 1.1 Migraine without aura and/or criteria B and C for 1.2 Migraine with auraC. On 8 days per month for >3 months, fulfilling any of the following3:1. criteria C and D for 1.1 Migraine without aura2. criteria B and C for 1.2 Migraine with aura3. believed by the patient to be migraine at onset and relieved by a triptan or ergot derivativeD. Not better accounted for by another ICHD-3 diagnosis.

Tension Type Headache (TTH)intense headache or suppress or bound , mild to moderate pain intensity, usually bilateral. at first may occur episodically and is associated with stress, anxiety or depression, not worsen with routine activities and can be accompanied by nausea, phonophobia or photophobia without vomiting

Infrequent episodic tension-type headacheDiagnostic criteria:A. At least 10 episodes of headache occurring on 25Obesity is a risk factor for chronic daily headaches (CDHs), headaches occurring 15 or more days per monthThe two most frequent subtypes of CDH are transformed migraine (TM) and chronic tension-type headache (CTTH)A longitudinal population study identified that among individuals with episodic headache, obesity was associated with a fivefold increased annual incidence of new-onset CDH.A large population study also suggested that obesity is associated with the frequency and severity of migraine attacksHypothesized : obesity being a risk factor for migraine frequency and severity, obesity is a stronger risk factor for TM than for CTTH.

MethodsPopulation sample and computer-assisted telephone interviewin three large metropolitan areas in the United States, from 1997 to 2000Include : All age-eligible individuals (>18 years old) from the household who agreed to participate were interviewed, approved the informed consent,.Who were subsequently scheduled for an interview with trained interviewers, using a validated computer-assisted telephone interview (CATI).

ContdIn the CATI, will asked:History the headache not due to a head injury, hangover, pregnancy, fluWhether they have a at least five headache in the previous yearhow many different types of headache they hadabout the most severe self-defined headache type that the respondent had in the last 12 monthsassessed demographic information (age, gender, race, educational level, marital status) and health status (history of several other medical conditions). Information about their weight and heightHeadache severity 10-point scaleanalgesik drug used in the last 3 months

SampelGroup 1: Persons with CDH had an average of 15 or more headache days per month, with an average duration of more than 4 hours per dayGroup 2: Controls had no headaches or had fewer than 108 headaches per year and did not fill criteria for migraine.

Headache Status Silberstein and Lipton [S-L] criteria, CDH divide it in four groups: TM, CTTH, new daily persistent headache (NDPH), and hemicrania continua (HC)The ICHD-2 defines a disorder analogous to TM, chronic migraine(CM), and presents criteria for the other CDH. It is important to emphasize that all subjects with CM also fill criteria for TM. The studies subdivided the persons with CDH into those with migraine attacks (herein called TM) and without migraine attacks (CTTH). Define TM as CDHs associated with at least 12 migraine attacks in the prior year.

Severity and disabilityA. Severity mild pain intensity ranged from 1 - 3moderate pain ranging from 4 - 7 severe pain ranging from 8 10B. Disability the subject missed activities because of their headache over a 3-month periodAnalysisUsing Stata (Intercooled Stata 6.0 for Windows, College Station, TX)BMI was calculated = (weight [lbs]/height2 [in]) * 703Underweight (35)X2 test compare proportions, Multivariate logistic regression estimate the odds ratio (OR), Multivariate model to estimate the differential effects of obesity on CDH and its subtypes

Result

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Discussion

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Obesity may influence migrain through several mechanism:Proinflammatory statesProthrombotic statesAdiponectin, leptin , resistinOrexinCGRP Autonomic nervous system

Conclusion Tension -type headache and migraine is a type of primary headache are the most common. Primary headache usually paroxysmal , but there is chronic. Chronic headache is a pain in the head > 15 days in a month and felt > 3 monthsRisk factors associated with chronic headache were obese (body mass index > 30), women, low education, low socioeconomic status, history of head injury, snoring (sleep apnea), stressful life events, high caffeine consumption, excessive use drugs - drugs acutely, and depressionObesity may influence migrain through several mechanism: Proinflammatory states Prothrombotic states, Adiponectin, leptin , resistin, Orexin, CGRP , Autonomic nervous system Chronic daily headache and obesity are associated. Obesity is a stronger risk factor for transformed migraine than for chronic tension-type headache.

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