A set of related medical disorders that lack a proper classification system and diagnostic criteria is like a society without laws. The result is incoherence at best, chaos at worst. For this reason, the International Classification of Headache Disorders (ICHD) is arguably the single most important breakthrough in headache medicine over the last 50 years. The ICHD identifies and categorizes more than a hundred different kinds of headache in a logical, hierarchal system. Even more important, it has provided explicit diagnostic criteria for all of the headache disorders listed. The ICHD quickly became universally accepted, and criticism of the classification has been minor relative to that directed at other disease classification systems. Over the 20 years following publication of the first edition of the ICHD, headache research has rapidly accelerated despite sparse allocation of resources to that effort. In summary, the ICHD has attained widespread acceptance at the international level and has substantially facilitated both clinical research and clinical care in the field of headache medicine.

International Classification of Headache Disorders

Fibromyalgia and Overlapping Disorders: The Unifying Concept of Central Sensitivity Syndromes

Studying the epidemiology of fibromyalgia (FM) is very important to understand the impact of this disorder on persons, families and society. The recent modified 2010 classification criteria of the American College of Rheumatology (ACR), without the need of tender points palpation, allows that larger and nationwide surveys may be done, worldwide. This article reviews the prevalence and incidence studies done in the general population, in several countries/continents, the prevalence of FM in special groups/settings, the association of FM with some sociodemographic characteristics of the population, and the comorbidity of FM with others disorders, especially with headaches.

Worldwide Epidemiology of Fibromyalgia

Objective To characterise and compare the sociodemographic profiles and the frequency of common comorbidities for adults with chronic migraine (CM) and episodic migraine (EM) in a large population-based sample. Methods The American Migraine Prevalence and Prevention (AMPP) study is a longitudinal, population-based, survey. Data from the 2005 survey were analysed to assess differences in sociodemographic profiles and rates of common comorbidities between two groups of respondents: CM (ICHD-2 defined migraine; ≥15 days of headache per month) and EM (ICHD-2 defined migraine; 0–14 days of headache per month). Categories of comorbid conditions included psychiatric, respiratory, cardiovascular, pain and ‘other’ such as obesity and diabetes. Results Of 24 000 headache sufferers surveyed in 2005, 655 respondents had CM, and 11 249 respondents had EM. Compared with EM, respondents with CM had stastically significant lower levels of household income, were less likely to be employed full time and were more likely to be occupationally disabled. Those with CM were approximately twice as likely to have depression, anxiety and chronic pain. Respiratory disorders including asthma, bronchitis and chronic obstructive pulmonary disease, and cardiac risk factors including hypertension, diabetes, high cholesterol and obesity, were also significantly more likely to be reported by those with CM. Discussion Sociodemographic and comorbidity profiles of the CM population differ from the EM population on multiple dimensions, suggesting that CM and EM differ in important ways other than headache frequency.

https://jnnp.bmj.com/content/jnnp/81/4/428.full.pdf

Sociodemographic and comorbidity profiles of chronic migraine and episodic migraine sufferers

Background:The epidemiology of fibromyalgia is poorly defined. The incidence of fibromyalgia has not been determined using a large population base. Previous studies based on prevalence data demonstrated that females are 7 times more likely to have fibromyalgia than males and that the peak age for fe

The incidence of fibromyalgia and its associated comorbidities: a population-based retrospective cohort study based on International Classification of Diseases, 9th Revision codes.

Fibromyalgia (FM) and transformed migraine (TM) are common chronic pain disorders. The authors estimated the prevalence of FM in 101 patients with TM, and analyzed its relationship to depression, anxiety, and insomnia. FM was diagnosed in 35.6% of cases. Patients with FM had more insomnia, were older, and had headaches that were more incapacitating than patients without FM. Insomnia and depression predicted FM in patients with TM.

Fibromyalgia is common in patients with transformed migraine

The association of chronic paroxysmal hemicrania and ticlike pain-chronic paroxysmal hemicrania-tic (CPH-tic)-is a recently described syndrome. The authors found only two previously reported cases. They report three new cases of this rare syndrome with both chronic paroxysmal hemicrania and ticlike pain concurrently and ipsilaterally. The trigeminal-autonomic cephalalgias (TAC) are considered as differential diagnoses. CPH-tic syndrome could be a different clinical entity.

Chronic paroxysmal hemicrania-tic syndrome.

This paper will discuss evidence which supports a link between ‘side locked’ migraine (SLM) and the trigeminal autonomic cephalgias (TACs). Recent papers brought strictly unilateral primary headaches into focus, proposing new classification and discussing pathophysiological mechanisms. We reviewed those proposals and present evidence that SLM falls in between the well-defined TACs and side shifting migraine (SSM). It is difficult to differentiate SLM from the recently proposed headache subtype called hemicrania generis incerti (i.e. hemicrania continua unresponsive to indomethacin). We also present cases that may exemplify the considerations made in the paper.

‘Side locked’ migraine and trigeminal autonomic cephalgias: evidence for clinical overlap

Episodic paroxysmal hemicrania (EPH) is a rare disorder characterized by frequent, daily attacks of short-lived, unilateral headache with accompanying ipsilateral autonomic features. EPH has attack periods which last weeks to months separated by remission intervals lasting months to years, however, a seasonal variation has never been reported in EPH. We report a new case of EPH with a clear seasonal pattern: a 32-year-old woman with a right-sided headache for 17 years. Pain occurred with a seasonal variation, with bouts lasting one month (usually in the first months of the year) and remission periods lasting around 11 months. During these periods she had headache from three to five times per day, lasting from 15 to 30 minutes, without any particular period preference. There were no precipitating or aggravating factors. Tearing and conjunctival injection accompanied ipsilaterally the pain. Previous treatments provided no pain relief. She completely responded to indomethacin 75 mg daily. After three years, the pain recurred with longer attack duration and was just relieved with prednisone. We also propose a new hypothesis: the EPH-cluster headache continuum.

/pdf/episodic-paroxysmal-hemicrania-with-seasonal-variation-case-2foytjesm7.pdf

Episodic paroxysmal hemicrania with seasonal variation: case report and the EPH-cluster headache continuum hypothesis.

Background

The role of socioeconomic status in the worldwide stroke burden has been studied with various methods using vital statistics and research-generated data.



Aim

The objective of our study was to describe the stroke mortality rates and the stroke mortality distribution, and to evaluate the association between stroke mortality rates and geographical distribution with the human development index in Sao Paulo, Brazil.



Methods

This ecological study evaluated a historical series of stroke mortality in Sao Paulo, Brazil, from 2004 to 2010. Standard stroke mortality rate per 100 000 inhabitants at each year, the address of residence assumed as the place of living, and the human development index applied as a social indicator were used in order to evaluate if stroke mortality correlated with socioeconomic status.



Results

The mean standardized stroke mortality in Sao Paulo decreased from 66 to 46·7 per 100 000 inhabitants from 2004 to 2010. Stroke mortality differed according to human development index strata with an almost three times higher stroke mortality in the lowest when compared with the highest human development index stratum. Visual inspection of the map of the districts with high stroke mortality disclosed regional clusters with high mortality in the east, northwest, and south regions, a finding suggestive of the presence of a stroke belt inside the city of Sao Paulo.



Conclusions

In conclusion, between 2004 and 2010, stroke mortality rates decreased by 28·5% in Sao Paulo. A geographical pattern in stroke mortality could be observed, with considerable differences according the human development index level of the place of living.

A. O. Kaup

Papers

Fibromyalgia is common in patients with transformed migraine

Chronic paroxysmal hemicrania-tic syndrome.

‘Side locked’ migraine and trigeminal autonomic cephalgias: evidence for clinical overlap

Episodic paroxysmal hemicrania with seasonal variation: case report and the EPH-cluster headache continuum hypothesis.

Georeferencing deaths from stroke in São Paulo: an intra-city stroke belt?