Showing papers by "Stefan Evers published in 2007"

Headache Prevalence Among Adolescents — The German DMKG Headache Study:

Abstract: This population-based cross-sectional study examined the 3-month prevalence of headache, migraine and tension-type headache (TTH) among adolescents aged 12-15 years in Germany. Students (n = 3324) from 20 schools completed a questionnaire on general and headache-specific pain which included a sociodemographic module. The headache-specific questionnaire complied with the respective revised criteria of the International Headache Society (IHS). 'Modified criteria' changed the item 'duration' in migraine (>30 min instead of > 4 h). The overall 3-month prevalence of headache was 69.4% (boys 59.5%, girls 78.9%), with 4.4% of the adolescents suffering from frequent (>or=14 days/3 months) and severe (grade 8-10 on a 10-point visual analogue scale) headache and 1.4% (boys 0.9%, girls 1.9%) from headache >or= 15 days/month. The 3-month prevalence of migraine was 2.6% (boys 1.6%, girls 3.5%) applying strict IHS criteria and 6.9% (boys 4.4%, girls 9.3%) with modified criteria; 12.6% (boys 8.3%, girls 16.7%) suffered from probable migraine, 0.07% fulfilled the criteria for chronic migraine, 4.5% (boys 4.6%, girls 4.3%) suffered from TTH, 0.2% from chronic TTH and 15.7% (boys 14.5%, girls 16.9%) from probable TTH. Headache and migraine were more common in girls than in boys and in teenagers, especially in girls, aiming at higher education. Recurrent headache and primary headache disorders are common complaints among German adolescents, especially among girls.

Comorbidity of Migraine and Restless Legs Syndrome—A Case-Control Study

Abstract: In order to evaluate a possible association between migraine and restless legs syndrome (RLS), we performed a case-control study on the comorbidity of RLS and migraine. Patients with migraine (n = 411) and 411 sex- and age-matched control subjects were included. Migraine was diagnosed according to International Headache Society criteria, RLS according to the criteria of the International Restless Legs Syndrome Study Group. Furthermore, all patients had to fill out a self-assessment test performance on depression [Beck's Depression Inventory (BDI)]. RLS frequency was significantly higher in migraine patients than in control subjects (17.3% vs. 5.6%, P < 0.001; odds ratio 3.5, confidence interval 2.2, 5.8). In our sample, there was no significant association between migraine and depression as defined by the BDI score (9.6% in migraine vs. 4.0% in control subjects, P = 0.190). Depression was, however, not significantly more frequent in migraine patients with RLS (13.6%) than in migraine patients without RLS (8.7%). In addition, migraine patients with RLS had a significantly higher BDI score. RLS features did not differ significantly between migraine patients with RLS and control subjects with RLS. There is an association between RLS and migraine and, in addition, a co-association with depression. The underlying mechanism, however, remains undetermined and might be related to a dysfunction of dopaminergic metabolism in migraine.

Headache associated with sexual activity: prognosis and treatment options.

Abstract: The aim of this study was to provide data on the prognosis and treatment options of headache associated with sexual activity (HSA). Sixty patients diagnosed with HSA between 1996 and 2004 were followed up between 2003 and 2006 at least 12 months after the first interview. The further course of the disease and their contentedness with therapy were requested. On average, the second interview was performed 35.9 months after the first examination. Of the 45 patients who had suffered from single attacks or bouts prior to baseline examination, 37 had no further attacks. Seven patients suffered from at least one further bout with an average duration of 2.1 months. One patient developed a chronic course of the disease after an episodic start. Of the 15 patients with chronic disease at the first examination, seven were in remission and five had ongoing attacks at follow-up. Ten patients received indomethacin for preemptive therapy, with good results in nine patients. Eighteen patients received beta-blockers for prophylaxis, with good results in 15 patients. Episodic HSA occurs in approximately three-quarters and chronic HSA in approximately one-quarter of patients. Even in chronic HAS, the prognosis is favourable, with remission rates of 69% during an observation period of 3 years. For patients with longer-lasting bouts or with chronic HSA, prophylactic treatment with beta-blockers or preemptive therapy with indomethacin are often successful.

Prevalence of cluster headache in Germany: results of the epidemiological DMKG study

Abstract: Cluster headache is a primary headache disorder diagnosed according to the criteria of the International Headache Society.1 Previous epidemiological studies have shown prevalence rates of 0.056–0.38%. These were lifetime prevalence rates which are subject to recall bias. No population based prevalence rates for Germany have been published to date. Despite the use of common criteria, sociocultural influences on the classification of cluster headache may be significant. Thus it is important to compare epidemiological study results from different countries to elucidate such relations. We conducted a population based survey on the prevalence of cluster headache in Germany which was part of a larger epidemiological study on the prevalence of different headache types and which was coordinated by the German Migraine and Headache Society (DMKG). A sample of 3425 inhabitants of the city of Dortmund, Germany, aged 25–75 years, was randomly selected and invited to participate in a larger epidemiological study …

Comorbidity of migraine and headache associated with sexual activity.

Abstract: In order to investigate the comorbidity of migraine and headache associated with sexual activity (HSA), we performed a case-control study based on migraine patients By means of a questionnaire and a personal interview, 100 migraine patients and 100 control subjects were examined regarding a diagnosis of HSA In five subjects from the migraine group vs none from the control group, a diagnosis of HSA could be established (P = 0021) Previous studies that have demonstrated comorbidity of migraine and HSA were all based on HSA patients Thus, it can now be concluded that the association between the two headache disorders is bilateral In addition, the prevalence of HSA in the general population can be estimated to average around at least 09%, which concurs with previously published data

Comorbidity of restless legs syndrome and HIV infection.

Abstract: Background The lifetime prevalence of restless legs syndrome (RLS) is about 10 % in the general population. The association of RLS with HIV infection is unknown. We aimed to investigate the prevalence of RLS in HIV positive patients and to define predictors.

Hypnic headache successfully treated with botulinum toxin type A.

Abstract: Hypnic headache is a primary dull headache that always awakens the patient from asleep. The diagnostic criteria [2nd edition of the International Classification of Headache Disorders (ICHD-II)] of hypnic headache require a dull headache without autonomic symptoms and no more than one of three symptoms nausea, photophobia, or phonophobia and at least two of the following three characteristics: occurrence 15 times a month, duration >15 min after awaking and first occurrence after the age of 50 years (1). The incidence is very low, <100 cases having been published to date. Randomized doubleblind studies do not exist, but, according to the most detailed review, the most efficient treatment is lithiumwith a good response in 26 out of 35 cases (2). Alternative, partly successful prophylactic strategies (more than two positive case reports with good response) include indomethacin, caffeine, flunarizine and melatonin (2). Botulinum toxin type A (BTX-A) has been extensively investigated as a prophylactic agent for idiopathic and symptomatic headache. Whereas the majority of double-blind, placebo-controlled studies with botulinum toxin do not confirm an efficacy in idiopathic headache disorders, for chronic daily headache with migraineous features the data are inconsistent and severely impaired subgroups seem to benefit from BTX-A injections (for review see (3)). No report on its efficacy in hypnic headache has yet been published in a peer-reviewed journal.

Therapie primärer chronischer Kopfschmerzen: Chronische Migräne, chronischer Kopfschmerz vom Spannungstyp und andere chronische tägliche Kopfschmerzen - Evidenzbasierte Empfehlungen der Deutschen Migräne- und Kopfschmerzgesellschaft in Zusammenarbeit m

Abstract: Die IHS-Kriterien definieren vier primare Kopfschmerzerkrankungen, die zu taglichen Dauerkopfschmerzen fuhren konnen: 1) chronische Migrane, 2) Kopfschmerz vom Spannungstyp, 3) Hemicrania continua, 4) neu aufgetretener Kopfschmerz. In der Praxis ist davon haufig der Kopfschmerz durch Medikamentenubergebrauch (fruher: Analgetikakopfschmerz) abzugrenzen. Die jetzt von der Deutschen, Osterreichischen und Schweizer Kopfschmerzgesellschaft gemeinsam vorgelegte Therapieleitlinie fasst die Literatur zur Therapie dieser Kopfschmerzformen zusammen und gibt Therapieempfehlungen, die die Literaturevidenz, aber auch die Praktikabilitat berucksichtigen.

The impact of ziprasidone in combination with sertraline on visually-evoked event-related potentials in depressed patients with psychotic features

Abstract: Background The use of atypical antipsychotics in major depression complicated by psychotic features has not been extensively investigated. Event-related potentials (ERP) have been reported to be impaired in depressed patients, probably due to serotonergic hypofunction. The objective of this study was to examine the effects of a combination therapy with ziprasidone and sertraline on ERP in major depression with psychotic features. Methods 19 patients with major depression with psychotic features were treated with ziprasidone and sertraline. Before and after four weeks of treatment, visually-evoked ERP (P3 — oddball paradigm) were investigated. Results While a significant clinical improvement assessed with the Brief Psychiatric Rating Scale and Hamilton Depression Rating Scale was noted, no significant changes in weight, basal prolactin values and scores on the Extrapyramidal Symptoms Scale were observed. A significant prolongation ( p = 0.041) of the QTc-interval between baseline and endpoint showed no clinical symptoms. Combination treatment with ziprasidone and sertraline over 4 weeks was associated with a significant decrease ( p = 0.033) of P3 latencies from baseline to week 4. After a four week treatment, significantly ( p = 0.008) fewer patients showed pathologically P3 latencies (> 450 ms) than at baseline. Discussion Our data, showing that ziprasidone in combination with sertraline lead to a decrease of prolonged P3 latencies, are in line with previous studies showing a decrease of prolonged P3 latencies by antidepressant treatment.

Effectiveness and Satisfaction with Zolmitriptan 5mg Nasal Spray for Treatment of Migraine in Real-Life Practice

Abstract: Objective: Addressing the needs of migraineurs by actively seeking patient feedback on disease-related disability and treatment satisfaction may lead to improved management and treatment outcomes Patient feedback can be collected in postmarketing surveillance (PMS) studies The objective of this PMS study was to evaluate the efficacy and tolerability of zolmitriptan 5mg nasal spray in the acute treatment of migraine attacks Patients and methods: Patients received zolmitriptan 5mg nasal spray to treat migraine attacks of any severity and were followed up after a maximum of 4 months Patients evaluated the efficacy and tolerability of zolmitriptan nasal spray, and were asked whether they wished to continue using zolmitriptan nasal spray and their preference compared with previous treatments Physicians also assessed the efficacy and tolerability of zolmitriptan nasal spray Results: A total of 1838 patients (848% females) participated in the study Within 30 minutes of administration of zolmitriptan nasal spray, 850% of patients reported improvements in headache pain, with 251% reporting an improvement within 10 minutes At 1 hour post-dose, 579% of patients were pain free and 617% were able to resume usual daily activities Most patients (729%) rated zolmitriptan nasal spray as ‘better’ than previous therapy The majority (888%) expressed a wish to continue using zolmitriptan nasal spray Physicians evaluated the efficacy of zolmitriptan nasal spray as ‘excellent’ or ‘good’ in 894% of patients Tolerability was evaluated as ‘excellent’ or ‘good’ in 916% of patients Conclusions: Zolmitriptan 5mg nasal spray provides favourable efficacy and tolerability in the acute treatment of migraine attacks Most patients assessed zolmitriptan nasal spray as ‘better’ than previous treatment, with nearly all wishing to continue using it

Controlled trials in pediatric migraine: crossover versus parallel group.

Abstract: Studies on the treatment of migraine in children and adolescents are rare and difficult to design. In particular, the high placebo response makes it difficult to show efficacy of a verum drug. When analyzing all published trials in the acute drug treatment of migraine in children, crossover trials show lower placebo rates and higher therapeutic gain, compared with parallel group trials. This should be considered in the future design of acute drug trials in childhood migraine.

Entwicklung eines Migräneprophylaxe-Screeninginstruments (MPS)

Abstract: Ziel der vorliegenden Studie war es, ein aus 3 Fragen bestehendes Screeningtool zu entwickeln, das Arzten, die nicht auf die Diagnose und Therapie von Kopfschmerzerkrankungen spezialisiert sind, wie z. B. dem niedergelassenen Allgemeinmediziner, als Entscheidungshilfe dienen kann, ob bei seinem Migranepatienten eine medikamentose Migraneprophylaxe Erfolg versprechend ist oder nicht. Dafur wurde von 132 Migranepatienten, die bei Kopfschmerzspezialisten vorstellig waren, ein aus 10 Items bestehender Fragebogen zu ihrer Migrane ausgefullt. Unabhangig davon fullten die Arzte einen Fragebogen aus, in dem sie angaben, ob der Patient ihrer Einschatzung nach fur eine Migraneprophylaxe in Frage kommt und wenn ja, welche Grunde sie dazu bewogen haben. Mittels logistischer Regression wurden anschliesend die 3 Fragen identifiziert, die in dem vorliegenden Datensatz den grosten Einfluss auf die Prophylaxeentscheidung hatten und die derzeit an 150 Migranepatienten in Praxen niedergelassener Allgemeinmediziner validiert werden:

Oral rizatriptan—an effective migraine therapy in pediatric patients?

Abstract: DESIGN AND INTERVENTION From January 2001 to November 2003, two Finnish pediatric hospitals recruited 96 children and adolescents (mean age 12.0 years, range 6–16.1 years; body weight of at least 20 kg) who had migraine with or without aura according to the International Headache Society criteria. Patients were eligible if they had at least two migraine attacks per month lasting at least 4 hours, and if they had been unsuccessfully treated with acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs). No participants received prophylactic drug therapy for migraine during the study. The trial had a double-blind, three-way crossover design in which each child received the study drugs to treat three moderate to severe migraine attacks at home. Two of these migraine attacks were treated with rizatriptan (rizatriptan-first and rizatriptan-second) and one attack was treated with placebo. The order of the study drugs was randomized for each participant, and the dose of rizatriptan was identical for both administrations of this drug (5 mg in children with a body weight of 20–39 kg, and 10 mg in children with a body weight of 40 kg or more). Headache severity was rated on a five-face pain intensity Oral rizatriptan—an effective migraine therapy in pediatric patients?