Migraine Disorders: Wang SJ

Silberstein S, Tfelt-Hansen P, Dodick DW, Limmroth V, Lipton RB, Pascual J, Wang SJ, Anonymous00408. · Jefferson Headache Center, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA. [corrected] · Cephalalgia. · Pubmed #18294250 No free full text.

Abstract: In 1991 the Clinical Trials Subcommittee of the International Headache Society (IHS) developed and published its first edition of the Guidelines on controlled trials of drugs in episodic migraine because only quality trials can form the basis for international collaboration on drug therapy, and these Guidelines would 'improve the quality of controlled clinical trials in migraine'. With the current trend for large multinational trials, there is a need for increased awareness of methodological issues in clinical trials of drugs and other treatments for chronic migraine. These Guidelines are intended to assist in the design of well-controlled clinical trials of chronic migraine in adults, and do not apply to studies in children or adolescents.

Wang SJ. · No affiliation provided · Expert Rev Neurother. · Pubmed #17868004 No free full text.

This publication has no abstract.

Wang SJ. · Neurological Institute, Taipei Veterans General Hospital, 112, Taipei, Taiwan. · Curr Neurol Neurosci Rep. · Pubmed #12583837 No free full text.

Abstract: Earlier studies have raised the issue that Asians have a much lower migraine prevalence than Westerners. This article reviews the recent epidemiologic studies of headache in Asia using International Headache Society (IHS) classification criteria. Except for the Korean study and the first Hong Kong study (1992 to 1993), the prevalence of migraine has been quite consistent, ranging from 8.4% to 12.7%. The sex-specific migraine prevalence was 11.3% to 14.4% in women and 3.6% to 6.7% in men. The prevalence of IHS tension-type headache has also been similar among these studies (15.6% to 25.7%). The consistency of the prevalence of migraine and tension-type headache among these Asian countries is interesting in a region where the cultural background and development are so diverse. These IHS migraine surveys show that migraine is a significant disease in Asia and that its prevalence rate is close to but in the low range of the those reported in Western countries. Two surveys of chronic daily headache conducted in Taiwan, one in the general population and the other in the elderly population, have also revealed prevalence rates (3.2% to 3.9%) similar to those of Western countries (3.0% to 4.7%). The geographic or ethnic diversity of migraine or other types of headache could be downplayed if a similar epidemiologic methodology and an identical case definition were used in the surveys among different regions of the world.

Chou CH, Fuh JL, Hu HH, Wu JC, Wang SJ. · Department of Neurology, Yuan-Shan Veterans Hospital, Yi-Lan, Taiwan. · Cephalalgia. · Pubmed #19055510 No free full text.

Abstract: The Queckenstedt's (Q)-test can aggravate headache intensity during migraine attacks (Q-test effect). The objective of this study was to delineate the Q-test effect in patients experiencing migraine attacks. We performed a 30-s Q- and a sham test on 39 patients with acute migraine attacks in both supine and sitting positions. Headache intensities during and 30 s after the Q- or sham tests were recorded on a 0-10 verbal scale. Brushing allodynia (BA) was recorded after using a gauze-brushing test over the patient's face and forearms. The Q- but not the sham test aggravated headache intensity in both sitting and supine positions. The presence of throbbing pain and higher pain intensities was associated with the Q-test effect in the supine position. However, the presence or absence of BA was not correlated. We concluded that the Q-test effect is likely to be related to peripheral sensitization of the meninges but not central sensitization. The Q-test effect may be used as an objective marker for peripheral sensitization.

Diener HC, Tfelt-Hansen P, Dahlöf C, Láinez MJ, Sandrini G, Wang SJ, Neto W, Vijapurkar U, Doyle A, Jacobs D, Anonymous00001. · Department of Neurology, University Essen, Hufelandstr 55, 45122 Essen, Germany. · J Neurol. · Pubmed #15316798 No free full text.

Abstract: Topiramate (TPM) has shown efficacy in migraine prophylaxis in two large placebo-controlled, dose-ranging trials. We conducted a randomised, double-blind, multicentre trial to evaluate the efficacy and safety of two doses of topiramate vs placebo for migraine prophylaxis, with propranolol (PROP) as an active control. Subjects with episodic migraine with and without aura were randomised to TPM 100 mg/d, TPM 200 mg/d, PROP 160 mg/d (active control), or placebo. The primary efficacy measure was the change in mean monthly migraine frequency from the baseline phase relative to the double-blind treatment phase. Five hundred and seventy-five subjects were enrolled from 61 centres in 13 countries. TPM 100 mg/d was superior to placebo as measured by reduction in monthly migraine frequency, overall 50% responder rate, reduction in monthly migraine days, and reduction in the rate of daily rescue medication use. The TPM 100 mg/d and PROP groups were similar with respect to reductions in migraine frequency, responder rate, migraine days, and daily rescue medication usage. TPM 100 mg/d was better tolerated than TPM 200 mg/d, and was generally comparable to PROP. No unusual or unexpected safety risks emerged. These findings demonstrate that TPM 100 mg/d is effective in migraine prophylaxis. TPM 100 mg/d and PROP 160 mg/d exhibited similar efficacy profiles.

Chia YC, Lim SH, Wang SJ, Cheong YM, Denaro J, Hettiarachchi J. · University Malaya Medical Centre, Kuala Lumpur, Malaysia. · Headache. · Pubmed #14511275 No free full text.

Abstract: BACKGROUND/OBJECTIVE: Nonsteroidal anti-inflammatory drugs continue to be one of the most widely used therapies for migraine, but their efficacy in treating moderate to severe migraine headache has not been well documented. In contrast, the efficacy of triptans in this group of patients is well documented, although no systematic research is available that evaluates the effectiveness of switching to a triptan in patients who respond poorly to nonsteroidal anti-inflammatory drugs. METHODS: One hundred thirteen patients who met International Headache Society criteria for migraine and who did not experience satisfactory response to nonsteroidal anti-inflammatory drugs, received open-label treatment with a 40-mg dose of eletriptan for one migraine attack. Efficacy assessments were made at 1, 2, 4, and 24 hours postdose and consisted of headache and pain-free response rates, absence of associated symptoms, and functional response. Global ratings of treatment effectiveness and preference were obtained at 24 hours. RESULTS: The pain-free response rate at 2 hours postdose was 25% and at 4 hours postdose, 55%; the headache response rate at 2 hours was 66% and at 4 hours, 87%. At 2 hours postdose, relief of baseline associated symptoms was achieved by 41% of patients with nausea compared to 82% of patients at 4 hours; for patients with phonophobia, 67% were relieved at 2 hours and 93% at 4 hours, and for patients with photophobia, 70% were relieved at 2 hours and 91% at 4 hours. Functional response was achieved by 70% of patients by 2 hours postdose. The high level of acute response was maintained over 24 hours, with only 24% of patients experiencing a headache recurrence and only 10% using rescue medication. At 24 hours postdose, 74% of patients rated eletriptan as preferable to any previous treatment for migraine. The most frequent reasons cited for this treatment preference were faster headache improvement (83%) and functional response (78%). Overall, eletriptan was well tolerated; most adverse events were transient and mild to moderate in severity. No serious adverse events were reported. CONCLUSION: Results of this open-label trial found the 40-mg dose of eletriptan to have a high degree of efficacy and tolerability among patients who responded poorly to nonsteroidal anti-inflammatory drugs.

Jia CS, Ma XS, Shi J, Wang YM, Li YF, Yuan J, Li M, Zheng LX, Zhang XJ, Wang SJ, Gao JY, Li XF, Huo YL. · TCM College of Hebei Medical University, Shijiazhuang 050091, China. · J Tradit Chin Med. · Pubmed #19514188 No free full text.

Abstract: OBJECTIVE: To observe the therapeutic effects of electroacupuncture (EA) at Qiuxu (GB 40) for treatment of migraine so as to provide clinical evidence for compilation of the Acupoints' Dictionary of the People's Republic of China. METHODS: 275 migraine patients admitted in 3 hospitals were randomly divided into a treatment group treated by EA at Qiuxu (GB 40), and a control group treated by EA at Tianshu (ST 25). The indexes of the migraine symptoms and the 5-HT level were observed in both the groups before and after treatment. RESULTS: There was a significant difference in VAS score between the two groups of the 3 clinical centers (P<0.01). The therapeutic effects of a 4-week treatment were much better in the treatment group than that of the control group. The 3-month follow-up survey showed that the long-term effects were in favor of the treatment group of the first and third clinical centers, though no significant difference was found in the treatment group of the second clinical center as compared with the control group. The results from the 6-month follow-up survey showed better effects in the treatment group of all the 3 clinical centers. CONCLUSION: EA at Qiuxu (GB 40) may show effect for migraine.

Wang SJ, Fuh JL, Juang KD, Lu SR. · The Neurological Institute, Taipei Veterans General Hospital, Taipei, 112, Taiwan. · Neurology. · Pubmed #19332691 No free full text.

Abstract: BACKGROUND: Awareness is growing among clinicians of the importance of suicidal ideation in adolescents. OBJECTIVES: To investigate the relationship between migraine and suicidal ideation in a nonreferred sample of adolescents. METHODS: This study surveyed migraine and depression in three middle schools in Taitung County, Taiwan. All students completed the questionnaires, including demographics, a validated headache questionnaire, the Adolescent Depression Inventory (ADI), and the Pediatric Migraine Disability Assessment (PedMIDAS) questionnaire. This study used the presence or absence of suicidal ideation as indicated by the ADI for the analysis. RESULTS: A total of 3,963 (2,040 male and 1,923 female; mean age 14.0 +/- 0.9 years) adolescents (93% of the target cohort) completed this study. Suicidal ideation was reported in 8.5% of the study group. Compared with nonmigraine subjects (6.2%), subjects with migraine displayed a higher frequency of suicidal ideation (16.1%; odds ratio [OR] = 2.9, 95% confidence interval [CI] 2.3-3.6; p < 0.001), especially those with migraine with aura (23.9%; OR = 4.6 [95% CI 3.0-7.0]; p < 0.001). Suicidal ideation was associated with higher headache frequency and headache-related disability as measured by the PedMIDAS. After controlling for depression score and sociodemographic characteristics, the association remained only for migraine with aura (adjusted OR = 1.79 [95% CI 1.07-2.99]; p = 0.025) and high headache frequency (>7 days/month; adjusted OR = 1.69 [95% CI 1.12-2.56]; p = 0.013) but not for migraine without aura or probable migraine or PedMIDAS score. CONCLUSIONS: This study identified a higher frequency of suicidal ideation in younger adolescents with migraine with aura or high headache frequency. These associations were independent of depressive symptoms. ADI = Adolescent Depression Inventory; AOR = adjusted odds ratio; CI = confidence interval; 5-HT = serotonin; ICHD-2 = International Classification of Headache Disorders, Second Edition; MINI-Kid = Mini-International Neuropsychiatric Interview-Kid; OR = odds ratio; PedMIDAS = Pediatric Migraine Disability Assessment.

Hsu SC, Wang SJ, Liu CY, Juang YY, Yang CH, Hung CI. · Department of Psychiatry, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Tao-Yuan, Taiwan. · Compr Psychiatry. · Pubmed #19216892 No free full text.

Abstract: OBJECTIVE: The aim of this study was to investigate the impact of anxiety disorders and migraine on sleep quality and to find the independent factors that predict sleep quality among patients with major depressive disorder (MDD). METHOD: Psychiatric outpatients diagnosed with MDD were enrolled in the study. Major depressive disorder and 7 anxiety disorders were diagnosed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Migraine was diagnosed based on the International Classification of Headache Disorders, Second Edition. Headache intensity and frequency were reported by the subjects. The Pittsburgh Sleep Quality Index and Hamilton Depression Rating Scale were used to evaluate quality of sleep and depression severity, respectively. Multiple linear regressions were used to identify independent factors related to sleep quality. RESULTS: One hundred thirty-five subjects (34 men and 101 women) with MDD were enrolled in the study. Subjects with panic disorder and agoraphobia were found to have poorer Pittsburgh Sleep Quality Index scores. Subjects with panic disorder, agoraphobia, and migraine had higher scores for items relating to sleep quality in the Hamilton Depression Rating Scale. Headache intensity and frequency correlated with sleep disturbance. Panic disorder was independently predictive of poor sleep quality. Both migraine and panic disorder independently predicted a greater severity of depression. CONCLUSION: Our study demonstrates the negative impact of panic disorder and migraine on MDD and some of the interrelations between depression, anxiety, and sleep quality. Future studies should further explore these interactions and consider possible therapeutic interventions.

Hung CI, Liu CY, Cheng YT, Wang SJ. · Department of Psychiatry, Chang-Gung Memorial Hospital and Chang-Gung University School of Medicine, Taiwan. · J Affect Disord. · Pubmed #19167091 No free full text.

Abstract: BACKGROUND: Research into the role of migraine in somatic symptoms of major depressive disorder (MDD) has long been neglected; hence, the aim of this study was to compare the impact of migraine and anxiety comorbidities on the somatic symptoms of patients with MDD. METHODS: Consecutive psychiatric outpatients with MDD in a medical center were enrolled. MDD and anxiety disorders were diagnosed using the Structured Clinical Interview for DSM-IV-TR; migraine was diagnosed according to the International Classification of Headache Disorders, 2nd edition. Four scales were administered and evaluated: the Hamilton Depression Rating Scale, the Depression and Somatic Symptoms Scale, the somatization subscale of the Symptom Checklist-90-Revised, and the Hospital Anxiety and Depression Scale. Multiple linear regressions were used to find the most powerful comorbidities in predicting somatic symptoms. RESULTS: One hundred and fifty five patients (106F, 49M) completed the study. Subjects with migraine had higher somatic, depression and anxiety severities. Panic disorder was the most important factor when predicting somatic severity among anxiety comorbidities. Migraine (R(2) change=0.28 to 0.04, p<.01) was the strongest independent factor in predicting somatic severity, even after controlling for anxiety comorbidities and demographic variables. LIMITATIONS: This study used certain exclusion criteria when enrolling MDD outpatients, possibly introducing bias. CONCLUSIONS: Comorbidity with migraine was found to be associated with more somatic symptoms in patients with MDD, and migraine was a strong and independent predictor for the somatic symptoms of MDD. Future studies on the somatic symptoms of MDD should therefore take migraine into consideration.

Hung CI, Liu CY, Chen JJ, Wang SJ. · The Neurological Institute, Taipei Veterans General Hospital, 201 Shi-Pai Rd., Section 2, Taipei 112, Taiwan. · Psychosomatics. · Pubmed #19122127 No free full text.

Abstract: BACKGROUND/OBJECTIVE: The aim of this study was to identify factors related to muscle tension in patients with major depressive disorder (MDD) with comorbid anxiety and migraine. METHOD: Consecutive psychiatric outpatients with MDD were enrolled. Self-reported muscle tension (SMT) during the previous week was evaluated with a 0-10 scale. RESULTS: Of 135 participants with MDD, 63 (46.7%) had migraine. Multiple-regression analyses showed that migraine and headache intensity were two major independent factors related to SMT. CONCLUSION: Further studies on musculoskeletal symptoms in MDD should not neglect the impact of migraine.

Wang SJ, Chung CS, Chankrachang S, Ravishankar K, Merican JS, Salazar G, Siow C, Cheung RT, Phanthumchinda K, Sakai F. · Neurological Institute, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan. · Headache. · Pubmed #19031500 No free full text.

Abstract: OBJECTIVES: This study aimed to survey the headache diagnoses and consequences among outpatients attending neurological services in 8 Asian countries. METHODS: This survey recruited patients who consulted neurologists for the first time with the chief complaint of headache. Patients suffering from headaches for 15 or more days per month were excluded. Patients answered a self-administered questionnaire, and their physicians independently completed a separate questionnaire. In this study, the migraine diagnosis given by the neurologists was used for analysis. The headache symptoms collected in the physician questionnaire were based on the diagnostic criteria of migraine proposed by the International Classification of Headache Disorders, second edition (ICHD-2). RESULTS: A total of 2782 patients (72% females; mean age 38.1 15.1 years) finished the study.Of them, 66.6% of patients were diagnosed by the neurologists to have migraine, ranging from 50.9% to 85.8% across different countries.Taken as a group, 41.4% of those patients diagnosed with migraine had not been previously diagnosed to have migraine prior to this consultation. On average, patients with migraine had 4.9 severe headaches per month with 65% of patients missing school,work, or household chores. Most (87.5%) patients with migraine took medications for acute treatment. Thirty-six percent of the patients had at least one emergency room consultation within one year. Only 29.2% were on prophylactic medications. Neurologists recommended pharmacological prophylaxis in 68.2% of patients not on preventive treatment. In comparison, migraine prevalence was the highest with ICHD-2 "any migraine" (ie, migraine with or without migraine and probable migraine) (73.3%) followed by neurologist-diagnosed migraine (66.6%) and ICHD-2 "strict migraine" (ie, migraine with or without aura only) (51.3%). About 88.6% patients with neurologist-diagnosed migraine fulfilled ICHD-2 any migraine but only 67.1% fulfilled the criteria of ICHD-2 strict migraine. CONCLUSIONS: Migraine is the most common headache diagnosis in neurological services in Asia. The prevalence of migraine was higher in countries with higher referral rates of patients to neurological services. Migraine remains underdiagnosed and under-treated in this region even though a high disability was found in patients with migraine. Probable migraine was adopted into the migraine diagnostic spectrum by neurologists in this study.

Chen SP, Fuh JL, Lu SR, Wang SJ. · Department of Neurology, Taoyuan Veterans Hospital, Taoyuan, Taiwan. · Cephalalgia. · Pubmed #19025550 No free full text.

Abstract: We employed a self-administered questionnaire to investigate exertional headache (EH) in students (ages 13-15 years) from two middle schools in Taiwan. In this study, the diagnosis of EH was made if the headache occurred during or immediately after exercise. In total, 1963 students completed the study (response rate 90.7%). The prevalence of EH was 30.4% (n = 596), was higher in girls and decreased with age. EHs were commonly bilateral (51.4%), pulsating (59.4%) and short-lasting (<or= 1 h in 79%). Only 13.8% of the adolescents with EH took painkillers for the headache. Migraineurs were more likely to have EH than non-migraineurs (47.5% vs. 21.1%, P < 0.001) and their EH had more features of migraine and needed more frequent treatment with painkillers. Only 200 subjects (10.2%) fulfilled the International Classification of Headache Disorders, 2nd edn criteria for primary EH excluding criterion C. Our study disclosed that EH was quite prevalent in adolescents. Migraineurs were vulnerable to EH and had more disabling attacks.

Ma Z, Wang SJ, Li CF, Ma XX, Gu T. · Department of Ultrasonography, QiLu Hospital of Shandong University, Jinan City, Shandong Province, China. · Neurol Sci. · Pubmed #18941936 No free full text.

Abstract: PURPOSE: To investigate brain metabolite change in rat migraine model by proton magnetic resonance spectroscopy (1H-MRS) in vivo and ex vivo. METHODS: 18 Adult SD rats were enrolled in the study. After nitroglycerin administration, the migraine rat model was established according to ethology evaluation. 1H-MRS was performed at 3T MR scanner in vivo and 14.7T Bruker MR spectrometer ex vivo. Area of peak for different metabolite material was obtained and compared by using independent-T test. The significance level was set at p<0.05. RESULTS: In thalami of experimental group, areas of peak for Cho, Cr and Glu both in vivo and ex vivo were higher than in control group(p<0.05). In contrast, there was no statistical difference in cerebellum. CONCLUSION: The elevated Cho and Cr spectral pattern were found in rat migraine model. Neuron activity in thalamus is significantly changeable during attacks.

Wang YF, Fuh JL, Chen WT, Wang SJ. · Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan. · Cephalalgia. · Pubmed #18727635 No free full text.

Abstract: Persistent visual aura without infarction is rare. Its pathogenic mechanism is unknown, and the response to migraine prophylactic agents varies. A systematic analysis of 29 patients (23 from the literature and six in the present report; 6M/23F, mean age 37.6 years) was carried out in terms of demographics, headache and visual symptom profiles, treatment regimens and outcomes. Patterns of visual disturbances (VDs) were re-assessed with the Visual Aura Rating Scale (VARS, score 0-10). Even though the majority of patients had headache improvement, only eight (27.6%) had complete resolution of persistent VD, without definite relevance to any specific agent. Patients with complete resolution of VD tended to have scotoma (50.0% vs. 0%; P = 0.003), unilateral/homonymous involvement (62.5% vs. 9.5%; P = 0.008), higher VARS scores (1.88 +/- 1.73 vs. 0.10 +/- 0.30; P < 0.001) and shorter duration of illness (10.0 +/- 12.9 vs. 60.2 +/- 90.9 months, P = 0.008) compared with those without. These findings remained even when the six current patients were not included for analyses. In conclusion, the prognosis of persistent VD was poor, and higher VARS scores, i.e. more typical of migraine visual aura, predicted a better outcome. For those with a potential for complete resolution, improvement would occur early in the course.

Hung CI, Wang SJ, Yang CH, Liu CY. · Department of Psychiatry, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan. · J Psychosom Res. · Pubmed #18655858 No free full text.

Abstract: OBJECTIVE: Our purpose was to determine if migraine, anxiety comorbidities, and chronic depression were independently related to health-related quality of life (HRQoL) in outpatients with major depressive disorder (MDD). METHOD: Consecutive psychiatric outpatients with MDD in a medical center were enrolled. MDD, chronic depression, and seven anxiety disorders were diagnosed using the Structured Clinical Interview for DSM-IV-TR. Migraine was diagnosed based on the International Classification of Headache Disorders, 2nd edition. The acute version of the Short-Form 36 and the Hamilton Depression Rating Scale (HAMD) were used to evaluate the HRQoL and the severity of depression, respectively. Multiple linear regressions were used to determine the independent factors related to HRQoL. RESULTS: There were 135 participants (34 men, 101 women) with MDD. Subjects with migraine, anxiety comorbidities, or chronic depression had higher HAMD scores and poor HRQoL. Migraine, specific phobia, and panic disorder were important and independent comorbidities predicting HRQoL. The impact of migraine on HRQoL, especially on bodily pain, was not inferior to those of some anxiety comorbidities or chronic depression. CONCLUSION: Future studies related to HRQoL of MDD should consider migraine and anxiety comorbidities simultaneously.

Fuh JL, Wang SJ, Lu SR, Tsai PH, Lai TH, Lai KL. · Neurological Institute, Veterans General Hospital-Taipei, and Department of Neurology and National Yang-Ming University School of Medicine, Taipei, Taiwan. · Cephalalgia. · Pubmed #18624806 No free full text.

Abstract: We established a cohort of 60 subjects with chronic daily headache (CDH) out of 1533 community-based elderly in 1993 and finished two short-term follow-ups in 1995 and 1997. All of the 26 survivors without dementia (4 M/22 F, mean age 82.7 +/- 3.4 years) finished the follow-up in 2006. The mean headache frequency was 8.4 +/- 11.8 days per month in the past year, and seven (27%) had persistent CDH. Based on the International Classification of Headache Disorders, 2nd edn, the CDH subtypes diagnoses were chronic migraine in three subjects, chronic tension-type headache in three, and one with medication-overuse headache. All these seven subjects had CDH during the 1995 and 1997 follow-ups. The diagnosis of CDH with migrainous features increased from 25 to 71% in those with CDH from 1993 to 2006. Migraine was the most common headache type in those with CDH resolution. Aggressive treatment should be applied especially for those with persistent CDH at short-term follow-ups.

Wang SJ, Fuh JL, Huang SY, Yang SS, Wu ZA, Hsu CH, Wang CH, Yu HY, Wang PJ, Anonymous00252. · Neurological Institute, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, 201 Section 2 Shih-Pai Road, Taipei, Taiwan. · J Formos Med Assoc. · Pubmed #18583220 links to  free full text

Abstract: BACKGROUND/PURPOSE: The objectives of this study were to: (1) survey migraine diagnoses among neurological outpatients in Taiwan; (2) compare neurologists' migraine diagnoses with the International Classification of Headache Disorders 2nd Edition (ICHD-2) criteria; and (3) evaluate the diagnostic ability of screening items on a patient migraine questionnaire. METHODS: This prospective study surveyed patients who consulted neurologists for the first time with a chief complaint of headache, excluding those experiencing headaches for > or = 15 days/month. Each neurologist interviewed a maximum of 10 patients. Patients were asked to complete a self-administered questionnaire and their physicians completed another questionnaire. The physicians were asked if patients could be diagnosed with migraine. In addition, a diagnosis of ICHD-2 migraine was made by the physician's questionnaire through a computer-generated algorithm. In this study, migraine without aura (code 1.1) or migraine with aura (code 1.2) were designated as "strict migraine", and the combination of strict migraine and ICHD-2 probable migraine (code 1.6) as "any migraine". RESULTS: Among 755 patients who were eligible for analysis, 537 (71%) were diagnosed as having "any migraine", 363 (48%) with "strict migraine", and 451 (60%) with physician-diagnosed migraine. Among the 537 patients diagnosed as having "any migraine", 308 patients (57%) had not been diagnosed by any physician before. A moderate agreement (kappa statistic around 0.5) was found between the physicians' diagnoses and ICHD-2 "strict migraine" or "any migraine". In patients with ICHD-2 probable migraine (n = 174), only 52% were diagnosed with migraine by our physicians. Nausea was the best single item for predicting migraine diagnosis, while any combination of two items among nausea/vomiting, moderate or severe pain and photophobia, provided the optimum screening tool. CONCLUSION: Migraine was the most common headache diagnosis in the neurologists' clinics. Probable migraine was not completely adopted as a migraine spectrum among neurologists. In contrast to ID Migraine(TM), moderate or severe headache intensity replaced headache-related disability as one screening item for migraine in Taiwan.

Fuh JL, Wang SJ, Lu SR. · The Neurological Institute, Taipei Veterans General Hospital, and National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC. · J Chin Med Assoc. · Pubmed #18290251 links to  free full text

Abstract: BACKGROUND: To estimate the economic impact of migraine on the employed labor force in Taiwan. METHODS: The age- and sex-specific migraine prevalence rates, self-reported missed workdays due to migraine, and monthly income were obtained from 3,377 subjects of a community-based headache questionnaire survey in the greater Taipei area. The migraine-related loss was projected to the whole Taiwanese population based on statistics from the Directorate General of Budget, Accounting and Statistics of the Executive Yuan, Taiwan. RESULTS: People suffering from migraines had a median of 2 missed workdays due to migraine in the year prior to the survey. It is estimated that there are about 1.7 million people who have migraines over the course of 1 year in Taiwan. Migraine resulted in 3.7 million estimated missed workdays and an estimated cost of NT$4.6 billion due to loss of workdays in 2005. Employed migrainous women aged 35-54 years accounted for 56% of the cost. CONCLUSION: Migraine is related to high work absence rates and causes significant economic loss to the society in Taiwan.

Hung CI, Liu CY, Wang SJ. · Department of Psychiatry, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Tao-Yuan, Taiwan. · J Psychosom Res. · Pubmed #18222138 No free full text.

Abstract: OBJECTIVE: The aim of this study was to investigate the common precipitating or aggravating factors for headache among patients with major depressive disorder (MDD) and to compare precipitating or aggravating factors specifically for migraine with those for other headaches. METHODS: Consecutive psychiatric outpatients with MDD in a medical center were enrolled. Headaches were diagnosed based on the International Classification of Headache Disorders, 2nd Edition. A 21-item self-report questionnaire was used to identify precipitating or aggravating factors. Subjects were divided into migraine and other-headache groups. RESULTS: Of 122 subjects (76% female) with headache, 63 (51.6%) were diagnosed with migraine. Mental stress and depressive symptoms were the most common precipitating or aggravating factors, and 17 factors affected >50% of the subjects. Compared with other-headache groups, the migraine group was more sensitive to emotional and perceptional stimuli and to the stress of daily activities. CONCLUSION: Treatment of depression and education of depressed patients about how to cope with mental stress might help to eliminate the negative impact of headache.

Liu YC, Fuh JL, Chen RC, Lin KP, Wang SJ. · Department of Neurology, Ten Chan [corrected] Hospital, Chung-Li, Taiwan, R O C. · J Chin Med Assoc. · Pubmed #18194894 links to  free full text

Abstract: BACKGROUND: Botulinum toxin type A (BoNT-A) for the treatment of patients with various forms of migraine has been studied, but there is a paucity of data regarding the use of BoNT-A in Asian headache patients. Our study was designed to evaluate the efficacy of BoNT-A in the treatment of transformed migraine (TM) in a population of Taiwanese patients. METHODS: We retrospectively analyzed 30 patients who underwent BoNT-A treatment for TM from July 2003 to May 2004. Of 30 patients, 14 had palpable muscle tenderness (or tender points) in the pericranial region and 16 did not. All patients received injections into the corrugator, procerus, frontalis, and temporalis muscles (a total of 30 U), while a subset of TM patients with tender points (6 of 14 patients) also received injections to additional muscles based on a follow-the-tenderness approach (mean dose, 45 U). RESULTS: Twenty-seven of the 30 patients (90%) surveyed reported effective relief of their symptoms with BoNT-A treatment (at least a 50% reduction in the number of headache days or in headache intensity). The greatest reduction in headache days per month and headache intensity was found in TM patients with tender points who received a mean dose of 45 U compared to those who received fixed-site dosing of 30 U. CONCLUSION: Our results suggest that BoNT-A may be an effective prophylactic treatment for TM in Taiwanese patients. Interestingly, similar efficacy was demonstrated in TM patients with tender points compared to those without tender points when an additional dose of BoNT-A was injected into the tender muscles in the former.

Fuh JL, Kuo KH, Wang SJ. · Neurological Institute, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan. · Cephalalgia. · Pubmed #17645765 No free full text.

Abstract: Primary stabbing headache (PSH) is a short-lasting but troublesome headache disorder which has been known for several decades. We surveyed and registered consecutive patients with PSH in a headache clinic in Taiwan. A total of 80 patients (24 M/56 F, 53.2 +/- 16.2 years) were enrolled in our study. Migraine was reported in 20 (25%) patients and was less common in those with PSH onset at >50 years than those with onset at <50 years (14% vs. 38%, P = 0.02). The headache was unilateral in 59% of the patients and always in a fixed area in 36%. The head pain frequently involved extratrigeminal regions (70%) and in 30 patients (38%) was accompanied by jolts, i.e. head or body movements. Indomethacin was effective (74%) in patients who received it. Our study showed primary stabbing headache was a common and easily treated headache disorder in headache clinic. However, 70% of our patients could not fulfil criterion A 'exclusively or predominantly in the distribution of the first division of the trigeminal nerve' and 15% could not fulfil criterion C 'no accompanying symptoms' of the International Classification of Headache Disorders-II criteria proposed for PSH.

Wang SJ, Juang KD, Fuh JL, Lu SR. · Department of Neurology, National Yang-Ming University School of Medicine, Taipei, Taiwan. · Neurology. · Pubmed #17470748 No free full text.

Abstract: OBJECTIVES: To investigate the prevalence and correlates of comorbid psychiatric disorders and suicidal risk in community-based adolescents with chronic daily headache (CDH). METHODS: We identified and recruited 122 adolescents with CDH from a non-referral student sample (n = 7,900). CDH subtypes were classified according to the most updated criteria of the International Classification of Headache Disorders, 2nd edition (ICHD-2). An in-person psychiatric interview was performed with each subject with CDH to assess depressive and anxiety disorders and suicidal risk based on the Mini-International Neuropsychiatric Interview-Kid (MINI-Kid). Clinical correlates and impacts were investigated. RESULTS: A total of 121 subjects (31 male/90 female, mean age 13.8 years) finished the psychiatric interview. Fifty-seven subjects (47%) had > or =1 assessed psychiatric comorbidity with major depression (21%) and panic disorder (19%) as the two most common diagnoses. Current suicidal risk was assessed as high (score > or = 10) in 20% of subjects. Female gender and older age were associated with depressive disorders. Presence of migraine was associated with psychiatric comorbidities (OR = 3.5, p = 0.002). The associations with psychiatric disorders were stronger for migraine with aura than for migraine without aura. Migraine with aura also independently predicted a high suicidal risk (score > or = 10) (adjusted OR = 6.0, p = 0.028). In contrast, CDH subtypes, headache frequencies, or medication overuse were not correlated. Comorbid psychiatric disorders were not related to physician consultations or more days of sick leave. CONCLUSIONS: This community-based study showed high comorbidity of psychiatric disorders and suicidal risk in adolescents with chronic daily headache. The presence of migraine attacks, especially migraine with aura, was the major predictor for these associations.

Wang SJ, Fuh JL, Wu ZA. · Neurological Institute, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC. · J Chin Med Assoc. · Pubmed #17339143 links to  free full text

Abstract: BACKGROUND: Triptan's efficacy in the treatment of migraine has never been reported in Taiwanese. A high placebo effect was reported in Japanese. The objective of this study was to evaluate the efficacy of intranasal sumatriptan in the acute treatment of migraine in Taiwanese patients. METHODS: Fifty-eight patients who had experienced migraine for at least 1 year were randomly assigned to 2 groups, self-administered intranasal sumatriptan 20 mg or placebo to treat a single migraine attack of moderate or severe intensity. RESULTS: A significant difference in headache relief rates between the 2 groups was observed at 30 minutes postdose (46% vs. 21%, p < 0.05). One hour postdose, 61% of sumatriptan recipients experienced headache relief compared with 43% of placebo recipients (p = 0.181). The difference in relief rates between groups diminished over time, mainly due to a high placebo response (54% at 2 hours postdose). CONCLUSION: Our study suggests that ethnicity might have a role in placebo response, and highlights the importance of a placebo group in acute migraine trials. However, the small sample size in this study should also be taken into consideration.

Wang SJ, Fuh JL, Lu SR, Juang KD. · Department of Neurology, National Yang-Ming University School of Medicine, Taiwan. · Neurology. · Pubmed #17182975 No free full text.

Abstract: OBJECTIVES: To assess the outcomes and predictors of chronic daily headache (CDH) in a community-based cohort of adolescents. METHODS: We established a field sample of 122 adolescents (32 M/90 F, ages 12 to 14) with CDH in 2000. These adolescents received annual follow-up by neurologists for 2 years via a semistructured telephone interview. CDH was defined as > or =15 headache days/month, average > or =2 h/day for >3 months; subtypes were classified based on the original and appendix criteria of the International Classification of Headache Disorders (2nd ed.; ICHD-2). Poor outcome was defined as persistence of CDH at 2 years. RESULTS: Follow-up response rates were 92% in 2001 and 84% in 2002. Average monthly headache frequency was 11.0 +/- 9.7 days in 2001 and 7.7 +/- 6.5 days in 2002. CDH persistence rates were 40% in 2001 and 25% in 2002. Medication overuse declined from 20% (baseline) to 6% at 2 years. The prevalence of migraine did not change throughout the follow-up (67 to 60%), whereas that of tension-type headache deceased from 86 to 46% (p < 0.001). Chronic migraine prevalence increased markedly at baseline and became the most common CDH subtype at follow-up when using the ICHD-2 appendix criteria. During follow-up, seven subjects (6%) dropped out of school. Independent predictors for CDH persistence were medication overuse and major depression. CONCLUSIONS: Most adolescents with chronic daily headache (CDH) continued to have frequent headaches, although the incidence of CDH declined at follow-up. Migraine diagnosis gained prominence as headache frequency decreased. The percentages of chronic migraine in adolescents with CDH increased obviously if the appendix criteria were applied.