BackgroundPrevious studies have shown that common headache triggers contribute to the onset of headache attacks on predisposed individuals and are considered important in the prevention of headache. The aim of this study was to compare the different characteristics of triggers among the most common primary headache subtypes (migraine without aura, migraine with aura and tension type headache).MethodsA total of 116 headache patients of the neurology outpatient department of a tertiary hospital in Athens were selected according to the criteria of the International Classification of Headaches—3nd Edition Beta. Patients were interviewed using a questionnaire that contained 35 potential trigger factors.ResultsThe findings showed that migraine and tension-type headache patients report multiple triggers, on a frequent but variable basis. The most frequent triggers reported by all subjects were stressful life events followed by intense emotions. The same applies to both genders, as well as the three headache subgroups. Patients suffering from migraine with aura reported the highest mean number of trigger per person and the highest frequency in almost all the trigger categories. Furthermore, patients with migraine with aura were more likely to report the following triggers: oversleeping, premenstrual period, stressful life events, hot/cold weather, relaxation after stress, menstruation, wind, intense emotions, shining, hunger and bright sunlight. These associations were mostly independent of the sociodemographic characteristics and the presence of anxiety or depressive symptoms.ConclusionThe sensitivity to trigger factors should be considered by both clinicians and headache sufferers.

Unruptured cerebral arterial aneurysms most often remain asymptomatic, but they may cause headache or other symptoms or signs. We describe herewith a case of headache attributed to an unruptured nternal carotid artery aneurysm, clearly mimicking the phenotype of hemicrania continua. Potential pathophysiological explanations and recommendations for recognition of similar cases are discussed.

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In order to investigate the plausible association of migraine recurrence with anxiety and depressive symptoms, a multicentre, randomized, double-blind, placebo-controlled, crossover clinical trial was conducted using sumatriptan as a vehicle drug. Migraineurs were randomly assigned to receive either 50 mg sumatriptan or placebo for three consecutive migraine attacks, and then cross over to the other treatment for three more migraine attacks. The primary measurements were the observed rate of migraine recurrence in relation to (i) patient's mood condition, measured by the Hamilton rating scales for depression and anxiety and (ii) patient's general health and functioning measured by the Symptom Checklist (SCL)-90-R. Migraine recurrence was defined as any migrainous headache that occurred within 24 h post treatment, only when pain free at 2 h was achieved. The analysis of efficacy was performed on 376 migraine attacks treated with sumatriptan and 373 attacks treated with placebo. Recurrence ratio was 14.1% and 5.1%, respectively (P = 0.045). The number needed to treat for pain free at 2 h post dose was 5.4. Recurrence was not affected by Hamilton scores for depression or anxiety, SCL-90-R scores or treatment. Apparently, depressive or anxiety symptoms do not influence headache recurrence in acute pharmaceutical migraine treatment, but further investigation is required.

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