Prevalence of Imploding, Exploding and Ocular Headache Types in a Women’s Health Outpatient Practice

Abstract

Objectives: (i) Determine the prevalence of imploding, exploding and/or ocular headaches in women with migraine in a primary care practice of women (ii) Investigate the concordance of physician diagnosis with patient self-diagnosis of pain directionality (iii) Assess correlation between the type of headache and severity of migraines, reproductive stage, and response to acute and prophylactic treatments Background: botulinum toxin A is a drug made from the toxin produced by Clostridium botulinum that works by weakening or paralyzing certain muscles or by blocking certain nerves.17 Recent migraine trials evaluating the efficacy of botulinum toxin A therapy noted differences in the efficacy of botulinum toxin A therapy based on directionality of pain ((imploding exploding and ocular). 5,6,7 However, the prevalence of these migraine types and their responses to conventional migraine prevention therapies has not yet been assessed. Methods: 201 patients participated in structured clinician-administered interviews and completed written questionnaires. Directionality of migraines were determined by both patients and physicians. Descriptive statistics, kappa coefficients and Kruskal-Wallis tests were used to assess migraine prevalence, physician-patient diagnosis concordance and association of migraine to severity, treatment and reproductive stage respectively. Results: 201 patients were enrolled with average age of 46. All patients reported directionality of their migraine and prevalence varied depending upon the method used to assign directionality and were: 33%-42% imploding headaches with or without ocular pain, 18%-44% exploding headaches with or without ocular pain, 7%-39% had ocular pain only, and 8%-13% had imploding and exploding headaches with or without ocular pain. The concordance between physician diagnosis of headache directionality with patient written response, between physician diagnosis and patient diagnosis via selection of representative picture, and between patient diagnosis via written question and via selection of representative pictures were week to moderate using Kappa coefficient. No correlation between the type of headache and severity of migraines, reproductive stage, and response to acute and prophylactic treatments was found (p>0.05). Conclusion: Improved methods of determining pain directionality and target therapy are needed.