SYNOPSISInformation on the prevalence of headache and its characteristic features and the factor provoking it was collected using a questionnaire similar to that introduced by Waters. The questionnaire was posted to every inhabitant over 15 years of age in a defined urban and a defined rural area in northern Finland. The reliability of the questionnaire was tested by neurological examination of a random sample of 200 persons. The response rate was 74.0% in the urban and 79.5% in the rural area, a total of 3067 questionnaires being returned. The prevalence of headache in the year preceeding the survey was 73.1% in women and 57.6% in men. This difference was significant. At the same time the prevalence was slightly higher (p<0.05) in the urban than in the rural area. The percentage with headache was highest between 15 and 64 years of age in both the urban and the rural men and women, and declined sharply after 65 years of age. Only in men aged 15-24 years was it significantly more common in the urban area. Education, social class and mode of employment did not influence the prevalence of headache once pensioners were excluded. Headache was slightly more common in urban self-employed people and in urban employees, but equally common in urban and rural students, housewives and pensioners. It was significantly more common in married men and women. The percentage of women with headaches related to the menstrual period was low. The most common provoking factor was stress, the sauna-bath ranking second. No correlation was found between smoking habits and headache in this survey.
Twenty-three patients suffering from continuous headache linked with habitual daily use of ergotamine tartrate were studied. Their headaches were classified clinically, and possible side effects of ergotamine medication, plasma levels of ergotamine, and occurrence of withdrawal symptoms after discontinuation of drug abuse were recorded. Seventeen of the patients were clinically diagnosed as suffering from "ergotamine headache", and seven of them complained of coldness in the extremities. Plasma ergotamine levels were measured by using a radioimmunoassay. In almost half of the patients the 1 h plasma levels after the daily dose were below the detection limit of the procedure (0.12 ng/ml). The duration and severity of the withdrawal symptoms did not correlate with the doses and plasma levels of ergotamine. In only 4 of the 21 patients who were followed up for 3 to 6 months did headache symptoms not improve after ergotamine withdrawal. The results indicate that even small (0.5-1.0 mg/day) doses of ergotamine tartrate taken regularly may cause continuous headache symptoms and withdrawal symptoms after discontinuation.
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