$486 Friday, November 11, 2005 Poster Abstracts

Results: Thirty CH patients, mean age 28 (range 18-47), n -- 23 women and n -- 7 men. Mean age for M H was 26 (range 18-45), n -- 25 women and II -- 5 men. Side locked headaches in II - 26 CH compared to II - 2 MH p < 0.0001. CH was occipitotemporal II -- 20, early frontal radiation II - 6, late frontal radiation II -- 15. M H was predomilialitly frontal II - 25, telirporo-occipital II -- 5, early occipital radiation II - 5, late radiation n -- 18 p < 0.05. Persistent headache between severe episodes CH n -- 23, M H n -- 3, p < 0.001. Late nausea n -- 20 (severe headache) and early n - 2 in CH, where as M H had very early nausea II -- 28, P < 0.0001. Vomiting reported in II - 11 M H none in the CH. Early photophobia and pholiophobia II - 2, late photophobia and phonophobia n - 8 in CH, n -- 25 M H had early photophobia and phonophobia p < 0.001. N -- 28 CH and one M H had neck stiffness and reduced mot ion p < 0.0001. Conclusion: CH can mimic MH. CH Call be differentiated froli1 M H on the proposed diagnostic criteria with attention to associated symptolirs particularly tire time of their onset in relation to headache.

1516 Medication Overuse Headache (MOH)- an under diagnosed common problem

Kushwaha S a, Gupta M a, Bala K a, Palidey S a . 1Institute of Human behaviour & Allied Sciences, Delhi, India

Background: To study the clinical profile, treatment and outcome of patients with medication overuse headache. Methods: Total no of 47 patients (37 F, 10M), with mean age was 31.6 yrs. fulfilling the International Headache Society (IHS) criteria-2004 for medication overuse were selected and evaluated. Headache > 15 day/ mon th for 3 months & Medication overuse; Analgesic intake > 5 tab/ week for 3 months , Ergotalifflie, Opiods & Triptalis 10 days or more. Results: Out of 47 patients 26 (55.3?,'0) had chronic tension type headache, 9 (119.1°'o) had migraine & 12 had mixed headache. The mean duration of headache was 4.2 yrs. Depression was present in 24 pts. Pericranial, back & neck IIlUSCle tenderness was present ill 24 pts. Neuroilimgilig was normal in all pts. Medications overused were Analgesics by 45, Ergotamine by 7, steroids by 4, Yriptans by 4, Benzodiazepines by 22 patients respectively, while 38 pts were on multiple drugs. After counseling and reassurance, detoxification was done, tire patients were put on appropriate treatment i.e. prophylactic for migraine and mixed headache and antidepressants for co-morbid depression. On follow-up all tire patients improved. 22 had 75"/0 and 18 had 35-50% reduction in headache after 1 month . All tire patients were asymptomatic after 2a~ - 3 months , however, 4 patients reverted to their medication overuse while 3 patients lost Follow-up. Conclusion: Medication overuse headache is a widely unrecognized condition because of lack of wide spread awareness and ulider- standing. Eiilphasis should be given on early recognition and treatment to prevent tiffs frequent form of headache as it carries a lot of morbidity in day-to-day life.

1517 Characteris~tics of Headaches in Healtheare Workers Arising From the Use of the N95 Face-mask During the SARS Crisis

Erle CH Lhn:, Raymond CS Seet 2, Kalig-Hoe, Lee 1, Belijaliffli, K C Ong:, Benjamin YS Chuala ~, Einar PV Wilder-Smith 2. 1Department of Medicine and," 2Department of Hernatology-Oneology National University Hospital, Singapore

Background: In 2003, during tire severe acute respiratory distress syndrome (SARS) epidemic, all healthcare workers in Singapore were mandated to wear the N95 face-mask as part of personal protective equipment, sometimes continuously for more than 4 hours. We noticed an increase in complaints of headaches. Method: We surveyed healthcare workers in our tertiary hospital to detetmilie the frequency of headaches, headache subtypes, risk factors associated with tire developlilelit of headaches and the impact of headaches (iiulirber o f sick days, frequency of headaches and tire use

of abortive or preventive headache medications) after we noticed an increase in headache complaints. Results: 212 (147 male, 165 female) healthcare workers of IIreali age 31 years (range, 21-58) participated in the survey. Of tire 79 (37.3"/0) respondents who reported headaches when they wore the face-mask, 26 (32.9"/0) reported headache frequency exceeding six times in a month. 6 (7.6?,'0) had taken sick leave from March 2003 to June 2004 (mean, 2 days; range, 1-4 days) and 47 (59.5?,'0) required the use of abortive analgesics because of headache. 4 (12.1%) were on preventive medications for headache during tiffs period. Multivariate logistic regression showed that pre-existent headaches [p - 0.041, OR - 1.97 (95%CI 1.03-3.77)] and continuous use of the N95 mask exceeding 4 hours (13 - 0.053) were associated with the development of headaches. Headache subtypes (migraine, tension-type headaches) were not associated with N95 mask-associated headaches in patients with pre-existent headaches (p - 0.191). Conclusion: Use of tire N95 face-mask in health care workers is associated with headaches, especially those with p re-existent headaches. Further studies are warranted to determine pathogenesis of these headaches.

1518 Topixaulate hliproves the quality of life of patients with Migraine: pooled data from three Placebo-controlled, migraine prevention trims

Loder E ~, DahlSf C 2, Diamond M 3, Mao L 4, Rupnow M 5, Papadopoulos G 6, Greeliberg S 4. 2Spaulding Rehabilitation Center, Boston, Massachusetts, United State of America; 2Institute of Clinical Neurosciences, Goteborg, Sweden; 3Diamond Headache Clinic, Chicago, Illinois, United States of America; 40rtho-MeNei! Neurologies, Inc., Titusville, New Jersey, United States of America; 5Janssen Medical Affairs, LLC, Titusville, New Jersey, United States of America; eYohnson & Johnson Pharmaceutical, Raritan, New Jersey, United States of America

Objective: Evaluate health-related quality-of-life (HRQoL) changes in subjects receiving topiramate 100 mg/d during three randomized, double-blind, placebo-controlled migraine prevention trials, and assess the relationship between reduced monthly migraine frequency and improved HRQoL. Backgxound: Topiramate 100 mg/d is approved for the prophylaxis of migrailie headache in adults. A favorable response to migrailie preventives is defined as a _>50% reduction in monthly migraine frequency. The most common adverse events in pivotal trials niduded: paresthesia, fatigue, anorexia, nausea, cognitive impairment. Method: Migrailie-Spedfic-Questioliiiaire (MSQ) scores were pooled and compared across trials for ilitelit-to-treat (:TT) subjects (mean age: 39.8y; female -- 84%) receivilig topiralirate 100 mg/d (if -- 384) or placebo (in - 372). For additional analyses, these patient groups were combined and divided into new groups based on a < 50?,'0 (n - 492) or _>50% (in - 262) decrease in monthly migraine frequency during the trials. All betweeli-group differences were analyzed using ANCOVA. Results: Significantly more patients on topiramate 100 mg/d were >50"/0 respoliders versus placebo (152"/o versus 23"/0; P < 0.001). Favorable responders (_>50?,'8 reduction in month ly migraine fre- quency) on either treatment had significantly-improved MSQ scores versus less favorable responders (i<50% reductions in month ly migraine frequency, P < 0.001). Subjects receiving topiralirate 100 mg/d experienced siguificalit improvelirelits on all 3 MSQ domains throughout the double-blind phase versus placebo (P - 0.024 at Week 8; P < 0.001 Weeks 16 and 26 for Role-Prevention; P < 0.001 for Role-Restriction and Emotional-Funct ion all time points). Contusions: A greater reduction in migraine frequency was associated with significant improvement in H R Q o L at every time-poilit measured. Topiralirate 100 mg/d was associated with siguificalitly increased H R Q o L and siglffficalitly reduced monthly migrailie frequency throughout the 6-month trials.