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519 PRESSURE PAIN SENSITIVITY MAPS FOR ASSESSING MECHANICAL MUSCLE HYPERALGESIA IN CHRONIC HEADACHE CONDITIONS
Poster Sessions / European Journal of Pain 13 (2009) S55–S285
determine their relationship with depression and anxiety, data from 229 FMS patients was collected by means of a self-applied questionnaire. The sample was composed largely of women (98%), aged 25–66 (42.69±0.64). Pain was reported as the most disturbing aspect of the condition, followed by fatigue, sleep disturbances, alteration of mood, memory loss and focus deficiency problems. The average level of satisfactoriness with the received medical care was 3.76±0.2 on a 10 points Lickert scale. Responders placed a high value on support from their life partners and family setting, but less so from their close social relationships. High anxiety and depression indices were found in FMS patients (m = 2.02±0.07 and m = 2.55±0.06, respectively on a 0–4 scale), as assessed by means of a SCL90-R checklist. Depression was negatively correlated with perceived social support from partners, family setting, and close social relationships. Anxiety scores were negatively correlated only with perceived support from the family setting and close social environment, but not with perceived support from partners or health care professionals. We suggest that interventions improving perceived social support may contribute to pain alleviation in FMS patients by lowering anxiety and depression. 517 A COMPARISON OF TWO MULTIDISCIPLINARY INPATIENT REHABILITATION PROGRAMMES FOR FIBROMYALGIA: A REGISTER LINKAGE STUDY ON WORK DISABILITY H. Suoyrjo¨ 1 *, T. Oksanen2 , K. Hinkka3 , J. Pentti2 , M. Kivimaki ¨ 4, T. Klaukka3 , J. Vahtera2 . 1 The Hospital District of South Ostrobothnia, Sein¨ ajoki, Finland; 2 Finnish Institute of Occupational Health, Turku, Finland; 3 Research Department, Social Insurance Institution of Finland, Turku, Finland; 4 Department of Epidemiology and Public Health, University College London, London, United Kingdom Background: Patients with fibromyalgia have a high risk of temporary and permanent work disability. Little is known about the effects of fibromyalgia rehabilitation on work disability. Aims: To determine whether a specific fibromyalgia rehabilitation programme is superior to a non-specific musculoskeletal rehabilitation of patients with fibromyalgia in terms of work disability. Methods: A prospective observational study of 215 local government employees with a 6-year post-intervention follow-up to monitor the occurrence of long sick-leave and disability pensions among the participants of two different fibromyalgia rehabilitation programmes. Results: Specific fibromyalgia rehabilitation was not superior to a non-specific musculoskeletal rehabilitation, with the corresponding hazard ratios (95% confidence intervals) after adjustments being 1.02 (0.75–1.40) for long sick-leave, 1.18 (0.75–1.87) for very long sick-leave, and 1.07 (0.63–1.83) for disability pension. Conclusion: The results suggest that in reducing work disability among patients with fibromyalgia a specific multidisciplinary fibromyalgia rehabilitation programme practised in Finland provides no benefit compared with non-specific multidisciplinary musculoskeletal rehabilitation. Further research is needed to develop an optimal programme (or several different programmes) to control the burden of work disability related to fibromyalgia.
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518 CLUSTER ANALYSIS OF DATA FROM FOUR DULOXETINE STUDIES IN FIBROMYALGIA P. Van Wambeke1 *, E.H. Choy2 , L.A. Bradley3 , I.A. Lipkovich4 , W. Deberdt5 . 1 University Hospitals Leuven, Leuven, Belgium; 2 King’s College London, London, United Kingdom; 3 University of Alabama, Birmingham, United States; 4 Eli Lilly and Company, Indianapolis, United States; 5 S.A. Eli Lilly Benelux N.V., Brussels, Belgium Aims: The aim was to identify distinct groups of subjects with fibromyalgia across multiple outcome measures and evaluate their predictors. Methods: Measures from 631 duloxetine-treated females collected post-treatment (12 weeks) in 4 randomized placebo-controlled trials were used to identify distinct subject groups using cluster analysis (k-means method). Corresponding classification rules were constructed using a classification tree method. Baseline predictors for outcome clusters were evaluated with logistic regression. Results: Five clusters were identified, ranging from “worst” with high pain levels and severe mental/physical impairment to “best” with low pain levels and nearly normal mental/physical function (Table 1). Table 1. Cluster characteristics (selection) and classification rules Cluster
1 (worst) 2 3 4 5 (best)
N
78 135 104 185 129
Week 12 mean score BDI BPI total Pain Pain intensity interference (BPIAI)
FIQ Interference with work (FIQ14)
depression (FIQ20)
25.08 7.93 15.81 5.99 3.46
8.26 6.29 4.82 3.16 0.77
6.91 1.45 5.09 1.12 0.57
7.58 5.93 4.12 3.55 1.43
7.89 4.77 4.21 2.23 0.60
Classification rule
BPIAI ≥ 7.14 3.29 ≤ BPIAI < 7.14, FIQ20 < 5 3.29 ≤ BPIAI < 7.14, FIQ20 ≥ 5 BPIAI < 3.29, FIQ14 ≥ 2 BPIAI < 3.29, FIQ14 < 2
BDI = Beck Depression Inventory; BPI = Brief Pain Inventory; FIQ = Fibromyalgia Impact Questionnaire.
Classification rules mimicking the clusters were derived and used to classify duloxetine- and placebo-treated female subjects at Week 12 (N = 1160) and at baseline. Duloxetine subjects were significantly more likely to transition to better outcome categories at Week 12 than placebo subjects. Conclusions: Outcomes were spread over a broad range. Baseline category and treatment were the most significant predictors. P Van Wambeke: advisory board member for Eli Lilly (Belgium); E Choy: consultant and advisor for Eli Lilly; L Bradley: consultant and advisor for Eli Lilly, Forest Laboratories, Cypress BioScience, Pfizer; grants from National Institutes of Health; I 519 PRESSURE PAIN SENSITIVITY MAPS FOR ASSESSING MECHANICAL MUSCLE HYPERALGESIA IN CHRONIC HEADACHE CONDITIONS 1 C. Fernandez-de-las-Pe ´ nas ˜ 1 , P. Madeleine2 , J. Fernandez-Carnero ´ *, H.Y. Ge2 , J.A. Pareja3 , L. Arendt-Nielsen2 . 1 Universidad Rey Juan Carlos, Alcorc´ on, Spain; 2 Center for Sensory-Motor Interaction (SMI), Aalborg, Denmark; 3 Fundaci´ on Hospital Alcorc´ on, Alcorc´ on, Spain Background and Aim: Our aim was to investigate topographical pressure pain sensitivity maps of the temporalis and trapezius muscles in a blinded design in chronic tension type headache (CTTH) and unilateral migraine as compared with controls. Methods: A pressure algometer was used to assess pressure pain thresholds (PPT) over 9 points of the temporalis muscle (3 in the anterior part, 3 in the middle, and 3 in the posterior part) and 11 over the trapezius muscle (4 in the upper part, 2 over the levator scapulae, 2 in the middle part, and 3 in the lower part) in 20 females with CTTH, 20 with unilateral migraine and 20 healthy women. Results: Both headache groups showed lower PPT at all points in both muscles than controls (P < 0.01). For the temporalis muscle in both headache groups, PPT maps were decreased bilaterally from the posterior to the anterior column of the temporalis muscle (P < 0.05), whereas within controls, PPT did not follow any anatomical distribution. For the trapezius muscle the most
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Poster Sessions / European Journal of Pain 13 (2009) S55–S285
sensitive location was the neck portion of the upper trapezius muscle in both patients and controls (P < 0.001). Further, side-toside differences were found in strictly unilateral migraine but not in CTTH or controls. Conclusions: This study provides important information about muscle sensitivity, as pressure sensitivity maps differed among CTTH, unilateral migraine and healthy controls. Therefore, inhomogeneity in spatial distribution of muscle sensitivity to pressure should be included in further studies as it may identify particular sources of pain. 520 THE ATYPICAL CASES OF PAINFUL OPHTHALMOPLEGIA SYNDROME M. Gavriliuc, A. Grumeza *, O. Schiopu. Institute of Neurology and Neurosurgery, Chsisnau, Moldova Objectives: To reveal clinical peculiarities of painful ophthalmoplegia cases treated in the Pain Department. Methods: The study included 6 cases of painful ophthalmoplegia admitted at the Pain Department in the period of 2004–2008 with atypical clinical presentations. All the patients underwent laboratory exams of blood and serum, lumbar puncture; imagistical exam by MRI of the brain and orbit with and without contrast, magnetic resonance angiography in 3 patients. The patients underwent standard steroid treatment. Outcome was measured by Visual Analogue Scale, and EuroQoL-5D. Results: In 3 patients painful ophthalmoplegia had between 3 and 5 relapses. The recurrences were localized on the same side. In 2 patients Tolosa-Hunt syndrome evolved atypically by changing the side of pain localization. In the cases of lateralization changing MRI exam was performed at the onset of symptoms to rule out the secondary etiology. The recurrences were treated by the same clinical protocol with oral steroids. In 3 cases different degree of permanent ophthalmoparesis was established, and in 2 cases decrease of visual acuity. The severity of permanent disability correlated with the number of recurrences. At each recurrence Visual Analogue Scale and EuroQoL-5 D were performed and as result in the acute phase the severity of symptoms decreased with each following recurrence, but in the light period these scales showed progression in residual pain syndrome and quality of life impairment. Conclusion: In painful ophthalmoplegia syndrome the number of recurrences is proportional to the permanent disability degree. The lateralization of syndrome can change in the same patient. 521 SELF-REGULATION, ANXIETY LEVEL AND BRAIN ACTIVITY IN YOUNG FEMALE STUDENTS WITH HEADACHES A. Kovaleva1 *, O. Voinovskaya2 . 1 Moscow Educational and Psychological University, Moscow, Russia; 2 Russian State University for the Humanities, Moscow, Russia Objectives: The main purpose of our study was to investigate some psychophisiological characteristics of the students with primary headaches in order to find possible non-pharmacological treatment approach. Methods: The type of headache (migraine, tension-type), the intensity and duration of pain were evaluated according to the questionnaire and neurologist consultation. The anxiety level was measured according to the Spielberger anxiety scale. To identify the personal way of self-regulation we used a special program: reaction time measurement in two different conditions (relaxation and mobilization). EEG was recorded from 8 cortical leads. Then the basic rhythms’ frequency and power were computerised. Statistical analysis was done using SPSS software package (descriptive statistics, Mann–Whitney U-test, Fisher test). Results: We examined 32 students (mean age 19.8). The whole sample was divided into two groups – with headaches (Hgroup, 18 females) and control group (14 females). As it was
expected, anxiety level in H-group was significantly higher than in control. Concerning self-regulation H-group had the same success in mobilization as control (reaction time about 250 ms), but in was difficult to them to reach relaxed state (reaction time during relaxation in H-group was higher, than in control). EEG data shows that H-group had higher theta-index and higher alpha-rhythm asymmetry in prefrontal lobes. Conclusions: Our investigation shows that females with headaches are more anxious, had some differences in brain activity and had difficulties in relaxation. So we suppose that relaxation training (biofeedback) should help in headache treatment. 522 HEADACHE ACCOMPANYING THE CHRONIC NASAL AND NASOPHARYNGEAL PATHOLOGY N. Lobjanidze *, M. Beridze, G. Buadze, M. Alpaidze, N. Kvirkvelia. State Medical University Clinic, Tbilisi, Georgia Aim: Study aimed at researching the nature of chronic cephalic pain in patients with chronic nasal and nasopharyngeal pathology(CNNP). Methods: One hundred and six patients with CNNP, aged from 6 to 75 years, 57 male and 49 female have been investigated. According to the type of nasal and nasopharyngeal pathology patients were classified in 5 groups, and were divided in three age categories: 6–18 years (39 patients), 19–65 years (38 patients), 66–75 years (29 patients). Headaches were estimated by neurologist before appropriate surgical and conservative treatment, after treatment and 6 months later. Cerebral blood flow was studied before treatment, after treatment and 6 months later by means of Transcranial Dopplerography. Control consisted of 30 age-matched healthy persons. Results: Chronic headache were established in 63 patients (59%). In all age categories the mean blood velocity in middle cerebral artery, anterior cerebral artery, basilar artery was significantly increased against control (p < 0.05), and pulsation index (PI) found to be decreased compared to control. After treatment blood flow velocity in the middle cerebral artery, anterior cerebral artery and in basilar artery in all age groups did not differ significantly from control (p < 0.5), and PI was significantly elevated against previous data (p < 0.05). Cephalic pain disappeared in 75% of treated patients and 25% noted the significant decrease in pain intensity and frequency. Conclusion: Treatment of CNNP can prevent the certain kind of cephalalgia, and improve the clinical course of accompaning headache. 523 AVOIDANCE AND DRUG PHOBIAS IN MOLDOVA: NEW FACTORS IN HEADACHE CHRONIFICATION? G. Pavlic1 *, I. Moldovanu2 , S. Odobescu3 . 1 State Medical and Pharmaceutical University “N. Testemitanu”, Chisinau, Moldova; 2 State Medical and Pharmaceutical University “N. Testemitanu”, Chisinau, Moldova; 3 Institute of Neurology and Neurosurgery, Chisinau, Moldova Background: Chronic headache is an emerging concept in headache disorders, brought to light by ICHD-II with multiple underlying mechanisms: psychological, behavioral, comorbidity, addiction, medication overuse (MO), etc. The objective of this study was to reveal the specific characteristics of chronic headaches in Moldavian patients. Material and Methods: The study group included 200 patients with chronic migraine referred to Headache Center during 2007. The diagnosis of chronic migraine and MO was made using the IHS classification and revised criteria for MO. All patients responded to an original questionnaire designed to test their attitude to medications and drug phobias together with general pain tolerance. Results: From the total number of 200 patients 134 (67%) didn’t have MO. The majority of them were females (102 or 76.1%), mean
determine their relationship with depression and anxiety, data from 229 FMS patients was collected by means of a self-applied questionnaire. The sample was composed largely of women (98%), aged 25–66 (42.69±0.64). Pain was reported as the most disturbing aspect of the condition, followed by fatigue, sleep disturbances, alteration of mood, memory loss and focus deficiency problems. The average level of satisfactoriness with the received medical care was 3.76±0.2 on a 10 points Lickert scale. Responders placed a high value on support from their life partners and family setting, but less so from their close social relationships. High anxiety and depression indices were found in FMS patients (m = 2.02±0.07 and m = 2.55±0.06, respectively on a 0–4 scale), as assessed by means of a SCL90-R checklist. Depression was negatively correlated with perceived social support from partners, family setting, and close social relationships. Anxiety scores were negatively correlated only with perceived support from the family setting and close social environment, but not with perceived support from partners or health care professionals. We suggest that interventions improving perceived social support may contribute to pain alleviation in FMS patients by lowering anxiety and depression. 517 A COMPARISON OF TWO MULTIDISCIPLINARY INPATIENT REHABILITATION PROGRAMMES FOR FIBROMYALGIA: A REGISTER LINKAGE STUDY ON WORK DISABILITY H. Suoyrjo¨ 1 *, T. Oksanen2 , K. Hinkka3 , J. Pentti2 , M. Kivimaki ¨ 4, T. Klaukka3 , J. Vahtera2 . 1 The Hospital District of South Ostrobothnia, Sein¨ ajoki, Finland; 2 Finnish Institute of Occupational Health, Turku, Finland; 3 Research Department, Social Insurance Institution of Finland, Turku, Finland; 4 Department of Epidemiology and Public Health, University College London, London, United Kingdom Background: Patients with fibromyalgia have a high risk of temporary and permanent work disability. Little is known about the effects of fibromyalgia rehabilitation on work disability. Aims: To determine whether a specific fibromyalgia rehabilitation programme is superior to a non-specific musculoskeletal rehabilitation of patients with fibromyalgia in terms of work disability. Methods: A prospective observational study of 215 local government employees with a 6-year post-intervention follow-up to monitor the occurrence of long sick-leave and disability pensions among the participants of two different fibromyalgia rehabilitation programmes. Results: Specific fibromyalgia rehabilitation was not superior to a non-specific musculoskeletal rehabilitation, with the corresponding hazard ratios (95% confidence intervals) after adjustments being 1.02 (0.75–1.40) for long sick-leave, 1.18 (0.75–1.87) for very long sick-leave, and 1.07 (0.63–1.83) for disability pension. Conclusion: The results suggest that in reducing work disability among patients with fibromyalgia a specific multidisciplinary fibromyalgia rehabilitation programme practised in Finland provides no benefit compared with non-specific multidisciplinary musculoskeletal rehabilitation. Further research is needed to develop an optimal programme (or several different programmes) to control the burden of work disability related to fibromyalgia.
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518 CLUSTER ANALYSIS OF DATA FROM FOUR DULOXETINE STUDIES IN FIBROMYALGIA P. Van Wambeke1 *, E.H. Choy2 , L.A. Bradley3 , I.A. Lipkovich4 , W. Deberdt5 . 1 University Hospitals Leuven, Leuven, Belgium; 2 King’s College London, London, United Kingdom; 3 University of Alabama, Birmingham, United States; 4 Eli Lilly and Company, Indianapolis, United States; 5 S.A. Eli Lilly Benelux N.V., Brussels, Belgium Aims: The aim was to identify distinct groups of subjects with fibromyalgia across multiple outcome measures and evaluate their predictors. Methods: Measures from 631 duloxetine-treated females collected post-treatment (12 weeks) in 4 randomized placebo-controlled trials were used to identify distinct subject groups using cluster analysis (k-means method). Corresponding classification rules were constructed using a classification tree method. Baseline predictors for outcome clusters were evaluated with logistic regression. Results: Five clusters were identified, ranging from “worst” with high pain levels and severe mental/physical impairment to “best” with low pain levels and nearly normal mental/physical function (Table 1). Table 1. Cluster characteristics (selection) and classification rules Cluster
1 (worst) 2 3 4 5 (best)
N
78 135 104 185 129
Week 12 mean score BDI BPI total Pain Pain intensity interference (BPIAI)
FIQ Interference with work (FIQ14)
depression (FIQ20)
25.08 7.93 15.81 5.99 3.46
8.26 6.29 4.82 3.16 0.77
6.91 1.45 5.09 1.12 0.57
7.58 5.93 4.12 3.55 1.43
7.89 4.77 4.21 2.23 0.60
Classification rule
BPIAI ≥ 7.14 3.29 ≤ BPIAI < 7.14, FIQ20 < 5 3.29 ≤ BPIAI < 7.14, FIQ20 ≥ 5 BPIAI < 3.29, FIQ14 ≥ 2 BPIAI < 3.29, FIQ14 < 2
BDI = Beck Depression Inventory; BPI = Brief Pain Inventory; FIQ = Fibromyalgia Impact Questionnaire.
Classification rules mimicking the clusters were derived and used to classify duloxetine- and placebo-treated female subjects at Week 12 (N = 1160) and at baseline. Duloxetine subjects were significantly more likely to transition to better outcome categories at Week 12 than placebo subjects. Conclusions: Outcomes were spread over a broad range. Baseline category and treatment were the most significant predictors. P Van Wambeke: advisory board member for Eli Lilly (Belgium); E Choy: consultant and advisor for Eli Lilly; L Bradley: consultant and advisor for Eli Lilly, Forest Laboratories, Cypress BioScience, Pfizer; grants from National Institutes of Health; I 519 PRESSURE PAIN SENSITIVITY MAPS FOR ASSESSING MECHANICAL MUSCLE HYPERALGESIA IN CHRONIC HEADACHE CONDITIONS 1 C. Fernandez-de-las-Pe ´ nas ˜ 1 , P. Madeleine2 , J. Fernandez-Carnero ´ *, H.Y. Ge2 , J.A. Pareja3 , L. Arendt-Nielsen2 . 1 Universidad Rey Juan Carlos, Alcorc´ on, Spain; 2 Center for Sensory-Motor Interaction (SMI), Aalborg, Denmark; 3 Fundaci´ on Hospital Alcorc´ on, Alcorc´ on, Spain Background and Aim: Our aim was to investigate topographical pressure pain sensitivity maps of the temporalis and trapezius muscles in a blinded design in chronic tension type headache (CTTH) and unilateral migraine as compared with controls. Methods: A pressure algometer was used to assess pressure pain thresholds (PPT) over 9 points of the temporalis muscle (3 in the anterior part, 3 in the middle, and 3 in the posterior part) and 11 over the trapezius muscle (4 in the upper part, 2 over the levator scapulae, 2 in the middle part, and 3 in the lower part) in 20 females with CTTH, 20 with unilateral migraine and 20 healthy women. Results: Both headache groups showed lower PPT at all points in both muscles than controls (P < 0.01). For the temporalis muscle in both headache groups, PPT maps were decreased bilaterally from the posterior to the anterior column of the temporalis muscle (P < 0.05), whereas within controls, PPT did not follow any anatomical distribution. For the trapezius muscle the most
S154
Poster Sessions / European Journal of Pain 13 (2009) S55–S285
sensitive location was the neck portion of the upper trapezius muscle in both patients and controls (P < 0.001). Further, side-toside differences were found in strictly unilateral migraine but not in CTTH or controls. Conclusions: This study provides important information about muscle sensitivity, as pressure sensitivity maps differed among CTTH, unilateral migraine and healthy controls. Therefore, inhomogeneity in spatial distribution of muscle sensitivity to pressure should be included in further studies as it may identify particular sources of pain. 520 THE ATYPICAL CASES OF PAINFUL OPHTHALMOPLEGIA SYNDROME M. Gavriliuc, A. Grumeza *, O. Schiopu. Institute of Neurology and Neurosurgery, Chsisnau, Moldova Objectives: To reveal clinical peculiarities of painful ophthalmoplegia cases treated in the Pain Department. Methods: The study included 6 cases of painful ophthalmoplegia admitted at the Pain Department in the period of 2004–2008 with atypical clinical presentations. All the patients underwent laboratory exams of blood and serum, lumbar puncture; imagistical exam by MRI of the brain and orbit with and without contrast, magnetic resonance angiography in 3 patients. The patients underwent standard steroid treatment. Outcome was measured by Visual Analogue Scale, and EuroQoL-5D. Results: In 3 patients painful ophthalmoplegia had between 3 and 5 relapses. The recurrences were localized on the same side. In 2 patients Tolosa-Hunt syndrome evolved atypically by changing the side of pain localization. In the cases of lateralization changing MRI exam was performed at the onset of symptoms to rule out the secondary etiology. The recurrences were treated by the same clinical protocol with oral steroids. In 3 cases different degree of permanent ophthalmoparesis was established, and in 2 cases decrease of visual acuity. The severity of permanent disability correlated with the number of recurrences. At each recurrence Visual Analogue Scale and EuroQoL-5 D were performed and as result in the acute phase the severity of symptoms decreased with each following recurrence, but in the light period these scales showed progression in residual pain syndrome and quality of life impairment. Conclusion: In painful ophthalmoplegia syndrome the number of recurrences is proportional to the permanent disability degree. The lateralization of syndrome can change in the same patient. 521 SELF-REGULATION, ANXIETY LEVEL AND BRAIN ACTIVITY IN YOUNG FEMALE STUDENTS WITH HEADACHES A. Kovaleva1 *, O. Voinovskaya2 . 1 Moscow Educational and Psychological University, Moscow, Russia; 2 Russian State University for the Humanities, Moscow, Russia Objectives: The main purpose of our study was to investigate some psychophisiological characteristics of the students with primary headaches in order to find possible non-pharmacological treatment approach. Methods: The type of headache (migraine, tension-type), the intensity and duration of pain were evaluated according to the questionnaire and neurologist consultation. The anxiety level was measured according to the Spielberger anxiety scale. To identify the personal way of self-regulation we used a special program: reaction time measurement in two different conditions (relaxation and mobilization). EEG was recorded from 8 cortical leads. Then the basic rhythms’ frequency and power were computerised. Statistical analysis was done using SPSS software package (descriptive statistics, Mann–Whitney U-test, Fisher test). Results: We examined 32 students (mean age 19.8). The whole sample was divided into two groups – with headaches (Hgroup, 18 females) and control group (14 females). As it was
expected, anxiety level in H-group was significantly higher than in control. Concerning self-regulation H-group had the same success in mobilization as control (reaction time about 250 ms), but in was difficult to them to reach relaxed state (reaction time during relaxation in H-group was higher, than in control). EEG data shows that H-group had higher theta-index and higher alpha-rhythm asymmetry in prefrontal lobes. Conclusions: Our investigation shows that females with headaches are more anxious, had some differences in brain activity and had difficulties in relaxation. So we suppose that relaxation training (biofeedback) should help in headache treatment. 522 HEADACHE ACCOMPANYING THE CHRONIC NASAL AND NASOPHARYNGEAL PATHOLOGY N. Lobjanidze *, M. Beridze, G. Buadze, M. Alpaidze, N. Kvirkvelia. State Medical University Clinic, Tbilisi, Georgia Aim: Study aimed at researching the nature of chronic cephalic pain in patients with chronic nasal and nasopharyngeal pathology(CNNP). Methods: One hundred and six patients with CNNP, aged from 6 to 75 years, 57 male and 49 female have been investigated. According to the type of nasal and nasopharyngeal pathology patients were classified in 5 groups, and were divided in three age categories: 6–18 years (39 patients), 19–65 years (38 patients), 66–75 years (29 patients). Headaches were estimated by neurologist before appropriate surgical and conservative treatment, after treatment and 6 months later. Cerebral blood flow was studied before treatment, after treatment and 6 months later by means of Transcranial Dopplerography. Control consisted of 30 age-matched healthy persons. Results: Chronic headache were established in 63 patients (59%). In all age categories the mean blood velocity in middle cerebral artery, anterior cerebral artery, basilar artery was significantly increased against control (p < 0.05), and pulsation index (PI) found to be decreased compared to control. After treatment blood flow velocity in the middle cerebral artery, anterior cerebral artery and in basilar artery in all age groups did not differ significantly from control (p < 0.5), and PI was significantly elevated against previous data (p < 0.05). Cephalic pain disappeared in 75% of treated patients and 25% noted the significant decrease in pain intensity and frequency. Conclusion: Treatment of CNNP can prevent the certain kind of cephalalgia, and improve the clinical course of accompaning headache. 523 AVOIDANCE AND DRUG PHOBIAS IN MOLDOVA: NEW FACTORS IN HEADACHE CHRONIFICATION? G. Pavlic1 *, I. Moldovanu2 , S. Odobescu3 . 1 State Medical and Pharmaceutical University “N. Testemitanu”, Chisinau, Moldova; 2 State Medical and Pharmaceutical University “N. Testemitanu”, Chisinau, Moldova; 3 Institute of Neurology and Neurosurgery, Chisinau, Moldova Background: Chronic headache is an emerging concept in headache disorders, brought to light by ICHD-II with multiple underlying mechanisms: psychological, behavioral, comorbidity, addiction, medication overuse (MO), etc. The objective of this study was to reveal the specific characteristics of chronic headaches in Moldavian patients. Material and Methods: The study group included 200 patients with chronic migraine referred to Headache Center during 2007. The diagnosis of chronic migraine and MO was made using the IHS classification and revised criteria for MO. All patients responded to an original questionnaire designed to test their attitude to medications and drug phobias together with general pain tolerance. Results: From the total number of 200 patients 134 (67%) didn’t have MO. The majority of them were females (102 or 76.1%), mean