Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
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An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


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Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2012 | Month : April | Volume : 6 | Issue : 2 | Page : 278 - 281

The Socio-demographic Profile, Classification and the Clinical Profile of Headache: A Semi-urban Hospital Based Study

Guruprasad Kundapura Gidibidi, Dadapeer Kareemsab, Niranjan Mambally Rachaiah

1. MD in Psychiatry, Assistant Professor, Dept. of Psychiatry 2. MS, DNB in Ophthalmology, Assistant Professor 3. MD, DNB in General Medicine, Assistant Professor, Dept. of Medicine Hassan Institute of Medical Sciences, Hassan 573201, Karnataka, India.

Correspondence Address :
Dr. Niranjan M.R.
Dept. of Medicine, Hassan Institute of Medical Sciences,
Hassan 573201, Karnataka, India.
Phone: 09448672501
E-mail: drniranjanmr@yahoo.co.in

Abstract

Context: Migraine and tension type headache are the two most common types of primary headaches. In spite of the internationally accepted diagnostic criteria, it is not uncommon to face difficulties in diagnosing headache in the clinical practice. Aims: Our aim was to study the socio-demographic profile, classification and the clinical profile of headache patients who attended in a hospital which was located in a semi-urban setting.

Settings and Design: A prospective, cross-sectional study.

Methods and Materials: Patients mainly presented with the complaint of headache who were more than 12 years of age, were included in the study. The demographic details, the onset and the lifetime duration of the illness, the pattern of headache, the associated features and the family history were recorded. The international classification of headache disorders (ICHD), version 2 was applied.

Statistical Analysis: Descriptive analysis was done by using SPSS, version 17.0.

Results: 74% of the patients were females and 44% of them were between 29 and 44 years of age. Migraine was the most common disorder (182 patients), followed by tension type headache (99 patients) and cluster headache (3 patients).

Conclusion: A number of symptoms that are presently not included in the ICHD-2 classification may help in differentiating migraine from the tension type headache.

Keywords

Cluster headache, Demographic details, Migraine, Symptoms, Tension type headache

Introduction
Headache is one of the most common maladies which affect humans. 76% of the women and 57% of the men report at least one significant headache per month, and more than 90% experience at least one noteworthy headache in their life time (1). While headache has been an unaddressed cause of morbidity around the world, it has remained to be largely unrecognized in the developing world (2). Most of the clinical and epidemiological studies have originated in the developed countries and there is scarce literature to support the treatment guidelines or the public health intervention which deal with headache in the low and middle income countries where 85% of the population lives (3). The aim of our study was to study the socio-demographic profile, classification and the clinical profile of the headache patients who attended a hospital which was located in a semi-urban setting.

Material and Methods

A prospective study of all the patients who presented with the chief complaint of headache to the departments of Medicine, Psychiatry, Ophthalmology and Otorhinolaryngology at the Sri Chamarajendra District Hospital which was attached to the Hassan Institute of Medical Sciences, Hassan, Karnataka, India between January 2011 to May 2011 was conducted. For each patient, a routine clinical questionnaire was completed. The questionnaire consisted of demographic details and detailsArticleon the onset and the lifetime duration of the illness, the pattern of the headache, the associated factors and the family history. Patients with secondary causes of headache were excluded from the study. The International Classification of Headache Disorders, version 2 was applied and as many diagnoses as was necessitated by the criteria and as was clinically justified, were assigned to each patient (4). The ethical committee’s clearance was taken for the study at the Sri Chamarajendra District Hospital. A written informed consent was taken from all the patients who were included in the study.

Statistical Analysis
The statistical analysis was done by using the Statistical Package for Social Sciences, version 17.0.

Results

A total of 356 patients were selected for the study, of which 56 were excluded due to secondary causes and the remaining 284 patients were included in the final study group. The study group included 210 (74%) females and 74 (26%) males. A majority of the patients were suffering from migraine-182(64%), followed by tension type headache-99(35%) and cluster headache-3 (1%). The clinical characteristics at presentation of the patients who were diagnosed with migraine have been summarized in (Table/Fig 1). Migraine was the most commonly diagnosed primary headachewhich was found in 182(64%) patients. 49% of the patients were in the age group of 29-44 years, 58% had migraine for a duration of 4 or more years and 42% had a frequency of headache of more than 15 times per month.

Eighty one percent of the patients had unilateral headache, the common sites of the pain being holocranial (26%) and parietotemporal (24%). The commonest type of pain was the throbbing type (43%) and stress was the major triggering factor (42%). Analgesic medications relieved the headache in 37% of the patients. Phonophobia (29%), nausea (25%) and photophobia (24%) were the commonly associated symptoms.

A majority of the patients (68%) did not have any family history of headache. The clinical characteristics at presentation of the patients who were diagnosed with tension headache have been summarized in (Table/Fig 2). A total of 99 patients were found to be having tension headache, of which 74(75%) were females and 25(25%) were males respectively.

Forty nine percent had tension headache for duration of 4 or more years, 59% had a frequency of headache of more than 15 times per month and the average duration of each episode lasted for more than 24 hours in 39% of the patients. The commonest type of pain was the pressure like pain (44%) and the site of the pain was holocranial (70%). Of the total study population, 3 were diagnosed to have cluster headache, out of which 2 were males and 1 was female.

Discussion

Migraine and tension type headache were the two most common presentations in this clinical study. Epidemiological evidence from around the world has suggested that tension type headachewas the most common cause of primary headache (5). In our study, migraine was found to be the most common reason for the consultation of a doctor for headache. Few reasons that can explain this are lack of awareness of the tension type headache and lesser complications among the tension headache patients. Literature reports have suggested that the amount of disability which was associated with tension headache on a societal level was much higher than that which was associated with migraine, especially when it was measured on the basis of the absence from work (6). However, there is a need for an increased awareness and an improved ability among the health practitioners and the primary care physicians to manage migraine and tension type headache, which are likely to help in decreasing the associated burden.

We found that females out numbered the males in the number of cases of both migraine and tension type headache. Migraine showed an approximately equal distribution in childhood; but in adults, women seemed to be more affected than the men (7). The prevalence of migraine was found to be higher in the 29-44 year age group in our study and this finding was consistent with the findings of Köseoglu, E., et al (8). The commonest type of pain which was observed in our study was throbbing (43%), followed by pressure like (30%), which was consistent with the findings of previous studies (9),(10),(11) (Rasmussen et al. 1991a; Russell et al. 1996; Stewart et al. 2003.). About 30% of the migraine patients in our study had an average duration of headache of more than 24 hours, which was consistent with the finding of a previous study (11) (Stewart et al. 2003).

The associated symptoms and signs were more prominent and common in migraine headache, the commonest associated symptoms which were found in our study being phonophobia or photophobia and nausea, which was consistent with the findings of previous studies (9),(12) [Rasmussen et al. 1991a; (Rasmussen and Olesen 1992a)]. Trigger factors are important in migraine management since their avoidance may result in a better control of the disorder. Several studies have reported stress, lack of sleep, and fasting as the most common triggering factors (13). Stress (42%), sleep deprivation (26%) and food related factors (12%) were the most common triggering factors in our study, which were consistent with the findings of previous mentioned studies.

The frequency of dietary trigger factors which were reported by the migraine patients varied widely from 7 to 44% (13) (Robbins 1994). However, in our study, we found 12% of the migraine patients have diet as a triggering factor. The average age of the onset of the tension type headache in our study was 13 to 28 years, which is similar to the findings of another study (14) (Lynberg et al 2005 b). The site of the pain was bilateral in 88% of the patients, which was consistent with the findings of other studies (15),(9) (Iversen et al 1990: Rasmussen et al 1991).

The average duration of the tension type of headache in a majority of the patients of our study group, were 12-24 hours and >24 hours. However, in comparison to previous studies, the average tension type headache duration in our study ranged from 30 min to 7 days (16) (Olesen et al 2004), with the reported to median duration ranging from 4 to 13 hours (17),(18) (Pryse-Phillips et al 1992: Jensen 1996).

Limitations
As our study was hospital based, the results of our study cannot be extrapolated to the general population. Secondary headache profiles were not included in this study. Migraine and tension type headache are the most common clinical presentations of headache.

Conclusion

Headache disorders constitute a public health problem of enormous proportions, with an impact, both on the individual sufferer and on the society. Migraine and tension type headaches are the most common clinical presentations among all the types of headaches. Epidemiological knowledge is required to quantitate the significance of these disorders.

References

1.
Saper JH. Headache disorders, chronic pain. Medical Clinics of North America 1999; 83 (3): 6633-39.
2.
Mateen F, Dua T, Stteiner T, Saxena S. Headache disorders in the developing countries; research over the past decade. Cephalagia. 2008.
3.
Murtaza M, Kisat M, Daniel H, Sonawalla AB. Classification and clinical features of headache disorders in Pakistan: A retrospective review of clinical data. PLoS One 2009; 4(6): E5827. DOI:10.1371/ journal.pone.0005827.
4.
The International Classification of Headache Disorders: 2nd edition Cephalagia 2004; 24 (Suppl 1): 9-160.
5.
Stovner I, Hagen K, Jensen R, Katsarava Z, Lipton R, et al. The global burden of headache: a documentation of the headache prevalence and disability worldwide. Cephalagia 2007; 27:193-210.
6.
Rasmussen BK, Jensen R, Olesen J Impact of headache on sickness; absence and utilisation of medical services: a Danish population study. J Epidemiology Community Health 1992; 46:443-46.
7.
Shah PA, Nafee A. Clinical profile of headache and cranial neuralgias. J Assoc Physicians India1999; 47(11):1072-75.
8.
Köseoglu E, Naçar M, Talaslioglu A, Cetinkaya F. Epidemiological and clinical characteristics of migraine and tension type headache in 1146 females in Kayseri, Turkey. Cephalalgia, 2003; 23: 381–88.
9.
Rasmussen BK, Jensen R, Olesen J. A population based analysis of the diagnostic criteria of the International Headache Society. Cephalagia 1991a; 11(3):129-34.
10.
Russell MB, Rasmussen BK, Fenger K, et al Migraine without aura and migraine with aura are distinct clinical entities: a study of four hundred and eighty four male and female migraineurs from the general population. Cephalagia 1996; 16(4):239-45.
11.
Stewart WF, Lipton RB, Kolodner K. The migraine disability assessment (MIDAS) score: relation to headache frequency, pain intensity and headache symptoms. Headache 2003; 43(3):258-65.
12.
Rasmussen BK, Olesen J Migraine with aura and migraine without aura: an epidemiological study. Cephalagia 1992a; 12 (4):221-28;
13.
Robbins L Precipitating factors in migraine: a retrospective review of 494 patients. Headache 1994; 34(4):214-16.
14.
Lyngberg AC, Rasmussen BK, Jorgensen T, et al Has the prevalence of migraine and tension-type headache changed over a 12 year- year period? A Danish population survey. Eur J Epidemiolo 2005b; 20(3):243-49.
15.
Iversen HK, Langemark M, Andersson PG, et al. Clinical characteristics of migraine and episodic tension type headache in relation to the old and new diagnostic criteria. Headache 1990; 30(8):514-19.
16.
Olesen J, Bousser M-G, Diener HC, et al. The International Classification of Headache Disorders, 2nd edition. Cephalalgia 2004; 24 (suppl 1):24-150.
17.
Pryse-Phillips W, Findlay H, Tugwell P, et al. A Canadian population survey on the clinical, epidemiologic and societal impact of migraine and tension type headache. Can J Neurol Sci 1992; 19(3):333-339.
18.
Jensen R. Mechanisms of spontaneous tension type headaches: an analysis of tenderness, pain threshold and EMG. Pain 1996; 64(2): 251-56.

DOI and Others

DOI: JCDR/3634:1953

Financial OR OTHER COMPETING INTERESTS:
None.


Date Of Submission: Nov 15, 2011
Date Of Peer Review: Jan 07, 2012
Date Of Acceptance: Jan 13, 2012
Date Of Publishing: Apr 15, 2012

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