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Enxaqueca na gravidez: uma revisão integrativa
No full textBackgroundMigraine is the most prevalent primary headache disorder in pregnancy, with unique clinical implications requiring specialized management approaches.ObjectiveTo provide a comprehensive review of migraine pathophysiology, clinical course, diagnosis, and management during pregnancy, postpartum, and lactation.MethodsSelective literature search of PubMed, Scopus, and Web of Science databases, complemented by AI-assisted tools (Elicit and Consensus) to ensure comprehensive coverage of emerging evidence, from 2003 to 2025.Key FindingsHormonal fluctuations drive migraine pathophysiology, with pregnancy\u27s hormonal stability typically improving symptoms in 60-70% of women with migraine without aura during the second and third trimesters. However, migraine with aura shows less predictable improvement, and de novo attacks may occur. Maternal migraine, particularly with aura, is associated with hypertensive disorders, preterm birth, cesarean delivery, fetal growth restriction, and increased ischemic stroke risk. Psychiatric comorbidities, including depression and anxiety, are frequent and linked to poorer outcomes.
Management
Non-pharmacological interventions form the foundation of treatment. When pharmacological therapy is required, acetaminophen is first-line, NSAIDs may be used only in the second trimester, and sumatriptan is the safest triptan option. Preventive treatment should be reserved for severe, refractory cases, with magnesium, propranolol, and amitriptyline as evidence-based options.ConclusionMigraine during pregnancy and postpartum requires a multidisciplinary approach prioritizing safe pharmacological strategies, individualized monitoring, and lifestyle optimization to ensure optimal maternal and fetal outcomes.Contexto
A enxaqueca é a cefaleia primária mais prevalente na gravidez, com implicações clínicas únicas que exigem abordagens de manejo especializadas.
Objetivo
Fornecer uma revisão abrangente da fisiopatologia, curso clínico, diagnóstico e manejo da enxaqueca durante a gravidez, o pós-parto e a lactação.
Métodos
Busca seletiva de literatura nas bases de dados PubMed, Scopus e Web of Science, complementada por ferramentas de inteligência artificial (Elicit e Consensus) para garantir a cobertura abrangente de evidências emergentes, de 2003 a 2025.
Principais Resultados
As flutuações hormonais impulsionam a fisiopatologia da enxaqueca, sendo que a estabilidade hormonal da gravidez geralmente melhora os sintomas em 60-70% das mulheres com enxaqueca sem aura durante o segundo e terceiro trimestres. No entanto, a enxaqueca com aura apresenta melhora menos previsível e podem ocorrer novos ataques. A enxaqueca materna, particularmente com aura, está associada a distúrbios hipertensivos, parto prematuro, parto cesáreo, restrição do crescimento fetal e aumento do risco de acidente vascular cerebral isquêmico. Comorbidades psiquiátricas, incluindo depressão e ansiedade, são frequentes e associadas a piores desfechos.
Manejo
Intervenções não farmacológicas constituem a base do tratamento. Quando a terapia farmacológica é necessária, o paracetamol é a primeira opção, os AINEs podem ser usados apenas no segundo trimestre e o sumatriptano é a opção mais segura entre os triptanos. O tratamento preventivo deve ser reservado para casos graves e refratários, com magnésio, propranolol e amitriptilina como opções baseadas em evidências.
Conclusão
A enxaqueca durante a gravidez e o pós-parto requer uma abordagem multidisciplinar que priorize estratégias farmacológicas seguras, monitoramento individualizado e otimização do estilo de vida para garantir os melhores resultados maternos e fetais
Best time for the application of the "blood patch" technique for post-spinal anesthesia headache: a systematic review
Full text linkIntroduction
With the puncture of the dura mater during spinal anesthesia, excessive cerebrospinal fluid (CSF) leakage can occur, leading to intracranial hypotension and, consequently, post-dural puncture headache. Currently, there are symptomatic supportive treatments, but they do not provide complete relief. The epidural blood patch has emerged as a treatment option with proven success, but there are still questions about the best timing for its use.
ObjectiveTo identify the best timing for the application of the epidural blood patch.
MethodSystematic review of clinical trials and randomized clinical trials on PubMed from 2000 to 2023.
ResultsThe review of the articles covers various topics on the use of the blood patch, including its effectiveness, comparison with conservative treatment, volume applied, timing of application, duration of supine positioning due to pain incapacity, and needle size. However, data regarding the timing of application were not extensively highlighted.
ConclusionIt was not possible to accurately determine the best timing for the application of the technique due to the lack of data, but its effectiveness is well-known, requiring further studies to better prescribe this treatment.
English
No full textBackground
Although evidence exists regarding the efficacy of galcanezumab in treating cluster headaches and other trigeminal autonomic cephalalgias (TACs), data on its effectiveness at lower doses are still lacking.
Objective
To report the clinical outcomes of Latin American patients treated with galcanezumab (GNZ) at a dose approved for migraine.
Methods
This case series included patients with cluster headaches, hemicrania continua, and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT-SUNA) who were treated with a 240 mg loading dose of GNZ followed by 120 mg monthly.
Results
A total of 18 subjects were included: 12 with cluster headaches, 4 with hemicrania continua, and 2 with SUNCT-SUNA who received 1 to 24 monthly cycles of GNZ. Among those with episodic cluster headaches, 7 of 8 patients experienced a reduction in attack frequency of more than 50%. In the chronic cluster headache group, this reduction was achieved in 2 of 4 patients. Additionally, 2 of the 4 patients with hemicrania continua became headache-free. In the SUNCT-SUNA group, 2 were included, both reduced their daily attack frequency from 120 to 30 and from 10 to 2, respectively.
Conclusions
These clinical observations suggest that lower doses of GNZ may be a viable option for treating Latin American patients with TACs.ResumoContexto: Embora haja evidências sobre a eficácia do galcanezumabe no tratamento da cefaleia em salvas e de outras cefaleias trigeminoautonômicas (CTAs), ainda faltam dados sobre sua eficácia em doses mais baixas.
Objetivo: Relatar os desfechos clínicos de pacientes latino-americanos tratados com galcanezumabe (GNZ) em uma dose aprovada para enxaqueca.
Métodos: Esta série de casos incluiu pacientes com cefaleia em salvas, hemicrania contínua e ataques de cefaleia neuralgiforme unilateral de curta duração com injeção conjuntival e lacrimejamento (SUNCT-SUNA) que foram tratados com uma dose de carga de 240 mg de GNZ seguida por 120 mg mensais.
Resultados: Um total de 18 sujeitos foi incluído: 12 com cefaleia em salvas, 4 com hemicrania contínua e 2 com SUNCT-SUNA, que receberam de 1 a 24 ciclos mensais de GNZ. Entre os pacientes com cefaleia em salvas episódica, sete de oito pacientes experimentaram uma redução na frequência dos ataques superior a 50%. No grupo com cefaleia em salvas crônica, essa redução foi observada em 2 de 4 pacientes. Além disso, 2 dos 4 pacientes com hemicrania contínua tiveram remissão completa da cefaleia. No grupo SUNCT-SUNA, os pacientes 1 e 2 reduziram a frequência dos ataques diários de 120 para 30 e de 10 para 2, respectivamente.
Conclusões: Essas observações clínicas sugerem que doses mais baixas de galcanezumabe podem ser uma opção viável para o tratamento de pacientes latino-americanos com CTAs
Migraine associated with psychosocial factors such as catastrophizing, anxiety and stress
Full text linkIntroduction
Migraine is a prevalent and disabling neurological disorder characterized by recurrent episodes of intense headache, often accompanied by nausea, photophobia, and phonophobia. Beyond its neurovascular and genetic nature, migraine is influenced by psychosocial factors that modulate symptom severity and frequency. Among these, pain catastrophizing, anxiety, and stress are highly relevant due to their impact on clinical outcomes and quality of life. This narrative review aims to synthesize the current literature on the influence of these psychosocial factors in migraine.
Methodology
This is a narrative literature review focused on the relationship between migraine and the psychosocial factors pain catastrophizing, anxiety, and stress. A search was conducted in the databases PubMed, Web of Science, and the Virtual Health Library (VHL) using the keywords: “catastrophizing” AND “anxiety” AND “migraine”.
Results
Pain catastrophizing is associated with increased pain intensity, reduced treatment response, and greater disability in individuals with migraine. Anxiety is a prevalent comorbidity that exacerbates symptoms through hyperactivation of limbic circuits. Stress acts as both a trigger and perpetuating factor, particularly in individuals with low adaptive capacity. These three factors interact dynamically, forming a biopsychosocial triad that contributes to migraine chronification and diminished quality of life.
Conclusion
Psychosocial variables significantly influence the course and burden of migraine. Their identification and management through integrative care strategies and public health initiatives are essential to improving clinical outcomes and reducing the societal impact of migraine
Cefaleia no Vale do Taquari: um estudo retrospectivo
No full textIntroduction
Primary headaches are highly prevalent neurological disorders and represent a global public health issue, with a significant impact on functionality and quality of life. Despite this, studies indicate that a considerable portion of sufferers, especially those with migraine, remain without a formal diagnosis, which hinders adequate clinical management. In this context, understanding the epidemiological profile at regional levels is essential.
Objective
Therefore, the aim of this study is to describe the profile of patients presenting with headache complaints at a specialized neurology center in Vale do Taquari (Lajeado/RS), to support healthcare strategies for this population.
Methods
Observational, descriptive, and retrospective study based on the review of medical records from a specialized clinical center in Vale do Taquari, Rio Grande do Sul. Patients aged 18 years or older, attended for primary headache complaints between August 2017 and February 2024 were included. Sociodemographic, clinical (ICHD-3 diagnosis), and treatment variables were collected and analyzed using descriptive statistics. The project was approved by the Research Ethics Committee.
Results
The sample consisted of 111 patients, with a mean age of 48 years and a predominance of females (n=91, 82%). Most self-identified as white (n=96, 87%), and (n=18, 35%) had a low level of education (5 to 8 years). The most prevalent diagnosis was migraine without aura (n=54, 48.6%), followed by cervicogenic headache (n=22, 19.8%) and tension-type headache (n=17, 15.3%). Neurological examination abnormalities were detected in some patients, mainly in cranial nerves and sensory function. Magnetic resonance imaging was the most requested imaging exam (n=51, 45.9%). Acute treatment was predominantly monotherapy, with common analgesics being the most prescribed. Prophylaxis was instituted in 74 (66.4%) of cases, mainly with tricyclic antidepressants and beta-blockers.
Conclusion
This study allowed the characterization of the clinical and sociodemographic profiles of patients presenting with headache complaints at a specialized center in Vale do Taquari, highlighting a predominance of females, a mean age of 48 years, and a higher prevalence of migraine without aura. A high rate of imaging requests was observed, not always aligned with guidelines, as well as predominant use of common analgesics for acute treatment and tricyclic antidepressants and beta-blockers for prophylaxis.IntroduçãoCefaleias primárias são distúrbios neurológicos de alta prevalência e representam um problema de saúde pública global, com impacto significativo na funcionalidade e na qualidade de vida. Apesar disso, estudos indicam que uma parcela considerável dos portadores, principalmente aqueles com enxaqueca, permanece sem diagnóstico formal, o que dificulta o manejo clínico adequado. Nesse contexto, a compreensão do perfil epidemiológico em nível regional é essencial.ObjetivoPortanto, o objetivo deste estudo é descrever o perfil dos pacientes que apresentam queixas de cefaleia em um centro especializado em neurologia no Vale do Taquari (Lajeado/RS), a fim de subsidiar estratégias de atenção à saúde dessa população.MétodosEstudo observacional, descritivo e retrospectivo, baseado na revisão de prontuários de um centro clínico especializado no Vale do Taquari, Rio Grande do Sul. Foram incluídos pacientes com 18 anos ou mais, atendidos com queixas de cefaleia primária entre agosto de 2017 e fevereiro de 2024. Variáveis sociodemográficas, clínicas (diagnóstico ICHD-3) e de tratamento foram coletadas e analisadas por meio de estatística descritiva. O projeto foi aprovado pelo Comitê de Ética em Pesquisa.ResultadosA amostra foi composta por 111 pacientes, com média de idade de 48 anos e predomínio do sexo feminino (n=91, 82%). A maioria se autodeclarou branca (n=96, 87%) e (n=18, 35%) apresentou baixa escolaridade (5 a 8 anos). O diagnóstico mais prevalente foi enxaqueca sem aura (n=54, 48,6%), seguido de cefaleia cervicogênica (n=22, 19,8%) e cefaleia tensional (n=17, 15,3%). Alterações no exame neurológico foram detectadas em alguns pacientes, principalmente em nervos cranianos e função sensorial. A ressonância magnética foi o exame de imagem mais solicitado (n=51, 45,9%). O tratamento agudo foi predominantemente monoterápico, sendo analgésicos comuns os mais prescritos. Profilaxia foi instituída em 74 (66,4%) dos casos, principalmente com antidepressivos tricíclicos e betabloqueadores.
ConclusãoEste estudo permitiu caracterizar o perfil clínico e sociodemográfico de pacientes com queixas de cefaleia atendidos em um centro especializado no Vale do Taquari, evidenciando predomínio do sexo feminino, média de idade de 48 anos e maior prevalência de migrânea sem aura. Observou-se alta frequência de solicitação de exames de imagem, nem sempre em consonância com as diretrizes, além do uso predominante de analgésicos comuns para tratamento agudo e de antidepressivos tricíclicos e betabloqueadores para profilaxia
Dialysis headache: a systematic review and meta-analysis
Full text linkIntroductionDialysis headache (DH) is a known but underexplored complication of hemodialysis, affecting some patients during treatment. While, it is recognized, the reported frequency, diagnostic criteria, and associated risk factors vary.ObjectiveThis systematic review and meta-analysis aim to determine the percentage and characteristics of dialysis headache, identify associated factors, and summarize available evidence from existing literature.MethodsA comprehensive literature search was conducted across Scopus, Medline, PubMed, and Google Scholar for studies published from 2000 to the present. A total of 15 studies were included, encompassing various study designs and geographic locations. Data on patients demographics, headache characteristics, diagnostic criteria, and hemodialysis parameters were extracted and analyzed. A proportional meta-analysis was performed using R-4.3.2.ResultsThe included studies reported DH prevalence ranging from 7% to 53%. The overall pooled estimate was 28% (95% CI: 19-36%). After refining the dataset by excluding studies with confounding factors and improving study selection criteria, the updated prevalence estimate was 16% (95% CI: 9-24%). DH onset typically occurred during hemodialysis sessions, predominantly in the second or third hour, and most cases resolved within four hours post-dialysis. Headaches were generally of moderate intensity and managed with simple analgesics.ConclusionsDialysis headache remains a prevalent but inconsistently reported complication of hemodialysis. Standardized diagnostic criteria and further research are needed to better understand its pathophysiology and improve management strategies.
“Percebendo-me pequeno: uma regressão do volume corporal aos três anos de idade” — uma nova manifestação da Síndrome de Alice no País das Maravilhas em um paciente com enxaqueca
No full textIntroduction
Alice in Wonderland Syndrome (AIWS) is a rare neurological condition often associated with migraine and characterized by perceptual distortions of body image, time, and space.
Case report
We report the case of a 33-year-old woman with a history of migraine since adolescence who presented with recurrent episodes of AIWS. During severe migraine attacks, she experienced microsomatognosia, perceiving her body as shrinking to the size of a child when her eyes were closed, along with temporal distortion described as “slow motion” of her surroundings. Neurological examination, brain MRI, and angiography were unremarkable. Despite prophylactic therapy with topiramate and acute treatment with triptans, disabling attacks persisted.
Conclusion
This case highlights the complex relationship between migraine and AIWS, reinforcing the need for clinicians to recognize AIWS manifestations as part of the migraine spectrum. Early identification can prevent misdiagnosis and improve patient management.Introdução
A Síndrome de Alice no País das Maravilhas (SAI) é uma condição neurológica rara frequentemente associada à enxaqueca e caracterizada por distorções perceptivas da imagem corporal, tempo e espaço.
Relato de caso
Relatamos o caso de uma mulher de 33 anos com histórico de enxaqueca desde a adolescência, que apresentou episódios recorrentes de SAI. Durante crises graves de enxaqueca, ela apresentou microsomatognosia, percebendo seu corpo encolhendo ao tamanho de uma criança quando seus olhos estavam fechados, juntamente com distorção temporal descrita como "câmera lenta" do ambiente ao redor. Exame neurológico, ressonância magnética cerebral e angiografia não apresentaram alterações. Apesar da terapia profilática com topiramato e do tratamento agudo com triptanos, as crises incapacitantes persistiram.
Conclusão
Este caso destaca a complexa relação entre enxaqueca e SAI, reforçando a necessidade de os médicos reconhecerem as manifestações da SAI como parte do espectro da enxaqueca. A identificação precoce pode prevenir diagnósticos equivocados e melhorar o manejo do paciente
Cefaleia por uso excessivo de medicamentos: das alterações cerebrais ao impacto da doença
No full textIntroductionMedication-overuse headache is a secondary headache that develops in patients with a pre-existing primary headache, most often migraine, who experience daily or near-daily headaches as a result of excessive intake of symptomatic medications. According to the ICHD-3 criteria, diagnosis requires ≥15 headache days per month and ≥10–15 days per month of medication use, depending on the drug class, for at least three months.ObjectiveTo review the pathophysiological mechanisms, risk factors, clinical impact, and regional characteristics, highlighting therapeutic implications and current research gaps.MethodsA narrative review of recent high-quality literature indexed in PubMed was conducted, integrating clinical, epidemiological, and experimental data, to ensure comprehensive coverage of emerging evidence.ResultsPathophysiology involves dysregulation of the trigeminovascular system, cortical hyperexcitability, maladaptive neuroplasticity, and dysfunction of dopaminergic reward circuits, showing parallels with addictive disorders. Major risk factors include female sex, high baseline headache frequency, psychiatric comorbidities, socioeconomic vulnerability, and genetic predisposition. Alterations in CGRP and endocannabinoid systems may further increase susceptibility. In Latin America, ergotamine remains the most frequently overused drug, unlike triptans and simple analgesics in developed countries, underscoring regional disparities and safety concerns.ConclusionMedication-overuse headache is a preventable yet underdiagnosed disorder with major personal and socioeconomic impact. Early diagnosis, patient and physician education, and effective withdrawal management are essential. Persistent gaps in pathophysiology, biomarkers, and tailored therapies demand further collaborative and multicenter research.Introdução
A cefaleia por uso excessivo de medicamentos é uma cefaleia secundária que se desenvolve em pacientes com cefaleia primária preexistente, geralmente enxaqueca, que apresentam cefaleias diárias ou quase diárias como resultado do uso excessivo de medicamentos sintomáticos. De acordo com os critérios da ICHD-3, o diagnóstico requer ≥15 dias de cefaleia por mês e ≥10–15 dias por mês de uso de medicamentos, dependendo da classe do fármaco, por pelo menos três meses.
Objetivo
Revisar os mecanismos fisiopatológicos, fatores de risco, impacto clínico e características regionais, destacando as implicações terapêuticas e as lacunas de pesquisa atuais.
Métodos
Foi realizada uma revisão narrativa da literatura recente de alta qualidade indexada no PubMed, integrando dados clínicos, epidemiológicos e experimentais, para garantir uma cobertura abrangente das evidências emergentes.
Resultados
A fisiopatologia envolve a desregulação do sistema trigeminovascular, hiperexcitabilidade cortical, neuroplasticidade mal adaptativa e disfunção dos circuitos dopaminérgicos de recompensa, apresentando paralelos com transtornos aditivos. Os principais fatores de risco incluem sexo feminino, alta frequência basal de cefaleia, comorbidades psiquiátricas, vulnerabilidade socioeconômica e predisposição genética. Alterações nos sistemas CGRP e endocanabinoides podem aumentar ainda mais a suscetibilidade. Na América Latina, a ergotamina continua sendo o medicamento mais frequentemente utilizado em excesso, diferentemente dos triptanos e analgésicos simples em países desenvolvidos, o que evidencia disparidades regionais e preocupações com a segurança.
Conclusão
A cefaleia por uso excessivo de medicamentos é um distúrbio evitável, porém subdiagnosticado, com grande impacto pessoal e socioeconômico. O diagnóstico precoce, a educação do paciente e do médico e o manejo eficaz da desintoxicação são essenciais. Lacunas persistentes na fisiopatologia, nos biomarcadores e nas terapias personalizadas exigem mais pesquisas colaborativas e multicêntricas
Intermittent tactile nummular allodynia: expanding the spectrum of nummular headache?
Full text linkIntroductionNummular headache (NH) is a rare primary headache characterized by pain in a well-defined, small, round, or oval area of the scalp, often associated with abnormal local sensations such as paresthesia or allodynia. However, sensory scalp disturbances without pain, such as intermittent tactile nummular allodynia (ITNA), remain poorly understood. This report aims to describe a case of ITNA and discuss its clinical significance in the spectrum of nummular syndromes.Case ReportA 53-year-old woman presented with a 9-year history of intermittent tactile allodynia in the right parietal region, affecting a round area of approximately 6 cm in diameter. The episodes occurred 6–7 times per year, each lasting about four days. The patient experienced significant discomfort upon touching or combing the area but denied spontaneous pain or headache. Neurological examination was unremarkable. Brain MRI showed no abnormalities. The patient also had a history of fibromyalgia. No other systemic or dermatological conditions were identified. The clinical picture was consistent with localized, episodic tactile hypersensitivity without persistent symptoms or headache.ConclusionThis case expands the clinical spectrum of focal scalp sensory disturbances and suggests that ITNA may represent a distinct entity or a non-painful variant of nummular headache. The absence of spontaneous pain, the circumscribed location, and the touch-evoked dysesthesia support a localized sensory dysfunction, possibly involving cutaneous nerve branches. Greater awareness of ITNA is essential to prevent misdiagnosis and unnecessary treatment; further studies are needed to define its pathophysiology and diagnostic boundaries better
Cefaleia associada a acidente vascular cerebral isquêmico: uma revisão narrativa
No full textIntroductionHeadache is a common symptom in acute ischemic stroke, with an average prevalence of approximately 14%. Its occurence involves neurovascular dysfunction, meningeal inflammation, and posterior circulation compromise. It is more common in women and in individuals with a history of primary headache. This review aims to describe the clinical, pathophysiological mechanisms, therapeutic considerations and prognostic implications of headache associated with ischemic stroke.MethodsA narrative review of literature was conducted, using Pubmed/MEDLINE, Scopus, and SciELO databases. Observational studies, secondary literature (systematic reviews and meta-analyses), and international consensus statements published between 2013 and 2025 were included.ResultsHeadache occurs in approximately 14% of patients with ischemic stroke, particularly in women, patients with posterior circulation infarcts and those with a history of migraine. Its characterized by moderate to intensity pain, gradual onset, frontal or temporal location, and presents tension-type or migraine-like pattern. Involves meningeal irritation, endothelial dysfunction, alterations in cerebral autoregulation, and activation of the trigeminovascular system. The SNNOOOP10 scale is useful for detecting warning signs and guiding the need for neuroimaging. Paracetamol is the safest analgesic option, NSAIDs, triptans and ergot derivatives should be avoided, CGRP antagonists appear safe, although long-term evidence is limited.ConclusionHeadache associated with ischemic stroke is a relevant clinical manifestation with diagnostic and prognostic implications. Its recognition and appropriate management require a careful balance between analgesic efficacy and vascular safety.IntroduçãoA cefaleia é um sintoma comum no acidente vascular cerebral isquêmico agudo, com uma prevalência média de aproximadamente 14%. Sua ocorrência envolve disfunção neurovascular, inflamação meníngea e comprometimento da circulação posterior. É mais comum em mulheres e em indivíduos com histórico de cefaleia primária. Esta revisão tem como objetivo descrever os mecanismos clínicos e fisiopatológicos, as considerações terapêuticas e as implicações prognósticas da cefaleia associada ao acidente vascular cerebral isquêmico.
MétodosFoi realizada uma revisão narrativa da literatura, utilizando as bases de dados PubMed/MEDLINE, Scopus e SciELO. Foram incluídos estudos observacionais, literatura secundária (revisões sistemáticas e meta-análises) e declarações de consenso internacional publicadas entre 2013 e 2025.
ResultadosA cefaleia ocorre em aproximadamente 14% dos pacientes com acidente vascular cerebral isquêmico, particularmente em mulheres, pacientes com infartos na circulação posterior e aqueles com histórico de enxaqueca. É caracterizada por dor de intensidade moderada a alta, início gradual, localização frontal ou temporal e apresenta padrão tensional ou semelhante à enxaqueca. Envolve irritação meníngea, disfunção endotelial, alterações na autorregulação cerebral e ativação do sistema trigeminovascular. A escala SNNOOOP10 é útil para detectar sinais de alerta e orientar a necessidade de neuroimagem. O paracetamol é a opção analgésica mais segura; AINEs, triptanos e derivados do ergot devem ser evitados; antagonistas do CGRP parecem seguros, embora as evidências a longo prazo sejam limitadas.
Conclusão
A cefaleia associada ao acidente vascular cerebral isquêmico é uma manifestação clínica relevante com implicações diagnósticas e prognósticas. Seu reconhecimento e manejo adequado exigem um equilíbrio cuidadoso entre a eficácia analgésica e a segurança vascular