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Cefaleia e transtornos mentais na prática
No full textIntroduction
Migraine is a major cause of global functional disability and is frequently associated with psychiatric disorders such as anxiety and depression. Although the literature highlights this association, few studies have explored these relationships in real-life contexts, outside controlled clinical environments.
Objective
To analyze the relationship between anxiety and depression levels and the impact of headache on the quality of life of patients with migraine in a real-life context.
Methods
A prospective longitudinal observational study was conducted between January and December 2024, involving 46 patients treated at a tertiary headache center. Data were collected using the REBRACEF questionnaire. Statistical analyses included correlation tests and comparisons between the MIDAS, PHQ-9, and GAD-7 scales, as well as the variables sex and age.
Results
The majority of participants were female (87%), with a mean age of 44.5 years. A significant negative correlation was found between age and MIDAS score (p=0.036), suggesting greater functional impact in younger patients. No significant correlation was found between MIDAS and PHQ-9 or GAD-7 scores. However, a positive correlation was observed between PHQ-9 and GAD-7 scores (p<0.001), indicating comorbidity between depression and anxiety.
Conclusion
The findings suggest that younger patients experience greater functional impairment due to migraine. Despite the high prevalence of anxiety and depression symptoms, these comorbidities did not show a direct association with the functional impact of pain. The results underscore the importance of multidimensional approaches and highlight the need for studies with larger samples and longitudinal designs.IntroduçãoA enxaqueca é uma das principais causas de incapacidade funcional global e está frequentemente associada a transtornos psiquiátricos, como ansiedade e depressão. Embora a literatura destaque essa associação, poucos estudos exploraram essas relações em contextos da vida real, fora de ambientes clínicos controlados.
ObjetivoAnalisar a relação entre os níveis de ansiedade e depressão e o impacto da cefaleia na qualidade de vida de pacientes com enxaqueca em um contexto da vida real.MétodosUm estudo observacional longitudinal prospectivo foi conduzido entre janeiro e dezembro de 2024, envolvendo 46 pacientes atendidos em um centro terciário de cefaleia. Os dados foram coletados utilizando o questionário REBRACEF. As análises estatísticas incluíram testes de correlação e comparações entre as escalas MIDAS, PHQ-9 e GAD-7, bem como as variáveis sexo e idade.ResultadosA maioria dos participantes era do sexo feminino (87%), com média de idade de 44,5 anos. Foi encontrada correlação negativa significativa entre idade e pontuação MIDAS (p=0,036), sugerindo maior impacto funcional em pacientes mais jovens. Não foi encontrada correlação significativa entre os escores do MIDAS e do PHQ-9 ou GAD-7. No entanto, foi observada uma correlação positiva entre os escores do PHQ-9 e do GAD-7 (p<0,001), indicando comorbidade entre depressão e ansiedade.ConclusãoOs achados sugerem que pacientes mais jovens apresentam maior comprometimento funcional devido à enxaqueca. Apesar da alta prevalência de sintomas de ansiedade e depressão, essas comorbidades não apresentaram associação direta com o impacto funcional da dor. Os resultados ressaltam a importância de abordagens multidimensionais e apontam para a necessidade de estudos com amostras maiores e delineamentos longitudinais
What we wish we had known before starting a headache clinical registry: insights from the Italo-Brazilian partnership
Full text linkAbstract
Headache registries have emerged as a logical solution for bridging the gap between what we know and what we do, empowering disease awareness, enhancing knowledge and facilitating personalized management. The role of headache registries in expanding our understanding of patients’ journeys, sociodemographic characteristics, endophenotypes, treatments and healthcare resource utilization is well documented around the world. This perspective article will explore some practical ideas to develop a headache clinical registry from the ground up, through the original contributions of Italian and Brazilian registries.
"Sinto uma vontade irresistível de bater a cabeça na parede": uma série de casos que destaca agitação e dor intensa na cefaleia em salvas
No full textAbstractIntroductionCluster headache is a primary headache disorder characterized by severe, unilateral pain, typically associated with cranial autonomic symptoms, including conjunstival injection, lacrimation, nasal congestion, rhinorrhea, eyelid oedema, forehead and facial sweating, miosis and ptosis. Beyond these hallmark features, patients often exhibit marked psychomotor agitation, sometimes expressing the wish to engage in head-banging behaviors as an instinctive response to unbearable pain. This case series highlights three such patients.Cases reportIn all cases, appropriate preventive therapies reduced both the frequency of attacks and the desire for self-injurious behavior. ConclusionThese reports highlight the extreme suffering associated with cluster headache and emphasize the importance of timely recognition and effective management strategies.ResumoIntroduçãoA cefaleia em salvas é uma cefaleia primária caracterizada por dor unilateral intensa, tipicamente associada a sintomas autonômicos cranianos, incluindo hiperemia conjuntival, lacrimejamento, congestão nasal, rinorreia, edema palpebral, sudorese frontal e facial, miose e ptose palpebral. Além dessas características marcantes, os pacientes frequentemente apresentam agitação psicomotora acentuada, às vezes expressando o desejo de bater a cabeça como uma resposta instintiva à dor insuportável.Relato de casosEsta série de casos destaca três desses pacientes. Em todos os casos, terapias preventivas adequadas reduziram tanto a frequência das crises quanto o desejo de comportamento autolesivo.ConclusãoEsses relatos destacam o sofrimento extremo associado à cefaleia em salvas e enfatizam a importância do reconhecimento oportuno e de estratégias de tratamento eficazes.
Acute and long-term neurological manifestations of Covid-19: insights from virology and neurology
Full text linkIntroduction
This literature review examines the profound impact of Covid-19, caused by SARS-CoV-2, on the nervous system. While the virus is predominantly associated with respiratory complications, emerging evidence highlights its strong neurotropic potential, leading to a broad spectrum of neurological disorders. This review explores the convergence of virology and neurology, emphasizing both acute and long-term neurological consequences of the disease.
Methods
A systematic review following PRISMA guidelines was conducted using databases such as PubMed, Scopus, and Web of Science. Studies were selected based on their relevance to the pathophysiology, clinical presentations, and prolonged neurological effects of Covid-19. Preference was given to peer-reviewed research, including meta-analyses and clinical case reports published between 2020 and 2024.
Results
The review identifies various pathways through which SARS-CoV-2 affects the nervous system, including direct neuroinvasion and systemic inflammatory responses. Acute neurological conditions such as encephalitis, stroke, and Guillain-Barré syndrome have been frequently reported, while chronic complications include cognitive dysfunction, neurodegenerative disorders, and psychiatric disturbances. These findings highlight the intricate and enduring neurological burden of Covid-19.
Conclusion
Neuro-Covid presents an ongoing challenge in the post-pandemic landscape. A deeper understanding of its neurological implications is essential for enhancing patient management and shaping future research directions. This review highlights the importance of increased clinical vigilance and a multidisciplinary strategy to effectively address the complex and evolving spectrum of Covid-19-related neurological disorders
Enxaqueca em crianças e adolescentes: o impacto clínico da alodínia
No full textIntroduction
The pathophysiology of migraine is strongly associated with central sensitization, the presence of which is related to cutaneous allodynia and cervical musculoskeletal dysfunction. However, these aspects remain understudied in children and adolescents. Thus, this study aimed to evaluate differences in clinical variables, sensitization, and musculoskeletal alterations between children (CR) and adolescents (AD) with migraine, considering the presence or absence of cutaneous allodynia.
Methods
One hundred and one participants aged 6 to 16 years with a clinical diagnosis of migraine were evaluated. Outcomes included cervical range of motion (ROM), pressure pain threshold (PPT) of cranio-cervical muscles, and presence of cutaneous allodynia.
Results
Significant differences were observed between CR and AD for age (p<0.001) and PPTs of the sternocleidomastoid (p=0.002), levator scapulae (p=0.006), suboccipital (p=0.006), trapezius (p<0.001), and anterior scalene (p<0.001) muscles. The subgroups CR and AD with and without allodynia showed significant differences in the PPTs of the sternocleidomastoid (p=0.020), levator scapulae (p=0.016), suboccipital (p=0.038), trapezius (p<0.001), anterior scalene (p<0.001) muscles, and in cervical ROM in the sagittal plane (p=0.016). The main differences were observed between adolescents and children with and without allodynia. No differences were found within the children and adolescents’ subgroups.
Conclusion
The presence of cutaneous allodynia is associated with increased muscle sensitivity and reduced cervical sagittal mobility. These findings highlight the importance of early assessment of allodynia and musculoskeletal sensitivity in children and adolescents with migraine.IntroduçãoA fisiopatologia da enxaqueca está fortemente associada à sensibilização central, cuja presença está relacionada à alodínia cutânea e à disfunção musculoesquelética cervical. No entanto, esses aspectos permanecem pouco estudados em crianças e adolescentes. Assim, este estudo teve como objetivo avaliar as diferenças nas variáveis clínicas, na sensibilização e nas alterações musculoesqueléticas entre crianças (CR) e adolescentes (AD) com enxaqueca, considerando a presença ou ausência de alodínia cutânea.MétodosCento e um participantes com idades entre 6 e 16 anos e diagnóstico clínico de enxaqueca foram avaliados. Os desfechos incluíram amplitude de movimento cervical (ADM), limiar de dor à pressão (LDP) dos músculos craniocervicais e presença de alodínia cutânea.ResultadosDiferenças significativas foram observadas entre RC e AD para idade (p<0,001) e LDP dos músculos esternocleidomastoideo (p=0,002), levantador da escápula (p=0,006), suboccipital (p=0,006), trapézio (p<0,001) e escaleno anterior (p<0,001). Os subgrupos RC e AD com e sem alodínia apresentaram diferenças significativas nos LDP dos músculos esternocleidomastoideo (p=0,020), levantador da escápula (p=0,016), suboccipital (p=0,038), trapézio (p<0,001), escaleno anterior (p<0,001) e na amplitude de movimento cervical no plano sagital (p=0,016). As principais diferenças foram observadas entre adolescentes e crianças com e sem alodínia. Não foram encontradas diferenças entre os subgrupos de crianças e adolescentes.ConclusãoA presença de alodínia cutânea está associada ao aumento da sensibilidade muscular e à redução da mobilidade sagital cervical. Esses achados destacam a importância da avaliação precoce da alodínia e da sensibilidade musculoesquelética em crianças e adolescentes com enxaqueca
Cefaleia de altitude: uma revisão narrativa
No full textPurpose of reviewThis narrative review aims to summarize current evidence on the epidemiology, pathophysiological mechanisms, risk factors, differential diagnosis, and preventive and therapeutic strategies of High-altitude headache (HAH) to raise awareness among physicians.Recent findingsHAH is the most common neurological symptom associated with acute mountain sickness (AMS) and has become a global health concern due to the increasing exposure to high altitudes through tourism, sports and work. Its pathophysiology is complex and multifactorial, involving hypobaric hypoxia, blood–brain barrier dysfunction, and trigeminovascular system activation.ConclusionsThe diagnostic criteria of the ICHD-3 and the Lake Louise Score are highlighted as essential clinical tools, especially regarding moment of evacuation. Knowledge gaps were identified in areas such as biomarkers, updated epidemiological data, diagnostic standardization and vulnerable populations. Improving understanding and management of HAH is critical as global exposure to high-altitude environments continues to rise.Objetivo da revisãoEsta revisão narrativa tem como objetivo resumir as evidências atuais sobre a epidemiologia, os mecanismos fisiopatológicos, os fatores de risco, o diagnóstico diferencial e as estratégias preventivas e terapêuticas da cefaleia de altitude (CA) para aumentar a conscientização entre os médicos.
Descobertas recentesA CA é o sintoma neurológico mais comum associado ao mal agudo da montanha (MAM) e tornou-se uma preocupação global de saúde devido à crescente exposição a grandes altitudes por meio do turismo, esportes e trabalho. Sua fisiopatologia é complexa e multifatorial, envolvendo hipóxia hipobárica, disfunção da barreira hematoencefálica e ativação do sistema trigeminovascular.
ConclusõesOs critérios diagnósticos da ICHD-3 e o Escore de Lake Louise são destacados como ferramentas clínicas essenciais, especialmente em relação ao momento da evacuação. Lacunas de conhecimento foram identificadas em áreas como biomarcadores, dados epidemiológicos atualizados, padronização diagnóstica e populações vulneráveis. Melhorar a compreensão e o manejo da CA é fundamental, visto que a exposição global a ambientes de grande altitude continua a aumentar
Migraine and brain tumors: a bibliometric analysis and narrative review
Full text linkIntroduction
The relationship between migraine and brain tumors remains an area of active research, with mixed findings across studies. Understanding this connection is crucial for improving clinical diagnoses and patient management.
Objective
This study aims to conduct a bibliometric analysis and narrative review to explore the trends, key contributors, and findings on the association between migraine and brain tumors.
Methodology
A total of 740 studies were retrieved from the Scopus database using search terms “migraine” AND “brain tumor” for the period January 2015 to December 2024. These studies were analyzed using VOSviewer. The review employed a combination of bibliometric techniques and narrative analysis to identify key publications, authors, institutions, and frequently discussed terms.
Results
The United States was the largest contributor, followed by Italy and the United Kingdom. BMJ Case Reports published the most documents on the topic, with Harvard Medical School being the leading institution. Key terms included migraine, headache, brain tumor, neuroimaging, and brain neoplasms. Studies presented varying findings: some suggested an increased risk of brain tumors in migraine patients, while others found no significant association. Notable studies highlighted the role of specific tumor types, such as pituitary adenomas and meningiomas, in causing headache symptoms.
Conclusions
The association between migraine and brain tumors remains complex and inconsistent. While some studies indicate a potential risk, others fail to confirm a significant relationship. Further large-scale, prospective studies are needed to clarify this association and inform clinical practices
Sinus migraine: a systematic review and meta-analysis
Full text linkIntroduction
Sinus headache is frequently misdiagnosed, with growing evidence suggesting that many cases may actually be migraine with sinus-like features.
Objective
To evaluate the prevalence of migraine among patients initially diagnosed with sinus headache and assess how often migraine is mistaken for sinus-related conditions.
Methods
This systematic review and meta-analysis adhered to PRISMA guidelines. Literature searches were performed in Scopus, Medline, PubMed, and Google Scholar using terms such as “sinus headache” and “sinus migraine.” Studies were screened based on predefined inclusion and exclusion criteria. A proportional meta-analyses were performed using conducted in R (version 4.3.2), and study quality was assessed using the JBI checklist.
Results
Twelve studies involving 4,392 patients were included. Eight studies (Group 1) assessed patients with sinus headache, finding a pooled migraine prevalence of 55% (95% CI: 0.42-0.68), increasing to 59% when probable migraine was included, and 65% when tension-type headache cases were considered. Four studies (Group 2) examined patients with confirmed migraine previously misdiagnosed as sinus headache, with misdiagnosis rates up to 81.5% and diagnosis delays up to 38 years. Female predominance was noted in both groups: 65% (95% CI: 53-77%) in Group 1 and 75% (95% CI: 71-80%) in Group 2.
Conclusions
A significant proportion of patients diagnosed with sinus headache were ultimately found to have migraine, with consistently high female predominance-particularly in cases of confirmed migraine misdiagnosis. Enhanced diagnostic vigilance and awareness are needed to reduce misclassification and promote appropriate treatment
Cefaleia persistente pós-craniotomia: uma revisão narrativa
No full textIntroductionPersistent post-craniotomy headache (PPCH) is a frequent yet underrecognized complication of cranial surgery, often leading to long-term disability and impaired quality of life. Defined as a headache developing within seven days of craniotomy and lasting more than three months, the true PPCH prevalence and incidence remains unclear and varied widely across studies and time windows. Despite its prevalence, the condition remains poorly understood, and standardized diagnostic and therapeutic protocols are lacking.ReviewPPCH arises from multifactorial mechanisms, including direct nerve injury, muscle adhesion to the dura mater, aseptic inflammation, and central sensitization. Five main phenotypes can be identified: scar-related neuropathic pain, occipital neuralgia–like headache, diffuse tension-type pattern, migraine-like phenotype, and mixed presentations. Risk factors include posterior fossa and suboccipital surgeries, pre-existing migraine, female sex, inadequate perioperative analgesia, and psychological comorbidities such as anxiety or depression. Evaluation must rule out secondary causes through clinical examination and selective imaging. Treatment should follow a multimodal, phenotype-driven approach combining pharmacologic agents with interventional procedures such as peripheral nerve blocks or scar-targeted botulinum toxin A injections. Surgery is reserved for refractory, well-defined cases involving neuromas or hardware irritation.ConclusionsPPCH represents a complex chronic secondary headache condition that demands systematic identification and personalized, stepwise management. However, evidence remains limited, and prospective multicenter studies with standardized definitions and outcomes are urgently needed to improve prognosis and quality of life for affected patients.IntroduçãoA cefaleia pós-craniotomia persistente (CPCP) é uma complicação frequente, porém subdiagnosticada, da cirurgia craniana, que muitas vezes leva à incapacidade a longo prazo e à redução da qualidade de vida. Definida como uma cefaleia que se desenvolve dentro de sete dias após a craniotomia e dura mais de três meses, a verdadeira prevalência e incidência da CPCP permanecem incertas e variam amplamente entre os estudos e os períodos de tempo. Apesar de sua prevalência, a condição ainda é pouco compreendida e faltam protocolos diagnósticos e terapêuticos padronizados.
RevisãoA CPCP surge de mecanismos multifatoriais, incluindo lesão nervosa direta, aderência muscular à dura-máter, inflamação asséptica e sensibilização central. Cinco fenótipos principais podem ser identificados: dor neuropática relacionada à cicatriz, cefaleia semelhante à neuralgia occipital, padrão de tensão difusa, fenótipo semelhante à migrânea e apresentações mistas. Os fatores de risco incluem cirurgias da fossa posterior e suboccipital, migrânea pré-existente, sexo feminino, analgesia perioperatória inadequada e comorbidades psicológicas, como ansiedade ou depressão. A avaliação deve descartar causas secundárias por meio de exame clínico e exames de imagem seletivos. O tratamento deve seguir uma abordagem multimodal, direcionada pelo fenótipo, combinando agentes farmacológicos com procedimentos intervencionistas, como bloqueios de nervos periféricos ou injeções de toxina botulínica A direcionadas à cicatriz. A cirurgia é reservada para casos refratários e bem definidos, envolvendo neuromas ou irritação do dispositivo implantado.
ConclusõesA cefaleia pós-operatória persistente (CPOP) representa uma condição complexa de cefaleia secundária crônica que exige identificação sistemática e manejo personalizado e gradual. No entanto, as evidências ainda são limitadas e estudos prospectivos multicêntricos com definições e desfechos padronizados são urgentemente necessários para melhorar o prognóstico e a qualidade de vida dos pacientes afetados
Spontaneous posterior vitreous detachment and chronification of migraine with aura: A case report exploring visual snow syndrome
Full text linkIntroduction
Posterior vitreous detachment is characterized by the separation of the vitreous humor from the retina, with its spontaneous occurrence involving photopsias and floaters. Treatment options in cases without retinal involvement are limited and observation is recommended. Migraine with aura may have visual snow syndrome as a comorbidity, with visual snow corresponding to dynamic visual changes similar to static dots.
Case Report
A 57-year-old woman reported the sudden onset of complex bright flashes filling her visual field, dysmorphous multicolored rays and progressive left-sided headache of severe intensity with a pattern similar to her migraine with aura, although the visual manifestations were distinct from her typical aura presentations. Neurological examination was normal and direct ophthalmoscopy showed no retinal alterations. After complementary investigation, left posterior vitreous detachment was demonstrated with ultra-wide field retinal imaging. She maintained higher migraine frequency and intensity after the event in the following year, with the floaters being occasionally accompanied by photophobia, impaired night vision and small moving snow dots occurring in the vision of both eyes and contributing to the headache.
Conclusion
This case indicates the importance of considering acute ocular abnormalities with the establishment of flashes and floaters and explores the development of secondary visual snow, an atypical clinical condition, after posterior vitreous detachment, which may be related to the chronification of the migraine