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O USO DIVERSO DE DERIVADOS DE CANÁBIS NO TRATAMENTO DA DOR CRÔNICA
No full textIntroductionChronic pain is a pathology that affects thousands of people annually, resulting from different factors and having different etiologies. Several treatments are available today for it, but some cases are still refractory.ObjectiveThis article seeks to highlight the impacts of using cannabis derivatives as an alternative in the treatment of chronic pain.MethodologyThis is a bibliographic review that used the PubMed and Scopus databases to search for and select articles on the use of cannabis derivatives in the treatment of chronic pain. Only clinical trials, cohort studies, case-control studies, and case reports were selected.Results336 articles were found, after applying the inclusion and exclusion criteria, 7 articles were selected to be analyzed, of which 3 used vaporized formulations, 3 used compounds for oral ingestion and 1 analyzed topical use.ConclusionGood efficiency was observed in the use of cannabis derivatives in the treatment of chronic pain, especially compounds rich in delta-9-tetrahydrocannabidiol (THC).INTRODUÇÃO: A dor crônica é uma patologia que afeta milhares de pessoas anualmente, resultante de diversos fatores e possuindo diferentes etiologias. Vários tratamentos estão disponíveis hoje para isso, mas alguns casos ainda são refratários. OBJETIVO: Este artigo busca destacar os impactos do uso de derivados de cannabis como alternativa no tratamento da dor crônica. METODOLOGIA: Trata-se de uma revisão bibliográfica que utilizou as bases de dados PubMed e Scopus para busca e seleção de artigos sobre o uso de derivados de cannabis no tratamento de dores crônicas. Foram selecionados apenas ensaios clínicos, estudos de coorte, estudos caso-controle e relatos de casos. RESULTADOS: foram encontrados 336 artigos, após aplicação dos critérios de inclusão e exclusão, foram selecionados 7 artigos para serem analisados, dos quais 3 utilizaram formulações vaporizadas, 3 utilizaram compostos para ingestão oral e 1 analisou uso tópico. CONCLUSÃO: Foi observada boa eficiência no uso de derivados de cannabis no tratamento de dores crônicas, especialmente compostos ricos em delta-9-tetrahidrocanabidiol (THC)
Relationship between the increase in temperature and cases of headache – un sustainable development goals – SDGs 3 and 13
Full text linkIntroduction: There appears to be a positive relationship between climate change and headache, but the literature remains scarce regarding the trend towards an increase in headache cases in conjunction with an increase in temperature. Objective: To evaluate the annual trend of headache cases in relation to climatic variation in environmental temperature. Materials and Methods: This is an ecological research, with a time series from the years 2014 to 2023, which was carried out through a search for secondary data from the cities of São Luís/MA and Porto Alegre/RS, chosen due to the differences in climate. Headache data were obtained from the Department of Informatics of the Unified Health System (DATASUS) and environmental temperature data were collected from the National Institute of Meteorology (INMET). The data was filtered from the systems, organized in Excel spreadsheets, after removing the lines with values, the Mann-Kendall test was used to check the monthly trends of climate change in relation to headache cases. Result: In São Luís- MA the sample was composed of n=125 cases, female n=88 (70%) aged 30 to 39 years; 2018 was the year with the highest frequency of notifications, with a prevalence rate of 2.1 (n=23) per 100,000 inhabitants, in Porto Alegre the sample was n=1,009 patients, the majority being female n=752 (75%), in the age group from 50 to 59 years old, 2022 was the year with the highest frequency of notification, with a prevalence rate of 8.63 per 100,000 inhabitants, the average, maximum and minimum monthly temperature in São Luís- MA it was 28ºC, 32.14±0.97ºC and 25.29±0.76ºC and for Porto Alegre it was 26ºC, 25.99±17ºC and 16.27±3.75 respectively. An increasing trend in maximum and minimum temperatures (p<0.001) was observed for both cities, with a tendency for headache cases to increase as the temperature increased (p=0.001). Conclusion: There was a tendency for headache cases to increase as monthly temperatures increased, pointing to the need for strategies to mitigate temperature changes and future planning in several areas, including environmental policies and health.Introdução: Parece existir uma relação positiva entre alterações clímáticas e cefaleia, porém a literatura ainda permanece excassa quanto a tendência do aumento de casos de cefaleia em conjunto com o aumento da temperatura. Objetivo: Avaliar a tendência anual de casos de cefaleia em relação a variação climática da temperatura ambiental. Matérias e Métodos: Trata-se de uma pesquisa ecológica, de série temporal dos anos de 2014 a 2023, que foi realizada através de uma busca de dados secundários das cidades de São Luís/MA e Porto Alegre/RS, escolhidas devido as diferenças de clima. Os dados de cefaleia foram obtidos do Departamento de Informática do Sistema Único de Saúde (DATASUS) e os dados de temperatura ambiental foram coletados do Instituto Nacional de Meteorologia (INMET). Os dados foram filtrados dos sistemas, organizados em planilhas de Excel, após a remoção das linhas com valores foi utilizado o teste de Mann-Kendall para verificar a tendências mensal das alterações climáticas em relação aos casos de cefaleia. Resultado: Em São Luís- MA a amostra foi composta de n=125 casos, sexo feminino n=88 (70%) com faixa de idade de 30 a 39 anos; 2018 foi o ano com maior frequência de notificação, com taxa de prevalência de 2,1 (n=23) a cada 100.000 habitantes, em Porto Alegre a amostra foi de n=1.009 pacientes, sendo a maioria formada pelo sexo feminino n=752 (75%), na faixa etária dos 50 a 59 anos, 2022 foi o ano de maior frequência de notificação, com taxa de prevalência de 8,63 a cada 100.000 habitantes, a temperatura média, máxima e mínima mensal em São Luís- MA foi de 28ºC, 32,14±0,97ºC e 25.29±0,76ºC e para Porto Alegre de 26ºC, 25,99±17ºC e 16,27±3,75 respectivamente. Foi observada tendência de aumento na temperatura máxima e mínima (p<0,001) para ambos as cidades, com a tendência de aumento de casos de cefaleia conforme o aumento da temperatura (p=0,001). Conclusão: Houve uma tendência do aumento de casos de cefaleia conforme o aumento das temperaturas mensais apontando para a necessidade de estratégias de mitigação do das alterações de temperatura e planejamentos futuros em diversas áreas, incluindo políticas ambientais e saúde
Necessidade urgente de reforma: abordando os cuidados de emergência inadequados para pacientes com dor de cabeça no sistema de triagem de Manchester
No full textIn the dynamic emergency services environment, the Manchester Triage System (MTS), developed in 1997, is crucial in saving lives and optimizing care. Its global adoption underscores its effectiveness in improving workflows and patient safety by ensuring patients receive timely care based on the severity of their conditions. MTS categorizes patients into five priority levels: \u27Immediate,\u27 \u27Very Urgent,\u27 \u27Urgent,\u27 \u27Standard,\u27 and \u27Non-urgent,\u27 using 55 flowcharts to guide information collection and analysis. However, challenges remain, particularly in triaging headache patients, who are often miscategorized as \u27Less Urgent,\u27 potentially overlooking extreme conditions like intracranial hemorrhage or meningitis. Studies highlight the need for regular review and adjustment of triage criteria to ensure accurate prioritization. Enhancing awareness, training, and clinical guidelines for headache management can improve care quality. Continuous reassessment post-triage is essential to address changing conditions and ensure timely interventions, thereby addressing systemic deficiencies and enhancing emergency care.No ambiente dinâmico dos serviços de emergência, o Sistema de Triagem de Manchester (MTS), desenvolvido em 1997, é crucial para salvar vidas e otimizar os cuidados. A sua adoção global sublinha a sua eficácia na melhoria dos fluxos de trabalho e da segurança dos pacientes, garantindo que os pacientes recebem cuidados atempados com base na gravidade das suas condições. O MTS categoriza os pacientes em cinco níveis de prioridade: \u27Imediato\u27, \u27Muito Urgente\u27, \u27Urgente\u27, \u27Padrão\u27 e \u27Não urgente\u27, usando 55 fluxogramas para orientar a coleta e análise de informações. No entanto, os desafios permanecem, particularmente na triagem de pacientes com dor de cabeça, que muitas vezes são categorizados erroneamente como “menos urgentes”, potencialmente negligenciando condições extremas como hemorragia intracraniana ou meningite. Estudos destacam a necessidade de revisão regular e ajuste dos critérios de triagem para garantir uma priorização precisa. Aumentar a conscientização, o treinamento e as diretrizes clínicas para o manejo da dor de cabeça pode melhorar a qualidade do atendimento. A reavaliação contínua pós-triagem é essencial para fazer face à evolução das condições e garantir intervenções atempadas, abordando assim as deficiências sistémicas e melhorando os cuidados de emergência
Percepções Epidemiológicas das Internações Hospitalares por Enxaquecas e Outros Distúrbios de Cefaleia em uma Cidade do Centro-Oeste do Paraná
No full textIntroduction: According to the WHO, half of the world\u27s population experiences headaches at some point. Understanding the epidemiology of such a prevalent and debilitating disease is essential for developing policies, organizing healthcare services, identifying associated factors, and assessing public health impacts. Therefore, knowing the epidemiology of headaches in Guarapuava, Paraná is crucial for devising effective clinical management and prevention strategies. Objectives: Analyze the epidemiological profile of migraines and headaches in Guarapuava, Paraná, from 2009 to 2023. Methodology: Analytical and retrospective study using data from the SUS Hospital Information System on hospitalizations for migraines and other headaches, without specifying differential diagnoses among pain syndromes, in Guarapuava, Paraná (2009-2023). The study included male and female individuals aged 5 to 80 years or older. Results: During the period assessed, 178 hospitalizations were reported, with 6 (3.37%) elective and 172 (96.62%) emergency cases. Average stay was 3.2 days, with a total cost of R$ 40,608.63. Of the patients, 52 (29.2%) were male and 126 (70.8%) female, including 2 (1.12%) aged 5-9 years, 16 (8.98%) aged 10-14 years, 15 (8.42%) aged 15-19 years, 28 (15.73%) aged 20-29 years, 35 (19.66%) aged 30-39 years, 31 (17.41%) aged 40-49 years, 24 (13.48%) aged 50-59 years, 15 (8.42%) aged 60-69 years, 9 (5.05%) aged 70-79 years, and 3 (1.68%) aged 80 years or older. Conclusion: Analysis of data on hospitalizations for headaches in Guarapuava provides insights into epidemiology, economic impact, and demographic characteristics. Most hospitalizations were among females, possibly due to hormonal, genetic, and social factors. The age distribution shows a peak between ages 30 to 49, comprising 37% of cases. A notable number of hospitalizations were also seen among adolescents (17.4%), underscoring headaches as a public health concern across age groups. The high percentage of emergency admissions (96.62%) suggests urgent hospital care needs, reflecting symptom severity or inadequate outpatient management. Understanding specific diagnoses within painful syndromes is crucial. Strategies to improve clinical management and reduce hospitalization costs are necessary for effective health policies addressing prevention and treatment of headaches
Epidemiological analysis of hospitalizations for migraine and other headache syndromes in southern Brazil between 2019 - 2023
Full text linkIntroduction: Migraine is a disease primarilycharacterized by pulsating headaches of moderate tosevere intensity, often accompanied by othersymptoms such as nausea, vomiting, and sensitivityto light and sound. Migraine is a common complaint, with Brazil reporting a total of 51,269 hospitalizationsdue to migraines and other headache syndromes. The Southern region of Brazil accounted for 25.86% of the recorded cases, totaling 13,260 hospitalizations from 2019 to December 2023. Objective: To map the epidemiological profile ofhospitalizations in the Southern region of Brazil from2020 to 2023. Methodology: This ecological, descriptive, retrospective study utilized data from theDepartment of Informatics of the Unified Health System (DATASUS) of the Ministry of Health, collected from January 2019 to December 2023. Results: The total number of individuals hospitalizedfor migraine and other headache syndromes in theSouthern region was 13,260, with 2019 having thehighest number of hospitalizations (4,017) and 2021 the lowest (1,771). Women were the most affected, representing 65% (8,566) of cases, while menaccounted for 35.4% (4,694). The predominant age group was 40 to 49 years, with 17.37% (2,303) ofcases reported, and the least affected age group wasunder 1 year, with 0.13% (17) cases reported. The white race accounted for 81.25% of reported cases. Conclusion: Analyzing the epidemiological profile ofthe population residing in the Southern region ofBrazil hospitalized for migraine and other headachesyndromes between 2019 and 2023 reveals that2019 had the highest number of hospitalizations. The most affected age group was 40 to 49 years, andwomen were the most impacted gender. The mostaffected ethnicity was white. Therefore, elucidatingthe specific epidemiological patterns of this region isvital for implementing appropriate and individualizedhealthcare measures
Cefaleia numular multifocal: relato de um caso
Full text linkIntrodução: A cefaleia numular é um tipo de cefaleia caracterizada por dor de duração variável (geralmente crônica) em uma área circunscrita do couro cabeludo, comumente descrita pelo paciente como circular ou em forma de moeda. A área dolorosa pode estar localizada em qualquer parte da cabeça, sendo mais comum na região parietal. Além disso, pode apresentar exacerbações espontâneas sobrepostas à dor de fundo e ser acompanhada de hipoestesia, disestesia, parestesias, alodinia e/ou hipersensibilidade.
Objetivo: Relatar um caso de cefaleia numular, detalhando o processo diagnóstico, os achados clínicos e as estratégias terapêuticas, a fim de contribuir para o conhecimento e compreensão desta condição rara na prática. Promover a identificação precoce e o tratamento adequado dos pacientes afetados
Revisão integrativa: MABS x Topiramato como tratamento profilático da migrânea
No full textIntroduction: Migraine is associated with central sensitization, a process involving increased excitability of neuronal membranes and decreased inhibitory influences, resulting in the chronicization of migraine pain. In this context, the pharmacodynamics of most preventive drugs involve suppressing pain signal transmission in central sensitization, thereby preventing chronic pain and its consequences. They are indicated for patients with frequent disabling migraine attacks or medication-refractory attacks. Monoclonal antibodies against calcitonin gene-related peptide (CGRP antagonists) innovate by blocking CGRP through crosstalk via trigeminal peripheral neuron blockade. Topiramate, an anticonvulsant, reduces neuronal excitability through modulation of ion channels and suppression of trigeminal neuron activation and excitatory neurotransmission.
Objective: To evaluate the efficacy and mechanism of action of each anti-CGRP mAb in the preventive treatment of migraine, through comparisons with the action of Topiramate, using an integrative review.
Methods: Electronic searches were conducted in the MEDLINE (PubMed) and LILACS databases using the descriptors "Calcitonin Gene-Related Peptide Receptor Antagonists" and "migraine", were included clinical trials, controlled and randomized trials, and meta-analyses related to studies in adults, with full-text available for free, published between 2020 and 2024, addressing MABS.
Results: Erenumab is a CGRP receptor antagonist, while Fremanezumab, Eptinezumab, and Galcanezumab antagonize the CGRP peptide. All showed early response in studies, with 12-week treatment, consistent efficacy in treatment-naive and refractory patients. Their monthly subcutaneous administration, except for Eptinezumab, intravenous, favors adherence and pharmacodynamics, without the need for adjustments for hepatic/nephropathies. Erenumab outperformed Topiramate in efficacy, onset of results and fewer side effects. Fremanezumab had the highest overall response rate, Galcanezumab and Fremanezumab were superior in reducing days with symptoms in episodic migraine. In chronic migraine, Fremanezumab had less impact, while Erenumab and Eptinezumab were more effective. Eptinezumab showed better safety and Galcanezumab had more side effects. The price of antibodies far exceeds that of Topiramate, with higher costs for Erenumab and Eptinezumab.
Conclusion: The mechanism of action of mAbs holds great potential in the future of migraine prophylactic treatment, presenting high importance in refractory cases. However, their conditions hinder widespread prophylactic distribution; high cost and low dissemination still restrict benefits to patients with contraindications, side effects, and refractory cases to oral prophylactic treatment. Thus, one way to increase population access to mAbs is through government investment to make this medication available through SUS (Brazil\u27s Unified Health System), thereby enhancing the therapeutic efficacy for headaches.Introdução: A migrânea está associada à sensibilização central, um processo no qual ocorre um aumento da excitabilidade das membranas neuronais e uma diminuição das influências inibitórias, resultando na cronificação da dor migranosa. Nesse contexto, a farmacodinâmica da maioria das drogas preventivas se dá na supressão da transmissão do sinal da dor na sensibilização central, evitando a dor crônica e suas consequências, é indicado em pacientes com crises frequentes, incapacitantes ou refratárias à medicação abortiva da crise. Os anticorpos monoclonais antagonistas do peptídeo relacionado ao gene da calcitonina (MABs anti-CGRP) inovam ao bloquear o CGRP através da comunicação cruzada via bloqueio de neurônios periféricos trigeminais. O topiramato, anticonvulsivante, reduz a excitabilidade neuronal através da modulação de canais iônicos e supressão da ativação de neurônios trigeminais e da neurotransmissão excitatória.
Objetivo: Avaliar a eficácia e mecanismo de ação de cada um dos MABS antagonistas CGRP no tratamento preventivo da migrânea, por meio de comparações com a ação do Topiramato, através de uma revisão integrativa.
Métodos: Realizada busca eletrônica nas bases de dados MEDLINE (PubMed) e LILACS com os descritores “Calcitonin Gene-Related Peptide Receptor Antagonists” e “migraine”, incluídos ensaios clínicos, testes controlados e aleatórios e meta-análises referentes a estudos em adultos, com texto disponível na íntegra gratuitamente, publicados entre 2020 e 2024, abordando MABS.
Resultados: Erenumab é antagonista do receptor do CGRP, enquanto Fremanezumab, Eptinezumab e Galcanezumab antagonizam o peptídeo CGRP. Todos mostraram resposta precoce em estudos, com tratamento de 12 semanas, eficácia consistente em pacientes nunca tratados e refratários. Sua administração mensal por via subcutânea, exceto para Eptinezumab, endovenoso, favorece a adesão e a farmacodinâmica, sem necessidade de ajustes para hepato/nefropatias. Erenumab superou o Topiramato em eficácia, início dos resultados e menos efeitos colaterais. Fremanezumab teve a maior taxa de resposta geral, Galcanezumab e Fremanezumab foram superiores na redução de dias com sintomas em enxaqueca episódica. Na enxaqueca crônica o Fremanezumab teve menor impacto, enquanto Erenumab e Eptinezumab foram mais eficazes. Eptinezumab apresentou melhor segurança e Galcanezumab mais efeitos colaterais. O preço dos anticorpos supera em muito o do Topiramato, maiores custos para Erenumab e Eptinezumab.
Conclusão: O mecanismo de ação dos mAbs confere grande potencial no futuro do tratamento profilático da migrânea. Porém, seu alto custo e baixa disseminação ainda restringem benefícios a pacientes com contraindicações, efeitos colaterais e refratários ao tratamento com profiláticos orais. Assim, uma forma de aumentar o acesso populacional aos mAbs é sua disponibilização pública, ampliando a eficácia terapêutica das cefaleias
IMPORTÂNCIA DA HIPERTENSÃO INTRACRANIANA IDIOPÁTICA FULMINANTE: RELATO DE CASO
No full textIntroduction:
Idiopathic intracranial hypertension (IIH) is a neurological condition predominantly affecting women, with obesity being the main risk factor. Symptoms include migraine, orthostatic headaches, transient visual obscurations, visual blurring, pulsatile tinnitus and diplopia. The prognosis worsens with faster progression. Understanding the clinical presentation and managing it efficiently are crucial, although a minority of patients present with the fulminant form of the disease.
Objective:
To report a case of fulminant IIH.
Case Report:
A 33-year-old female patient with no comorbidities and a BMI of 29.5 was admitted to a neurology hospital in Curitiba, PR, due to progressive decrease in visual acuity (VA), bilateral tinnitus and headaches that worsened when lying down. Physical examination revealed bilateral papilledema with VA of 20/200 in the left eye and 20/50 in the right eye. Cranial CT without relevant findings. Lumbar puncture with an opening pressure >50 cm H2O and no inflammatory signs. Pharmacological treatment with acetazolamide was initiated, gradually increasing to two tablets every 6 hours, later adjusted to every 8 hours due to side effects. Topiramate 25 mg twice daily was added, but visual complaints persisted. MRI and MRA revealed bilateral sigmoid sinus stenosis. After ruling out secondary structural and metabolic causes, a diagnosis of IIH was considered. During hospitalization, acetazolamide was suspended because of electrolyte disturbances (metabolic acidosis and hypokalemia), with only topiramate being continued. Due to worsening visual acuity after 8 days of hospitalization, a right frontal ventriculoperitoneal shunt was performed with neuronavigation assistance. After recovery, patient discharged without headache or tinnitus complaints, with severe VA 20/260 (left eye) and moderate VA 20/100 (right eye). At a follow-up outpatient, the patient reported resolution of headache, relief of left pulsatile tinnitus, and partial improvement of bilateral visual changes, although right visual impairment was more pronounced and bilateral papilledema persisted, despite regression. For follow-up, brain MRI, computerized visual field testing, optical coherence tomography, fluorescein angiography, and neuro-ophthalmologic consultation were requested.
Conclusion:
Due to the urgency of the fulminant form of IIH, it is crucial to monitor the rapid and progressive evolution of visual loss, characteristic of the pathology, in order to minimize neurological sequelae.Introdução:
A hipertensão intracraniana idiopática (HII) é uma condição neurológica que afeta predominantemente mulheres, sendo a obesidade o principal fator de risco. Os sintomas incluem cefaleias migranosa e/ou ortostática, obscurecimento visual transitório, turvação visual, tinnitus pulsátil e diplopia. O prognóstico piora com a progressão rápida. Compreender a apresentação clínica e manejá-la eficientemente é crucial, embora uma minoria dos pacientes apresente a forma fulminante da doença.
Objetivo:
Relatar um caso de HII fulminante.
Relato de Caso:
Paciente do sexo feminino, 33 anos, sem comorbidades e com IMC de 29,5, foi admitida em um hospital de neurologia em Curitiba, PR, devido à redução progressiva da acuidade visual (AV), tinnitus bilateral e cefaleia que se intensificava ao decúbito. O exame físico revelou papiledema bilateral com AV de 20/200 no olho esquerdo e 20/50 no olho direito. A tomografia craniana não mostrou achados relevantes. A punção lombar apresentou pressão de abertura >50 cm H2O e ausência de sinais inflamatórios. O tratamento farmacológico com acetazolamida foi iniciado, em aumento progressivo para dois comprimidos a cada 6 horas, posteriormente ajustado para cada 8 horas devido a efeitos colaterais. Topiramato 25 mg duas vezes ao dia foi adicionado, mas as queixas visuais persistiram. A ressonância magnética (RM) e a angiorressonância (ARM) revelaram estenose bilateral dos seios sigmoides. Após excluir causas estruturais e metabólicas secundárias, considerou-se o diagnóstico de HII. Durante a hospitalização, a acetazolamida foi suspensa por distúrbios eletrolíticos (acidose metabólica e hipocalemia), mantendo-se apenas o topiramato. Devido à piora da acuidade visual após 8 dias de internação, foi realizada derivação ventriculoperitoneal frontal direita com auxílio de neuronavegação. Após a recuperação, a paciente recebeu alta sem queixas de cefaleia ou tinnitus, com AV severa de 20/260 (olho esquerdo) e AV moderada de 20/100 (olho direito). Em retorno ambulatorial, a paciente relatou resolução da cefaleia, alívio do tinnitus pulsátil à esquerda e melhora parcial das alterações visuais bilaterais, embora o comprometimento visual direito tenha sido mais acentuado e o papiledema bilateral persistisse, apesar da regressão. Para seguimento, foram solicitadas RM de encéfalo, campimetria computadorizada, tomografia de coerência óptica, angiofluoresceinografia e consulta neuro-oftalmológica.
Conclusão:
Devido à urgência da forma fulminante da HII, é crucial monitorar a rápida e progressiva evolução da perda visual, característica da patologia, a fim de minimizar as sequelas neurológicas
Inglês
No full textIntroduction
Cervicogenic headache (CH) is a secondary headache that can be related to temporomandibular joint (TMJ) disorders due to anatomical and functional links, and is associated with sensitization of the trigeminocervical nucleus. Both temporomandibular dysfunction (TMD) and CH impact quality of life and have non-pharmacological treatment strategies such as manual therapy. Thoracic and cervical spine manipulation can be part of a comprehensive treatment strategy for cervicogenic headaches associated with TMD to enhance patient outcomes.
ObjectivesSummarize the findings of an integrative review on the role of manual therapy in CH associated with TMD.
MethodA comprehensive search of MEDLINE, PubMed, and PEDro databases was conducted in June 2024 using "Temporomandibular disorder" AND "Headache" AND "Cervicogenic" AND "Manual therapy" as descriptors and operators. It yielded 10 results, of which 5 met the inclusion criteria for analysis.
ResultsThis review encompasses 5 studies conducted in Germany, the Netherlands, and the United Kingdom between 2010 and 2016, comprising a literature review, a cross-sectional study, and three randomized controlled trials (RCTs). The RCTs included male and female participants with previous diagnosis of headache and/or without head or facial pain. Manual therapies encompass a range of techniques used by physical therapists to treat musculoskeletal dysfunctions through hands-on manipulation. These techniques aim to enhance mobility, reduce pain, restore function, and promote overall health and well-being. Among the main techniques are joint mobilization, joint manipulation, myofascial release, therapeutic massage, and muscle energy techniques.
Manipulation or mobilization of the thoracic spine demonstrated efficacy in neck pain management, as did cervical spine manipulation when combined with exercises. However, the evidence remains inconclusive regarding the efficacy of isolated cervical spine manipulation or mobilization for neck pain of any duration and for temporomandibular disorders (TMDs). Additionally, manual therapy for TMD appears to enhance patient outcomes more effectively when associated with orofacial physiotherapy.
ConclusionDespite methodological inconsistencies, studies indicate the benefits of manual therapy in the treatment of CH when associated with TMD. Further research is needed to elucidate the role of therapy in the physiology of these conditions. However, the multidisciplinary treatment of CH, including physiotherapy, is well established in literature.in literature
ASIA Syndrome and the nociceptive storm: a case report of a refractory headache
Full text linkIntroduction
Autoimmune Syndrome Induced by Adjuvants (ASIA) encompasses a set of immune-mediated diseases that can affect genetically predisposed individuals exposed to immunoadjuvant compounds, like silicone. Although headache is typical in these cases, the literature lacks information about its characteristics in ASIA.
Objective
Describe and discuss a case of ASIA with headache as the main symptom, approaching its clinical aspects.
Case Report
A 45-year-old female patient presenting with a silicone breast implant sought medical attention for a severe holocranial nocturnal headache (VAS-10). Initially, the acute episodes lasted a few days and were accompanied by tinnitus and visual disturbances. The cephalalgia became chronic and daily, unresponsive to prophylactic and acute migraine medications. The patient reported holocranial headaches with a gradual increase in intensity over a 2-4 hour peek, with a throbbing, pulsating, and stabbing pattern. Additionally, she experienced symptoms such as muscle weakness, cold intolerance, sweating, cognitive impairment, dermatological manifestations, body aches, and transient recurrent hemiparesis, often associated with ipsilateral allodynia and pain. The patient had no prior history of headaches and no familial migraine predisposition. Her medical history disclosed a history of breast augmentation in 2000, with subsequent replacements at 13 and 17 years. The last one, following surgical treatment for ductal carcinoma in situ, occurred in the same year that symptoms of ASIA began. Physical, neurological, and psychiatric evaluations, as well as imaging and immunological tests, yielded normal results. Removal of the silicone breast implant resulted in significant improvement, with the patient reporting relief from symptoms five days post-procedure and complete resolution of headaches 40 days post-explant.
Conclusion
This case report links ASIA syndrome with refractory headache, whose semiological aspects description are lacking for this condition in the literature. Due to non-specificity, clinical symptoms of ASIA often do not meet the diagnostic criteria for well-defined immune-mediated rheumatic diseases, leading to inefficient treatment of psychosomatic illnesses. For the first time we bring you a semiological and clinical presentation of a headache in ASIA