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Hospital admissions for migraine and other cephalgic syndrome pain and socioeconomic indices in Brazil
Get PDFIntroduction: Migraine is a neurological condition characterized by recurrent episodes of intense headache, often accompanied by nausea, vomiting, and hypersensitivity to sensory stimuli such as light and sound. This condition affects millions of individuals worldwide, exerting a substantial impact on the quality of life and functional capacity of those affected. Objective: To investigate the correlation between hospitalization rates for headaches and socioeconomic indicators (SI) in Brazil. Methods: This retrospective study employed a quantitative approach using data from the Hospital Admission System (SIH) of DATASUS, in accordance with the International Classification of Diseases (ICD-10), and from the Atlas of Human Development (ADH) in Brazil, from 2016 to 2021. The average hospitalization rate for headaches, for each federative unit, was calculated from the annual hospitalization rates (hospitalization / resident population * 100,000). The Human Development Index (HDI) and its sub-indices (education, longevity, and income) were analyzed. Through simple linear regression with a 95% confidence interval, Pearson\u27s coefficient (r) was obtained to correlate the average hospitalization rate and socioeconomic indicators. Results: A total of 58,601 hospitalizations were identified, with 2019 being the year with the highest number of hospitalizations (12,120). Statistically significant (p<0.05) and positive (r>0) correlations were observed between the hospitalization rate for headaches and higher HDI (r=0.26), HDI-education (r=0.33), and HDI-longevity (r=0.18). Only one of the indices, HDI-income, did not show a significant correlation. The highest average hospitalization rate was recorded in the state of Paraná (15.34), while the lowest average was observed in Rio Grande do Norte (0.34). Conclusion: As the level of human development, measured by access to healthcare, education, and income distribution, increases, so does the impact on the total number of hospitalizations. This is due to factors associated with regions with high human development, such as early screening, access to primary care, rigorous reporting, and conditions typical of industrialization, as well as occupational exposure to carcinogenic agents, which may contribute to these findings
Cannabidiol in the treatment of migraine: studies and future perspectives
Get PDFIntroduction: Migraine is one of the most disabling and prevalent conditions in the population. Is related to the release of pro-inflammatory mediators in the central nervous system, triggering painful episodes. Cannabidiol (CBD) has significant potential to inhibit such pro-inflammatory mediators and consequently reduce pain symptoms. Objective: To describe the progression of a patient diagnosed with refractory migraine, analyzing the relationship between CBD use and symptom improvement. Case Report: A 37-year-old female patient from Teresina has been patient with refractory migraine for 1 year. She has experienced headaches since the age of 11, with sporadic episodes that improved with dipyrone use. There was an increase in frequency, occurring three times a week, with improvement after using non-steroidal anti-inflammatory drugs. She was undergoing psychiatric treatment, using benzodiazepine and antipsychotic. A year ago, she consulted a neurologist, complaining of a headache lasting 38 days, with a pain score of 8/10 VAS, refractory to NSAIDs, with throbbing pain in the occipital region radiating to the cervical area, associated with photophobia, phonophobia, and aura, which worsened with physical exertion and stress. She was treated with topiramate, oral corticosteroids, and beta-blockers for control, and triptan for acute relief. Due to the lack of response to initial treatment, she used anticonvulsant and muscle relaxant, along with lifestyle changes. However, with the persistence of pain, anticonvulsant and antipsychotic were added to her regimen alongside topiramate. Given the inefficacy in pain control, treatment with progressive doses of cannabidiol was initiated at 20 mg/day, with an increase of 25 mg/week, along with continuous anticonvulsant use. There was an improvement in the headache with symptom resolution by the fourth week. Currently, she uses 1 mL/day (50 mg/mL) of CBD, reporting one episode of headache (VAS 6/10) after a month of CBD use, relieved with triptan. Conclusion:The diagnosis and treatment of migraine should be individualized for each patient. In this context, the therapeutic use of cannabidiol for treatment-refractory migraine cases is a recent alternative in the scientific literature, requiring further studies to be effectively understood and established as a potential approach for a broad spectrum of disease manifestations.
English English: English
No full textBackground
Migraine is a prevalent neurological disease impacting around one billion people globally. According to the Global Burden of Diseases 2021, it is the third leading cause of disability among central nervous system disorders. Despite its significant impact, there are substantial gaps in the optimal management of preventive migraine therapy within global health systems.
Objective
The objective of this study was to review the patterns of access to healthcare treatment for preventive migraine medication among individuals diagnosed with migraine in various GBD regions.
Methods
A search of PubMed for articles published between January 1, 2000, and June 25, 2024, was conducted. Studies included those that reported on healthcare resource utilization, treatment access, unmet needs, and undertreatment of migraines. The American Headache Society (AHS) 2021 Consensus Statement algorithm was used to determine candidacy for preventive treatment.
Results
Out of 587 publications retrieved, 80 met the inclusion criteria. These included 56 from High-Income regions, 14 from South-East Asia, East Asia, and Oceania, 4 from Central Europe, Eastern Europe & Central Asia, 2 from Sub-Saharan Africa, 1 from Latin America & Caribbean, 1 from South Asia, and 2 from North Africa & Middle East. The prevalence of preventive treatment in the migraine population ranged from 0% in Nigeria to 36.2% in Japan, with a global 1-year-age adjusted prevalence of 17.8%.
Based on the AHS consensus statement algorithm, approximately 38.7% of the global migraine population would qualify for preventive treatment. However, around 79.8% of these candidates are not receiving preventive treatment, equating to approximately 275 million people globally.
Conclusions
There are significant gaps and a lack of recent information in the literature regarding the preventive treatment of migraines. More recent, population-based studies are necessary to assess the recognition of migraine preventive candidates and those undergoing preventive treatment, to inform better public health strategies for migraine diagnosis and treatment.
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors
MENTAL HEALTH AND HEADACHE IN UNIVERSITY PROFESSORS
Get PDFIntroductionThere is a lot of discussion about the world\u27s quality of life, mental health, disease improvement standards according to the WHO, and so many actions and attitudes in a movement to improve life, in addition to life expectancy.ObjectivesTo determine the mental health status of university medical professors at Unifipa. emphasizing the relation between headache disabling and depression and anxiety’scores.MethodologyCross-sectional cohort in a single intervention, which consisted of responding to a health and quality of life questionnaire, focusing on mental health, and in this report, headaches.ResultsParticipants’ number was 46. About 51% were between 31 and 40 years old; 56.5% were women, 67.4% were married or in a stable union, 21.7% had a master\u27s degree and 26.1% had a PHD. Regarding mental health, it was noted that professors with severe depression showed the presence of a moderate or severe level of anxiety, while those with minimal depression showed a low level of anxiety. Regarding to the headaches, it was observed that HIT-test scores above 50 correlated more with higher depression and anxiety scores and lower HIT-test scores correlated with lower depression and anxiety scores.ConclusionResearch is important to evaluate the university professors’ mental health and predict actions that can be taken to improve it. And headaches cause disabling when associated to depression and anxiety. We conclude that headache’s burden can related to worsening depression and anxiety’scores, even though not significantly.Introdução: Muito se discute sobre a qualidade de vida do mundo, saúde mental, padrões de melhoria de doenças de acordo com a OMS, e tantas ações e atitudes num movimento para a melhora da vida, além da expectativa de vida. Objetivos: Determinar o estado de saúde mental dos professores universitários de medicina da Unifipa. Pesquisar a qualidade de vida dos professores universitários de medicina da Unifipa. Metodologia: Coorte transversal em uma única intervenção, que foi responder a um questionário de saúde e qualidade de vida, com foco em saúde mental e neste relato, a cefaleia.
Resultados: O número de participantes foi de 46. Cerca de 51% estavam entre 31 e 40 anos, 56,5% eram mulheres, 67,4% eram casados ou em união estável, 21,7% tinham mestrado e 26,1 % tinham PHD. Com relação à saúde menstal, notou-se professores com depressão severa evidenciaram a presença de nível de ansiedade moderado ou severo, já aqueles com depressão mínima mostraram baixo nível de ansiedade. Com relação à Cefaleia, foi obervado que os escores de HIT-test acima de 50 se correlacionaram mais com os escores maiores de depressão e ansiedade e os escores menores de HIT-test se correlacionaram com escores menores de depressão e ansiedade
Discussão e Conclusão: A pesquisa é importante para avaliar como anda a qualidade de vida dos professores universitários e prever ações que podem ser realizadas para a melhora desta qualidade de vida, e concluímos que a incapacidade pela cefaleia pode estar associada a piores escores de depressão e ansiedade, ainda que não estatisticamente significativa
The role of diet in migraine control: deconstructing myths
Get PDFIntroduction: Migraine can be controlled through effective drug treatments, both during headache attacks, as a preventative measure, but also through non-drug treatments, including diet therapy. This treatment consists of eliminating food triggers and adding improvement factors.
Objective: To address the role of diet in controlling migraine, through the elimination of food triggers and the addition of improvement factors, in addition to demystifying some mistaken behaviors.
Method: This study was an integrative and retrospective review of articles on the relationship between food and migraine.
Results: Three relationships were found between diet and migraine attacks: 1) food may be a triggering factor; 2) food may be a mitigating factor; or 3) food may be an aggravating factor. There is no specific diet therapy for migraine, but diets that are based on the pathophysiological mechanisms of migraine.
Conclusions: Food can be a trigger or a factor in improving migraine attacks and diet therapy for controlling migraine consists of removing food triggers and replacing them with a healthy diet.Introdução: A migrânea pode ser controlada por meio de tratamentos medicamentosos eficazes, tanto durante as crises de cefaleia, como medida preventiva, como também por meio de tratamentos não medicamentosos, incluindo a dietoterapia. Esse tratamento consiste na eliminação de gatilhos alimentares e adição de fatores de melhora.
Objetivo: Abordar o papel da dieta no controle da migrânea, por meio da eliminação de gatilhos alimentares e adição de fatores de melhora, além de desmistificar alguns comportamentos equivocados.
Método: Este estudo foi uma revisão integrativa e retrospectiva de artigos sobre a relação entre alimentação e migrânea.
Resultados: Foram encontradas três relações entre dieta e crises de migrânea: 1) a alimentação pode ser um fator desencadeante; 2) a alimentação pode ser um fator atenuante; ou 3) a alimentação pode ser um fator agravante. Não existe uma dietoterapia específica para migrânea, mas sim dietas que se baseiam nos mecanismos fisiopatológicos da migrânea.
Conclusões: A alimentação pode ser um gatilho ou um fator de melhora das crises de migrânea e a dietoterapia para controle da migrânea consiste na remoção dos gatilhos alimentares e sua substituição por uma dieta saudável
Testes de triagem para migrânea aplicados à população do campus de Bauru da Universidade de São Paulo: um estudo de prevalência
No full textIntroduction: Migraine is a prevalent neurological disorder marked by recurrent and severe headaches that significantly impacts individuals\u27 quality of life. Objective: This study aims to apply migraine screening tools to the population of the Bauru campus of the University of São Paulo (USP) to estimate the prevalence of migraine and assess the impact of pain on daily life.
Methods: A cross-sectional study involved 216 participants, comprising students, faculty, and staff, who completed online questionnaires, including the “ID Migraine,” “International Headache Society Migraine Diagnosis,” and “Migraine Screen Questionnaire.” The impact of migraine on daily activities was assessed using the “Headache Impact Test. The data were analyzed using the Shapiro-Wilk test, Student\u27s t-test, Mann-Whitney test, and Pearson\u27s correlation, adopting a 5% significance level.
Results: Out of 216 respondents, 69 (31.94%) were diagnosed with migraine using the ID Migraine tool. The International Headache Society questionnaire identified 86 participants (39.81%) as having migraine, while the Migraine Screen Questionnaire indicated 94 participants (43.52%). A combined analysis identified 20.83% of participants (n=45) as having migraine across all questionnaires. A total of 113 participants (52.31%) tested positive for migraine in at least one questionnaire. Results also revealed a strong correlation between positive migraine diagnosis and significant limitations in daily activities, as assessed by the Headache Impact Test (p<0.001).
Conclusion: Using multiple migraine screening questionnaires enhances sensitivity and specificity in identifying individuals with migraine. The findings reveal a substantial population at the USP campus likely affected by migraines, emphasizing the need for further research and intervention strategies.Introdução: A migrânea é um distúrbio neurológico prevalente, caracterizada por dores de cabeça recorrentes e intensas que impactam significativamente a qualidade de vida dos indivíduos. Objetivo: Este estudo objetiva aplicar ferramentas de triagem de migrânea à população do campus de Bauru da Universidade de São Paulo (USP), com o objetivo de estimar a prevalência da enxaqueca e avaliar o impacto da dor na vida diária. Métodos: Um estudo transversal foi realizado com 216 participantes, incluindo estudantes, professores e funcionários, que responderam a questionários online, como o “ID Migraine”, “International Headache Society Migraine Diagnosis” e “Migraine Screen Questionnaire”. O impacto da migrânea nas atividades diárias foi avaliado com o “Headache Impact Test”. Os dados foram analisados utilizando os testes de Shapiro-Wilk, t de Student, Mann-Whitney e correlação de Pearson, adotando-se um nível de significância de 5%. Resultados: Dos 216 respondentes, 69 (31,94%) foram diagnosticados com enxaqueca pela ferramenta ID Migraine. O questionário da International Headache Society identificou 86 participantes (39,81%) com migrânea, enquanto o Migraine Screen Questionnaire indicou 94 participantes (43,52%). Uma análise combinada identificou 20,83% dos participantes (n=45) com migrânea em todos os questionários. Um total de 113 participantes (52,31%) testou positivo para migrânea em pelo menos um questionário. Os resultados também revelaram uma forte correlação entre o diagnóstico positivo de migrânea e limitações significativas nas atividades diárias, conforme avaliado pelo Headache Impact Test (p<0,001). Conclusão: O uso de múltiplos questionários de triagem de migrânea aumenta a sensibilidade e especificidade na identificação de indivíduos com enxaqueca. Os achados revelam uma população significativa no campus da USP possivelmente afetada por migrânea, destacando a necessidade de mais pesquisas e estratégias de intervenção
Cefaleia como evento adverso pós-vacinal mais prevalente após vacinação contra Covid-19
No full textContext: In 2020, the first vaccines were approved, according to the WHO. However, speculations have arisen regarding its efficacy and post-vaccination adverse events (AEFI). Objective: To evaluate the prevalence of headache as AEFI from the SARSCoV-2 vaccine in Piauí, Brazil.Methods: This is a quantitative, observational, cross-sectional and prevalence study. The data were provided by the Post-Vaccination Adverse Events Information System (SI-AEFV), of cases reported in the period from January to September 2021. The data were analyzed and the research was approved by the Research Ethics Committee of the UFPI. Results: 2,008 cases were analyzed. Headache was reported in 752 cases (27.99%) as AEFI after vaccination against SARS-CoV-2. In most cases, the patients were from Teresina (67.62%), of mixed race/ethnicity (52.67%), female (79.00%) and the majority were not healthcare professionals (54. 27%). The most common age of patients, with the original data, was 33 years old. After correcting the data, the most common age was 28 years old. The majority of these cases were not serious (96.44%) and the majority of cases were associated with the first dose of the Covid-19-Covishield-Oxford/AstraZeneca vaccine (43.18%). Conclusion: Thus, it is concluded from the partial analysis of the results that headache is the most common adverse event after vaccination against SARS-CoV-2. The profile of patients with the most notifications was mixed-race women aged between 30 and 40 years who received the first dose of the Covid-19-Covishield-Oxford/AstraZeneca vaccine. Regarding the severity of the events, the vast majority were considered non-serious and no deaths were mentioned, demonstrating the safety of immunobiologicals.Fundamentos: O SARS-CoV-2, identificado em 2019 na China, desencadeou uma pandemia global com milhares de mortes. Em 2020, as primeiras vacinas foram aprovadas, segundo a OMS. Entretanto, surgiram especulações sobre sua eficácia e eventos adversos pós-vacinação (EAPV). Objetivo: Avaliar a prevalência de cefaleia como EAPV da vacina SARSCoV-2 no Piauí, Brasil. Métodos: Trata-se de um estudo quantitativo, observacional, transversal e de prevalência. Os dados foram fornecidos pelo Sistema de Informação de Eventos Adversos Pós-Vacinação (SI-EAPV) da Secretaria de Estado da Saúde do Piauí, de casos notificados de janeiro a setembro de 2021. Os dados foram analisados e a pesquisa foi aprovada pelo Comitê de Ética em Pesquisa da UFPI. Resultados: No total foram analisados 2008 casos. A cefaleia foi relatada em 752 casos (27,99%) como um EAPV após a vacinação contra o Sars-CoV-2. Na maioria desses casos, os pacientes eram de Teresina (67,62%), de cor/raça parda (52,67%), do sexo feminino (79,00) e a maioria não era profissional de saúde (54,27%). A idade mais comum dos pacientes, com os dados originais, foi de 33 anos. Após a correção dos dados, a idade mais comum foi de 28 anos. A maioria desses casos não foi grave (96,44%) e a primeira dose da vacina Covid-19-Covishield-Oxford/AstraZeneca gerou a maioria dos casos (43,18%). Conclusão: Desta forma, conclui-se a partir da análise parcial dos resultados que a cefaleia o evento adverso mais comuns após a vacinação contra o Sars-Cov-2. O perfil dos pacientes que mais apresentaram notificações foram as mulheres pardas na faixa etária de 30 a 40 anos que receberam a primeira dose da Covid-19-Covishield-Oxford/AstraZeneca. Em relação à gravidade dos eventos, grande maioria foi considerado como não grave e nenhuma morte foi mencionada, demonstrando segurança dos imunobiológicos
Chronic migraine after catamenial pneumothorax: a case report of headache associated with extra-abdominal endometriosis
Get PDFIntroduction:
Endometriosis is a chronic condition characterized by the presence of endometrial tissue outside the uterus, which can result in chronic pelvic pain and infertility. Its pulmonary form is rare and manifests with chest pain, hemoptysis, pneumothorax, and catamenial hemothorax. Migraine is a neurological disorder characterized by intense headache attacks associated with nausea, vomiting, and photophobia, more frequent in women of reproductive age.Migraines are more common in women with endometriosis, probably due to central sensitization and amplification of the pain response due to inflammation and chronic pain from endometriosis.
Objective:
To report an atypical case of endometriosis with catamenial pneumothorax in a patient whose menstrual migraine worsened and became chronic after the pulmonary condition.
Case Report:
A 35-year-old woman started having weekly episodes of headache and worsening related to the menstrual cycle. She suddenly presented with dyspnea and chest pain during her menstrual cycle, which progressed to pneumothorax, requiring two surgeries. Biopsy of the right upper lung lobe identified subpleural emphysema which, along with the clinical presentation and pelvic MRI, was presumptively diagnosed as catamenial pneumothorax. After the pneumothorax, the headache became daily, right temporo-occipital, intense (subjective pain scale 9/10), pulsating, radiating to the right hemiface, with intra and extracranial allodynia, aura with nausea, blurred vision, scotomas, photophobia and phonophobia. Post-crisis, mood swings and hyporexia. Dipyrone, sumatriptan and tromethamine do not provide relief. She denies consuming foods that trigger migraines. Currently, at 48 years, she is in the menopause and infertile.
Conclusion:
Endometriosis-related migraine usually occurs during the menstrual period and tends to decrease in climacteric due to hormonal decline. In this case, however, the headaches worsened after menopause, suggesting anomalous foci of endometriosis, delaying the climacteric. Thoracic endometriosis is a rare presentation that manifests with right shoulder pain and hemoptysis during the menstrual period, consistent with this patient\u27s presumptive diagnosis of deep thoracic endometriosis. Biopsy is a limited option as it may not detect endometrial tissue depending on the time of the menstrual cycle at which it is performed. The persistence of hormonal stimulation induced by endometriosis acts as a trigger for migraines, aggravated in the climacteric
Craniofacial and Neck disability predict the presence of symptoms related to Central Sensitization in individuals with Temporomandibular Disorders
Get PDFBackground: Temporomandibular disorders (TMD) are the major cause of non-dental pain in the orofacial region. Patients with TMD frequently report craniofacial disability and pain in other areas of the body, like neck pain. However, there is still a gap regarding the relationship between the presence of symptoms related to Central Sensitization (CS) and craniofacial and neck disability in patients with TMD.
Objective: To explore the relationship between the presence of symptoms related to CS, as measured by the CSI, and craniofacial and neck disability.
Methods: This study was a cross-sectional study conducted with 87 individuals diagnosed with painful and mixed TMD. They were assessed for the presence of central sensitization symptoms using the Central Sensitization Inventory (CSI), craniofacial pain and disability using the Craniofacial Pain and Disability Inventory (CF-PDI), and neck disability using the Neck Disability Index (NDI). A Multiple Linear Regression was used to assess the relationship between craniofacial and neck disability and the presence of symptoms related to CS. Also, the association between the craniofacial disability domains and the presence of these symptoms was analyzed by multiple linear regression. In addition, the Chi-squared Test (P < 0.05) was used to verify the association between CS-related symptoms and the level of neck disability. Finally, the Prevalence Ratio of CS symptoms about the level of neck disability was calculated.
Results: The presence of CS-related symptoms is predicted by craniofacial disability and neck disability in 36%. In addition, the pain domain and the frequency of comorbidities domain of craniofacial disability can predict the presence of these symptoms in 30%. Finally, individuals with neck disability (moderate and severe disability) have 1.84 times more symptoms related to CS than individuals without neck disability (no disability and mild disability).
Conclusion: The results of this study support that craniofacial disability and neck disability are predictors for the presence of symptoms related to CS. Furthermore, the pain domains and frequency of comorbidities domain of craniofacial disability are considered predictors of these symptoms. Finally, individuals with a neck disability have more symptoms related to CS than those without a neck disability
A novel arthrocentesis technique with vacuum-assisted irrigation for tmj disc displacement without reduction: a case report
Get PDFIntroduction:Arthrocentesis is an effective treatment to reduce or eliminate pain, increase maximal interincisal distance, and eliminate joint effusion in patients with disc displacement without reduction. This study aims to expose and discuss a new technique proposal of temporomandibular joint arthrocentesis applied in the treatment of a single case of disc displacement without reduction.
Objective: To present and evaluate the outcomes of a new arthrocentesis technique for the management of temporomandibular joint (TMJ) disc displacement without reduction.
Case Report: An 18-year-old female patient sought treatment due to joint pain and mouth opening limitation. The maximal interincisal distance was 30.28 mm. Magnetic resonance imaging confirmed the diagnosis of disc displacement without reduction with signs of joint effusion in the right TMJ. TMJ arthrocentesis was performed under selective sensory nerve block of the auriculotemporal, masseteric, and posterior deep temporal nerves. Two needles were inserted into the upper compartment of the TMJ. In the second needle, a transparent catheter was connected to a vacuum pump. Clinically, after the arthrocentesis, the maximal interincisal distance increased to 46.25 mm, and the patient reported no more pain. After six months, a magnetic resonance imaging was performed to observe the results, and there were no more signs of joint effusion.
Conclusion: TMJ arthrocentesis was an effective treatment for this patient with disc displacement without reduction. The aspect of this technique that is particularly relevant for clinical practice was the connection of a transparent catheter to a vacuum pump. This allowed the visualization of the solution fluidity and guided the flow of the solution used for joint washing, optimizing the irrigation. However, new studies are necessary to compare different protocols of irrigation with and without the associated use of a vacuum pump.