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Association between plasma levels of interleukin 1 and clinical aspects of migraine
Get PDFIntroduction: Migraine is a highly prevalent and relevant disease, significantly impacting the quality of life of its sufferers. Its etiology involves interactions among genetic, immunological, and environmental factors; however, the mechanisms underlying its pathophysiology remain poorly understood. Studies indicate an association of inflammatory cytokines with specific stages of the disease. interleukin (IL)-1β is known to activate various inflammatory pathways, which are important in the pathogenesis of migraine. Objectives: This study aims to evaluate the association between plasma IL-1β levels and clinical aspects of migraine. Methods: A case-control study was carried out with individuals diagnosed with migraine and treated at the Headache Clinic of Pontifical Catholic University of Paraná, Campus Londrina, Paraná, Brazil. Peripheral blood samples were collected from patients with migraine (case group) and healthy individuals (control group). Structured interviews and self-administered questionnaires were used to obtain epidemiological, clinical, and therapeutic data. IL-1β levels were measured using the immunofluorimetric assay. Results: A total of 176 individuals were included, including 80 patients with migraine (case group) and 96 controls. Among the 80 patients, 62 (77.5%) were female, and among the 96 controls, 68 (70.8%) were female. There were no significant differences in sex, age, or ethnicity between patients and controls (p>0.05). Of the 80 patients, 32 (40.0%) reported the presence of aura, 71 (88.7%) reported photophobia, 65 (81.2%) phonophobia, and 46 (58.2%) reported osmophobia. The IL-1β values ranged from non-detectable (<9.0 pg/mL) to 116.8 pg/mL, with a median of 9.0 pg/mL (interquartile range of 90.51 pg/mL). Patients with migraine had an average IL-1β levels of 10.38±12.25 pg/mL, while controls had an average of 10.10±6.46 pg/mL (p=0.855). Significant associations were found between higher IL-1β levels and chronic migraine (p=0.015) and migraine with aura (p=0.026), while other variables did not show significant differences (>0.05). A marginal association was observed between IL-1β levels and migraine disability evaluated using the MIDAS questionnaire (p=0.059). Conclusion: This study contributes to a better understanding of migraine management by considering IL-1β levels in relation to specific clinical characteristics, as well as suggests IL-1β as a possible biomarker for the disease and/or new target for specific medications.Introdução: A migrânea é uma doença altamente prevalente e relevante, impactando significativamente a qualidade de vida dos seus portadores. Sua etiologia envolve interações entre fatores genéticos, imunológicos e ambientais; no entanto, os mecanismos subjacentes à sua fisiopatologia permanecem pouco compreendidos. Estudos indicam uma associação de citocinas inflamatórias com estágios específicos da doença. A interleucina (IL)-1β é conhecida por ativar várias vias inflamatórias, que são importantes na patogênese da migrânea. Objetivos: Este estudo visa avaliar a associação entre os níveis plasmáticos de IL-1β e aspectos clínicos da migrânea. Métodos: Um estudo caso-controle foi realizado com indivíduos diagnosticados com migrânea e tratados no Ambulatório de Cefaleia da Pontifícia Universidade Católica do Paraná, Campus Londrina, Paraná, Brasil. Amostras de sangue periférico foram coletadas de pacientes com migrânea (grupo caso) e indivíduos saudáveis (grupo controle). Entrevistas estruturadas e questionários autoaplicáveis foram utilizados para obter dados epidemiológicos, clínicos e terapêuticos. Os níveis de IL-1β foram medidos utilizando o ensaio imunofluorimétrico. Resultados: Um total de 176 indivíduos foram incluído, sendo 80 pacientes com migrânea (grupo caso) e 96 controles. Entre os 80 pacientes, 62 (77,5%) eram mulheres, e entre os 96 controles, 68 (70,8%) eram mulheres. Não houve diferenças significativas em sexo, idade ou etnia entre pacientes e controles (p>0,05). Dos 80 pacientes, 32 (40,0%) relataram a presença de aura, 71 (88,7%) relataram fotofobia, 65 (81,2%) fonofobia e 46 (58,2%) relataram osmofobia. Os valores de IL-1β variaram de não detectáveis (<9,0 pg/mL) a 116,8 pg/mL, com uma mediana de 9,0 pg/mL (intervalo interquartil de 90,51 pg/mL). Pacientes com migrânea apresentaram níveis médios de IL-1β de 10,38±12,25 pg/mL, enquanto controles apresentaram uma média de 10,10±6,46 pg/mL (p=0,855). Associações significativas foram encontradas entre níveis mais altos de IL-1β e migrânea crônica (p=0,015) e migrânea com aura (p=0,026), enquanto outras variáveis não mostraram diferenças significativas (>0,05). Uma associação marginal foi observada entre os níveis de IL-1β e a incapacidade pela migrânea avaliada pelo questionário MIDAS (p=0,059). Conclusão: Este estudo contribui para uma melhor compreensão do manejo da migrânea ao considerar os níveis de IL-1β em relação às características clínicas específicas, bem como sugere a IL-1β como um possível biomarcador para a doença e/ou novo alvo para medicamentos específicos
Relationship between central sensitization, headache impact and neck disability in migraine
Get PDFIntroduction: Neck pain is a frequent symptom of migraine. Central sensitization (CS) is a feature of migraine and may be related to the development of neck pain and the process of migraine chronification. These symptoms could lead to a more severe impact of headache. There\u27s no gold standard tool to access CS, but the Central Sensitization Inventory (CSI) has been suggested. However, the relation between CSI and other assessment tools, such as the headache impact and neck pain disability, is still unclear.
Objective: To evaluate the correlation between CS, measured by CSI and headache impact, measured by Headache Impact Test (HIT-6) and neck disability, measured by Neck Disability Index (NDI).
Methods: The local Research Ethics Committee (5,253,045/2022) approved this cross-sectional study. One hundred individuals diagnosed with migraine, according to the third edition of the International Classification of Headache Disorders, were recruited. Sociodemographic data were collected, plus the CSI, HIT-6 and NDI questionnaires. Clinic and demographic data were analyzed by mean and standard deviation. The Shapiro-Wilk test was performed to verify data distribution, and Pearson\u27s correlation was used to verify the association between CSI and the HIT-6. A posteriori, the correlation between the CSI and NDI was performed. The correlation was interpreted using a range of -1 to 1, considering <0.3 as a weak correlation, between 0.3 and 0.7 as a moderate correlation and >0.7 as a strong correlation.
Results: The evaluated individuals had a mean age of 36.6 years (SD= 9.7), with a mean body mass index of 26.1 (SD= 4.2). The mean illness duration was 17.1 (SD=10.1), with a mean frequency of 13.8 (SD=8.8) headache days per month, with a mean intensity of 7.9 (SD= 1.8). The mean score of the CSI questionnaire was 50 points (SD=15.8), from HIT-6 was 63 points (SD=9) and from NDI was 13 points (SD= 8). A positive and moderate correlation was found between CSI and HIT-6 (r= 0,43; p<0,001) and between CSI and NDI (r= 0,42; p<0,001).
Conclusion: The CSI correlates moderately with HIT-6 and NDI, two validated assessment tools for migraine. Therefore, we can suggest the use of CSI to evaluate migraineurs
National campaign “bordeaux may” 2024 to raise awareness and combat headaches: event report
Get PDFIntroduction: The Global Burden of Disease 2021 study ranks headache disorders as the third leading cause of years lived with disability, however, they are still under-recognized, under-diagnosed and under-treated globally. The Brazilian Headache Society, through its "Bordeaux May " campaign, aims to raise awareness about headaches among the general population and health care professionals. Objective: To describe the sociodemographic profile and clinical characteristics of the headaches of those interviewed during the event. Methods: This is a cross-sectional study, conducted by the Federal University of Pernambuco in partnership with the Brazilian Headache Society. The event took place on May 19th, 2024, in the Jaqueira Park, Recife, and 157 volunteers were interviewed (60.9% women, 39.1% men). Data regarding age, sex, presence of headache, visits to the emergency room due to headache, medication administered in such visits and whether they were resolutive or not, as well as self-medication habits, proper health care access and its efficiency were collected. Results: Headaches were referred in 77.1% of the sample (n=121/157, 75 women, 45 men), and led to emergency room visits up to 3 times within the last year for 26 individuals (15 women, 5 men). The medications most administered on these occasions were analgesics, being resolutive in 69,2% of the patients. Self-medication was reported by 82.5% of the sample, while 78.3% are not undergoing any treatment for their condition. The main triggering factors were stress (62.5%), sleep deprivation (54.1%), and menstrual cycle (53.3% of the women). Conclusion: There was a high prevalence of headache in the sample, and women were more affected than men. Over half of the volunteers experiencing headaches did not seek medical help, likely leading to the high rate of self-medication observed. These findings highlight the urgent need to educate the population about headaches, as well as expanding access to proper health care
Inglês
No full textBackground: Headaches pose a significant public health concern, affecting the quality of life of the global population and ranking among the top medical complaints. They manifest as symptoms of underlying structural or organic alterations, resulting from lifestyle factors, or as primary headaches with unknown etiopathogenesis. This multifaceted nature drives the problematic issue of self-medication, a practice that can lead to dependency and mask underlying conditions. Objectives: To understand the importance of addressing headaches to prevent exacerbations, mitigate public health burdens in Brazil, and preserve the well-being of patients presenting with this complaint. Methods: A search was conducted using the BVS (Virtual Health Library) with the descriptors "headache" and "symptom." Exclusion criteria included: (1) studies conducted in other countries; (2) articles that treated headache as a secondary topic; (3) non-article publications. Eight articles were selected after analyzing the results. Results: Six articles highlight the prevalence of headaches in medical practice, affecting up to 90% of the global population at some point in their lives and requiring urgent care in at least one episode. Thorough investigation is warranted when associated with meningitis, focal neurological symptoms of oculomotor paresis, cranial nerve palsy, hemiparesis, or loss of consciousness. The personal impact on academic performance, lost workdays, and public health consequences, such as healthcare costs and self-medication, are also discussed. Two additional articles address the inconclusive correlation between headache and temporomandibular joint dysfunction (TMJ), while acknowledging it as a common symptom. Finally, the importance of identifying red flags to rule out serious illnesses is emphasized. Conclusions: This study aimed to underscore the importance of attention to patients presenting with headache complaints. It concludes that due to the diversity of causes and effects, a comprehensive clinical examination should be performed for early detection of treatable conditions and to rule out serious illnesses. Non-pharmacological approaches are valuable allies in achieving favorable outcomes, and encouraging appropriate treatment seeking should be promoted to reduce self-medication practices associated with this condition
Lifestyle factors in the evolution of cluster headache to fibromyalgia: a case report"
Get PDFIntroduction: Cluster headache is considered a male-dominated disorder, but female patients may display a more severe phenotype, with a greater extent diagnosed with the chronic cluster headache subtype and longer bouts compared with male participants. The comorbidity of cluster headache, migraine and fibromyalgia does not seem to be infrequent and substantially increases the psychosocial burden and decreases overall quality of life of patients.
Objective: To promote reflections on possible lifestyle factors involved in the chronification of pain, specifically chronic headache and fibromyalgia.
Case Report: E.C.U.M, 58 years old, female, from Castro, Paraná, Brazil, former housekeeper, catholic, married. In April 2015, started severe, incapacitating headache located in the left supraorbital and temporal region, lasting four to five days, associated with conjunctival injection, ptosis, and ipsilateral eyelid edema. Comorbidities included systemic arterial hypertension and migraine without aura for 20 years, which had been controlled for the last 5 years. Former smoker since 35, denied alcohol consumption, sedentary, had non-restorative sleep, insomnia and regular diet. Complementary exams showed no significant alterations. Was diagnosed with probable cluster headache. Patient remained under outpatient follow-up without pain remission despite several therapeutic attempts. Lifestyle modifications were advised but not adhered to. Continued non-restorative sleep and depressive/anxious symptoms. Progressed to chronic cluster headache and was diagnosed with fibromyalgia in September 2021, with Widespread Pain Index of 19 and Severity Symptoms Scale of 11.
Conclusion: The central sensitization process in these nociplastic pain syndromes explain part of evolving and generalization of pain, but lifestyle choices and systemic chronic inflammation (SCI) may offer additional explanations. Unhealthy lifestyle factors like smoking, alcohol overuse, sleep disturbances, psychological stress and high BMI seems to be more prevalent among patients with chronic pain
Epidemiological Profile of Women Admitted for Migraine and Other Headache Syndromes in the Southern Region of Brazil, between 2018 and 2023
Get PDFIntroduction: Migraine is a chronic neurological disorder that negativelyinfluences personal, economic, and social aspects of individuals\u27 lives, as wellas reducing health-related quality of life. Its highest incidence occurs amongmiddle-aged individuals, with women being the most affected. Regardingmonthly headache days, about one-third of migraine sufferers experience four or more days, and approximately 7% have 15 or more days. Acute therapy aimsto alleviate pain and restore function during attacks, while preventive treatmentaims to reduce the frequency and severity of episodes. Disease progressioncan occur in some individuals, underscoring the importance for physicians toidentify modifiable risk factors to enhance patients\u27 quality of life. The majority ofmigraine sufferers seek medical care in primary healthcare settings, highlightingthe critical need for these professionals to be prepared to manage the condition.
Objective: To identify the epidemiological profile of women hospitalized for migraine and other headache syndromes in the Southern region of Brazilbetween 2018 and 2023.
Methods: Ecological, cross-sectional, retrospective, and descriptive studyconducted through data collection from the Hospital Information System of theUnified Health System (SIH/SUS), linked to DATASUS, focusing on variablessuch as age, race/ethnicity, type of care, and hospital service costs.
Results: A total of 16,488 women were hospitalized for migraine and otherheadache syndromes. The year 2019 had the highest number of admissions(4,052), while 2021 had the lowest (1,820). Of these, 17.3% (2,907) werewomen aged 40-49 years, 16.8% were aged 30-39 years, 15.4% were aged 20-29 years, and the least affected age group was under 1 year (0.1% - 18 cases). Regarding race/ethnicity, 81.6% (13,449) were White, 8.8% (1,450) were MixedRace, 2.5% (418) were Black, 0.7% (117) were Yellow, 0.02% (4) wereIndigenous, and 6.3% (1,050) did not have race information available. 93.5% ofadmissions were for urgent care, while only 6.5% were elective. The total hospital service costs during this period amounted to R 2,100,630.40) and 2021 the lowest (R 1,467,777.68), while the lowest was under 1 year (R$ 2,820.53).
Conclusion: This study reveals, through the epidemiological profile of womenhospitalized for migraine and other headache syndromes in the Southern regionof Brazil between 2018 and 2023, that 2019 had the highest number ofadmissions and highest costs. The most affected age group, and consequentlythe most costly, was 40-49 years old. White individuals were the most affectedby race, and the majority of admissions were for urgent care. Therefore, understanding the specific epidemiological patterns of this condition in thesepatients is crucial for providing adequate and personalized healthcare
Neuralgia do trigêmeo secundária: relato de caso de espessamento da dura-máter no cavum do trigêmeo por doença relacionada à IgG4.
No full textIntrodução: A cefaleia por uso excessivo de analgésicos (CAA) é um desafio terapêutico em pacientes com cefaleia crônica. Este relato apresenta um caso em que o rimegepant, um antagonista do receptor CGRP aprovado para enxaqueca episódica, foi eficaz no tratamento da CAA. Os detalhes clínicos e implicações deste tratamento serão discutidos.
Objetivo: Utilização de novas terapias preventivas para enxaqueca como o rimegepant para desmame de analgésicos.
 
INTERNAÇÕES POR CEFALEIAS ASSOCIADA À MUDANÇA CLIMÁTICA: UM ESTUDO TRANSVERSAL
No full textIntroduction: Headache is one of the most common medical complaints and can affect all ages and lifestyles. This complaint is old and as it was studied it became clear that it varies in intensity and duration. Currently, it is clear how environmental factors can influence the frequency and severity of headaches. Studies suggests that climate changes, such as an increase in the planet\u27s temperature and changes in the atmosphere can worsen headache episodes and this is visible in the increase in the number of hospitalizations for headache over the years. Objective: To analyze the incidence of hospitalization cases due to headache associated with climate change in Brazil between 2000 and 2022. Methods: Descriptive, cross-sectional study with a quantitative approach to time series analysis. Data from DATASUS/TABNET were selected, considering records of hospitalizations resulting from migraine and headache attacks, which occurred in all states of Brazil, from January 2000 to December 2022, correlating with the climate changes that occurred during this same period. Results: The analysis showed a significant increase in the number of hospitalizations between the analyzed period, coinciding with an increase in ambient temperature. 772 cases were observed in 2020 and 10,406 cases in 2022, an increase of approximately 13 times. While the temperature in 2000 showed little variation, from 2011 to 2020 there was a deviation in temperature of up to 0.9°C. Furthermore, another important increase in the number of cases was observed in the northeast region, coinciding, again, with an increase in ambient temperature. The year 2000 with only 51 reported cases, 2008 with 426 cases and 2022 with 3459 registered cases, representing 33.2% of Brazil\u27s total cases in 2022. Conclusion: It is important to recognize and address the significant impacts of climate change on neurological health. The results of this study suggest another perspective that has been less studied so far, showing that the increase in hospitalizations for headache coincides with the increase in ambient temperature in the country. Therefore, there is a need for actions related to climate change that can protect the neurological health of the population most susceptible to these changes.Introdução: A cefaleia é uma das queixas médicas mais frequentes e pode afetar pessoas de todas as idades e estilos de vida. Essa queixa é antiga e à medida que foi sendo estudado foi se entendendo que varia em intensidade e em duração. Atualmente, é perceptível como fatores ambientais podem influenciar a frequência e a severidade das cefaleias. Estudos sugerem que mudanças climáticas, como aumento da temperatura do planeta e mudanças da atmosfera podem agravar episódios de cefaleia e isso é visível em aumento dos números de internações por cefaleia ao longo dos anos. Objetivo: Analisar a incidência dos casos de internação por cefaleia associados a mudanças climáticas no Brasil entre 2000 e 2022. Métodos: Estudo descritivo, transversal com abordagem quantitativa de análise de série temporal. Foram selecionados, dados do DATASUS/TABNET, sendo considerados os registros de internações decorrentes de crises de enxaqueca e cefaleia, que aconteceram em todos os estados do Brasil, de janeiro de 2000 a dezembro de 2022, correlacionando com as mudanças climáticas que ocorreram durante esse mesmo período analisado. Resultados: A análise mostrou um expressivo aumento do número de internações entre o período analisado, coincidindo com aumento da temperatura ambiente. Foi observado 772 casos em 2020 e 10.406 casos em 2022, sendo um aumento de aproximadamente 13 vezes. Enquanto a temperatura de 2000 apresentava pouca variação, de 2011 a 2020 houve um desvio na temperatura de até 0,9°C. Além disso, foi observado outro importante acréscimo em números de casos na região do nordeste, coincidindo, novamente, com aumento da temperatura ambiente. O ano de 2000 com apenas 51 casos relatados, 2008 com 426 casos e 2022 com 3459 casos registrados, representando 33,2% dos casos totais do Brasil em 2022. Conclusão: É importante reconhecer e abordar os impactos significativos das mudanças climáticas na saúde neurológica. Os resultados desse estudo sugerem outra perspectiva menos estudada até então, mostrando que o aumento das internações por cefaleia é coincidente com o aumento da temperatura ambiente no país. Portanto, fica claro, a necessidade de ações relacionadas às mudanças climáticas que podem proteger a saúde neurológica da população mais suscetível a essas alterações
Non-Pharmacological approaches in migraine treatment: literature review
Get PDFIntroduction: Migraine has various triggering factors, whether environmental, psychological, or biological, commonly reported during early childhood and adolescence. Despite the high prevalence of underdiagnoses, treatments, when administered, demonstrate low adherence due to their complexity. The interaction of various drugs, which can be ineffective or contraindicated, as well as triggering unpleasant side effects, can lead to other complications such as the chronicization of headaches and medication overuse. Therefore, non-pharmacological measures have been considered in recent years.
Objective: to analyze the different non-pharmacological approaches in the treatment of migraine, their indications, and to understand which ones have the greatest clinical efficacy.
Methods: the present study is a literature review, where scientific articles were searched in the PubMed and Google Scholar databases, addressing the management of migraine and its non-pharmacological treatments. Randomized clinical trials and systematic reviews from the last 7 years were included in the research.
Results: the biofeedback technique increased the efficacy of pharmacological treatment, leading to a reduction in the use of analgesics and the frequency of migraines. Mindfulness meditation as a prophylactic treatment was as effective as prophylactic medication in reducing the frequency of migraine attacks. Aerobic exercises combined with amitriptyline reduced migraine attacks more than amitriptyline alone. Acupuncture demonstrated efficacy comparable to botulinum toxin A and topiramate. Vagus nerve stimulation and transcranial magnetic stimulation were effective in reducing the frequency and intensity of migraines. The use of nutraceuticals such as magnesium and riboflavin showed efficacy in the treatment of migraine.
Conclusion: this study highlighted the significant impact of non-pharmacological therapies in the treatment of migraine patients, making it clear that drugs are not the only treatment options for pain management. Understanding these alternatives is important for reducing polypharmacy and improving patients\u27 quality of life
Chronic daily headache: literature review on management and prevention
Get PDFIntroduction: Chronic daily headache (CDH) has a multifactorial etiology and is defined as a migraine lasting more than 4 hours per day for 15 or more days per month. It can be subdivided into three modalities: chronic tension-type headache, new daily persistent headache, transformed migraine, and hemicrania continua. Its high prevalence is a significant public health issue, given the substantial impact on individuals\u27 quality of life and the high cost to public and private sectors.
Objective: To understand the management and prevention of chronic daily headache.
Methods: This research is a narrative literature review, with scientific articles sourced from Google Scholar, LILACS, PubMed, and BVS databases. The descriptors used were "chronic daily headache," "management," and "prevention." Inclusion criteria were (a) articles available in English and Portuguese and (b) articles available for free. Exclusion criteria were (a) articles that do not fit the theme and (b) not available for free.
Results: Patients with CDH often manifest psychological symptoms and psychosomatic manifestations, usually presenting a significant family history of headaches. The quality of pain is variable, ranging from pressure-like to tightness, and may also include stiffness or tension in the neck muscles. Regarding pain location, the most common topographies are bifrontal, occipitonuchal, bitemporal, vertex, and holocranial. The primary management approach is prophylactic medication treatment, where the choice of the agent should be based on the type of CDH, side effects, and comorbidities presented. Examples of medications include antidepressants, antiepileptics, antihypertensives, and anti-serotonergic drugs. Another measure is the implementation of non-pharmacological therapies, such as cognitive-behavioral therapies and healthy lifestyle habits, with special attention to sleep.
Conclusion: Chronic daily headache is a challenge for medical care in terms of its management and prevention, given the variety of diagnostic alternatives and the diversity of disorders that contribute to the development of this condition. Thus, it is evident that CDH is a generalist term and "diagnosis," making it necessary for the neurologist to perform differential evaluations to determine the type of headache and its appropriate treatment