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Insomnia in migraine patients: impact on disability, depression, and anxiety - a partial analysis
Get PDFIntroduction: Migraine is a complex neurological disorder with profound interactions with the body\u27s homeostasis, particularly the sleep-wake cycle.
Objective: To evaluate the effect of sleep parameters on individuals with migraine and their association with migraine severity and mood.
Methods: This is a cross-sectional study involving 49 participants diagnosed with migraine and treated at the Headache Clinic of PUC-PR, Londrina-PR, Brazil. Demographic, anthropometric, and clinical data were collected, along with responses to validated questionnaires: Migraine Disability Assessment (MIDAS), Headache Impact Test (HIT-6), 12-item Allodynia Symptom Checklist (ASC-12), General Anxiety Disorder-7 (GAD-7), Beck Depression Inventory (BDI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESE), and Morningness-Eveningness Questionnaire (MEQ). Spearman\u27s correlation was used to examine the relationships between variables, considering statistical significance for p<0.05. Results: The study participants were predominantly female (69.4%) with a median age of 36 (27-47) years. Chronic migraine was present in 35 (71.4%) participants, 11 (22.4%) were using preventive medications, and 24 (49.0%) had medication overuse. The most common chronotype was intermediate (49.0%), followed by morning (44.9%) and evening (6.1%). Moderate to severe insomnia was identified in 10 (20.4%) and excessive daytime sleepiness in 15 (30.5%) participants. There was a strong correlation between insomnia and depressive symptoms (ρ=0.555; p<0.001; R²=0.308), as well as between insomnia and anxiety symptoms (ρ=0.521; p<0.001; R²=0.271). Additionally, there was a moderate correlation between insomnia and migraine-related disability (ρ=0.302; p=0.035; R²=0.091) and insomnia with age (ρ=0.331; p=0.02; R²=0.109).
Conclusion Sleep disorders are common among individuals with migraine and impact their mood and migraine-related disability.
Key-words: Insomnia, Migraine, Depression, Anxiety
Evaluation of immediate efficacy of transcutaneous electrical nerve stimulation (tens) in individuals with chronic migraine: a randomized clinical trial
Get PDFINTRODUÇÃO : A enxaqueca é uma cefaleia primária considerada crônica quando ocorre por mais de 15 dias por mês. Muitos recorrem a medicamentos, que muitas vezes apresentam contraindicações e efeitos adversos. Portanto, é necessária a investigação de tratamentos alternativos, como a estimulação elétrica nervosa transcutânea (TENS), método analgésico não farmacológico. Ensaios clínicos demonstraram que a TENS é bem tolerada e segura para pacientes com enxaqueca, e meta-análises indicaram que reduz o número de dias de dor de cabeça. Entretanto, a maioria dos estudos avalia a eficácia da TENS em longo prazo, carecendo de informações sobre seus efeitos em curto prazo.
OBJETIVO : Analisar se a TENS proporciona benefícios em indivíduos com enxaqueca crônica imediatamente após uma única aplicação.
MÉTODOS : Ensaio clínico randomizado, duplo-cego e controlado por placebo. Os pacientes elegíveis foram distribuídos aleatoriamente em dois grupos: TENS ativa e TENS placebo. Os indivíduos receberam terapia por 30 minutos, com frequência de 4 Hz ou 100 Hz, duração de pulso de 100 µs e eletrodos colocados nos músculos frontal e trapézio superior bilateral. Desfechos: limiar de dor à pressão (algometria), amplitude de movimento cervical (inclinometria) e intensidade da dor durante crises de cefaleia em participantes que as apresentaram no dia da aplicação atual (Escala Numérica de Dor). Além disso, foi mensurada a intensidade da dor durante movimentos da região cervical em participantes que relataram dor durante flexão, extensão, flexão para direita e esquerda e rotação para direita e esquerda no dia da aplicação (Escala Numérica de Dor). Todas as variáveis foram avaliadas antes e após o tratamento.
RESULTADOS : Trinta e cinco pacientes foram incluídos no estudo, sendo 18 no grupo TENS ativa e 17 no grupo TENS placebo. Não houve diferenças significativas entre os grupos em relação ao limiar de dor à pressão ou amplitude de movimento cervical. Nem todos os participantes estavam apresentando crise de cefaleia ou dor de movimentação cervical. Além disso, não houve diferenças significativas entre os grupos na intensidade da dor de cabeça ou na dor do movimento cervical.
CONCLUSÃO : Portanto, uma única aplicação de TENS em frequência mista não proporciona benefícios imediatos no alívio da dor em indivíduos com enxaqueca crônica
Perfil das cefaleias infantis num centro terciário
No full textBackgroundThe aims of this study were to analyze the profile of childhood headache complaints in a tertiary headache center, verify the differences between children and adolescents, and provide the clinical characteristics that are related to the headaches.MethodsA review of 384 medical records of children aged between 4-12 years old (n=206) and adolescents (n=178) aged >12 to 18 years old. The variables evaluated were reported as percentages, compared between children and adolescents and selected the variables that were related to headaches diagnosis.ResultsThe majority of the sample were females (60.7%), diagnosis of migraine (70.3%), pulsatile pain (60.2%), episodic attacks (60.2%) and no need for imaging tests associated with the diagnosis (69.3%), which were associated with different clinical characteristics (LR X2(52); p<0.001; Log likelihood = -322.434; Pseud R2 = 0.154). The group of adolescents had a higher proportion of use of antidepressants (29.8%) as prophylactic medication than children, who on the other hand, had a higher prevalence of use of antivertiginous drugs (32%). The abortive medication used was common analgesics (37.8%) and the main outcome after treatment was discharge from the service (32%).ConclusionThe evaluation and the treatment for these patients should take into account the main complaints, considering the particularities of each type of headache and also the age group, in order to identify, treat the disease properly and avoid chronification and continuity in the tertiary service, referring them to less complex services
Provision of pharmacological treatment for migraine in a health region of a Brazilian Southern State: a comparative analysis
Get PDFIntroduction: Migraine affects 15% of the Brazilian population and is a frequent reason for seeking medical care. Proper management requires specific pharmacological therapy. Therefore, analyzing the provision of adequate medications for migraine within the Sistema Único de Saúde (SUS) is crucial. Medication provision within SUS follows guidance from the National List of Essential Medicines (RENAME) and local adaptation through the Municipal List of Essential Medicines (REMUME).
Objective: To diagnose the availability of pharmacological prophylactic and abortive treatments for migraine within the SUS in a health region in the southern Brazilian state of Paraná, through analyzing the REMUMEs of each municipality.
Methods: A documentary research was carried out, consulting the REMUMEs of the municipalities in the 20th Regional Health Division of Paraná to identify the availability of medications for migraine treatment. Medications listed by UpToDate® with evidence levels 1A, 1B, 2A, 2B, and 2C were used as comparison parameters. An average availability index was calculated for prophylactic and abortive treatment medications.
Results: The average availability index for recommended medications was 76.85% for first-line prophylactic treatment, 40.55% for second-line prophylactic treatment, and 27.77% for medications intended for abortive treatment. Among the 18 municipalities analyzed, 4 (22%) provided topiramate, an important prophylactic medication for migraines. On average, 3.4 first-line preventive treatment medications are available per municipality, highlighting tricyclic antidepressants and beta-blockers. Second-line medications have greater availability, notably anticonvulsants (83%). For abortive treatment of migraine crises, each municipality provides an average of 7.4 medications, especially analgesics and non-steroidal anti-inflammatory drugs (67.66%), while classes with high efficacy and safety in migraine treatment, such as triptans, CGRP (Calcitonin Gene-Related Peptide) antagonists, and serotonin receptor agonists, are not available in any of the surveyed municipalities.
Conclusion: Numerous medication combinations are publicly available for the treatment of migraines in this health region. However, some first-line treatment drugs, particularly those with specific pharmacodynamics for migraines, are not widely accessible. These gaps require increased public health investment to ensure medication availability, crucial to provide effective, individualized, and safe treatment for migraines
Hospital admissions due to headaches in children and adolescents in Brazil: An ecological study from 2013 to 2023.
Get PDFIntroduction: Headaches are among the most common pains in childhood and are one of the reasons why most parents seek specialized neurological care. Objectives: To analyze the epidemiological profile of hospitalizations for headaches in children and adolescents in Brazil between 2013 and 2023. Method: Descriptive ecological study, through data collection by the SUS Hospital Information System (SIH/SUS), linked to the Department of Informatics of the Unified Health System (DATASUS) in may 2024. The number of hospital admissions due to headaches in the pediatric population, aged 0 to 19 years, in the period 2013-2023 was analyzed. The variables used were: Age group, gender, race, year of hospitalization, region, average value and average length of stay. Results: During the period analyzed, there were 17,924 children and adolescents hospitalized because of headaches. The Southeast region had the highest number of hospitalizations (35.8%, 6,423), and the year 2023 had the highest number of cases (2,092). Regarding sex/race, the analyses showed a higher prevalence of hospitalizations among females (62.3%, 11,166) with brown skin color (43.3%, 7,774) as the majority. The predominant age group was between 15-19 years (43.9%, 7,866). The average length of stay of hospitalizations was between 3 and 5 days, with a higher average for the age group under 1 year (5.9 days). The average value of hospitalizations was also higher in this population (1,833.84 reais), a value considered above the average of the pediatric age groups of around 691.39 reais. In relation to total expenditures, migraine in the pediatric population generated a total cost of 6,499,527.48 reais in the period analyzed. Conclusion: In view of the analyses, the epidemiological profile of hospitalizations was led by the age group of 15-19 years. Most of them are female, brown and residents of the state of São Paulo. Finally, biological and behavioral factors may be linked to the occurrence of headaches in children and adolescents, and public policies aimed at the prevention and treatment of this condition need to be adequate and improved
A disfunção temporomandibular altera a força muscular cervical em adultos jovens?
No full textIntroduction: Literature indicates relationships between temporomandibular disorder (TMD) pain and disability related to the cervical spine, but studies evaluating the strength of cervical muscles, especially in young adults, are still scarce. Objectives: To evaluate cervical muscle strength in young adults with and without temporomandibular disorder. Materials and Methods: This study included young adults aged 18 to 25 years from a private university, both with and without a diagnosis of TMD, and in generally good health. Individuals with neck/head trauma; disc herniation and degeneration; systemic diseases such as fibromyalgia, lupus; pregnancy; or anesthetic block in the last 3 months were excluded. Those scoring >50 points on the Fonseca Anamnestic Index questionnaire were considered to have TMD. The Neck Disability Index was used to assess the level of disability related to cervical spine pain. Cervical muscle strength of the flexors and extensors was measured by maximum isometric voluntary contraction using a handheld dynamometer, model 2201163, Lafayette, IN, USA. A significance level of <0.05 was adopted. Results: A total of n=64 individuals were evaluated, with n=30 in the TMD group, averaging 20 to 22 years of age, with moderate TMD being the most observed (n=34, 53%). A reduction in muscle strength was identified in the TMD group compared to the non-TMD group for all movements, with a significant difference for the flexion movement (p<0.05). Conclusion: Individuals with TMD show lower muscle strength for all cervical spine movements compared to those without the condition, with this difference being significant for the flexion movement.
Keywords: (Temporomandibular Disorder, isometric contraction, flexor strength, extensor strength)Introdução: A literatura aponta relações entre Disfunção temporomandibular (DTM) e incapacidade relacionada a dor na coluna cervical, porém ainda são escassos os estudos que tenham avaliado a força dos músculos cervicais sobretudo em adultos jovens. Objetivos: Avaliar a força muscular cervical em adultos jovens com e sem Disfunção temporomandibular. Materiais e Métodos: Participaram deste estudo, adultos jovens de 18 a 25 anos de uma universidade particular, com e sem diagnóstico de DTM e em bom estado geral de saúde. Foram excluídos os indivíduos com trauma no pescoço/cabeça; hérnia e degeneração discal; doenças sistêmicas como fibromialgia, lúpus; gravidez; bloqueio anestésico durante os últimos 3 meses. Foi considerado como com DTM aqueles que obtivessem >50 pontos no questionário Índice Anamnésico de Fonseca, Neck Disability Index foi utilizado para avaliar o nível de incapacidade relacionado a dor na coluna cervical. A avaliação da força muscular dos músculos flexores e extensores da cervical foi mensurada pela contração voluntária isométrica máxima utilizando o dinamômetro manual, modelo 2201163, Lafayette, IN, USA, realizada 3 vezes em ordem aleatória de movimentos, com duração de 3 minutos cada contração, a média dos testes foi utilizada nos resultados. O nível de significância de <0,05 foi adotado. Resultados: Foram avaliados n=64 indivíduos, o grupo com DTM com n=30, com média de idade de 20 a 22 anos, sendo a DTM moderada a mais observada n=34 (53%). Foi identificado redução da média de força dos músculos do grupo DTM em relação ao grupo sem DTM para todos os movimentos, extensão 7,11±1,23kg e 7,87±1,2kg e flexão 5,08±0,41 e 6,05±0,72 respectivamente com diferença significativa para a força de flexão (p=0,04). Conclusão: Indivíduos com DTM apresentam menor força muscular dos músculos da coluna cervical em comparação com indivíduos que não apresentam a mesma condição, sendo que essa diferença se apresenta de forma significativa para a força de flexão.
Palavras-chave: (Disfunção Temporomandibular, contração isométrica, força flexores, extensores
Epidemiological study of migraine in the state of São Paulo between 2019-2023 and the interference of oral contraceptives
Get PDFIntroduction: Migraine, a chronic neurovascular disease, manifests as a primary headache disorder with varying degrees of severity. Duringmenstruation, a rapid decrease in estrogen levels often triggers migraineattacks without aura, affecting approximately 50-60% of women. Conversely, high estrogen levels can lead to migraine attacks with aura. Women with a history of migraine with aura are advised not to use combined oral contraceptives (COCs) due to the increased risk of stroke and thromboembolicevents. Additionally, those who develop migraines while on medication are recommended to discontinue its use. Objectives: This study aims to analyzethe epidemiological patterns of migraine-related hospitalizations in the state ofSão Paulo and investigate the influence of oral contraceptives in patients with a prior history of migraine. Methodology: Conducted as an ecological, retrospective, and descriptive study from DATASUS regarding the epidemiologyof migraine in the state of São Paulo from 2019 to 2023, focusing on variablessuch as hospitalizations, age groups, race/ethnicity, and year of treatment. Articles from the past 10 years in english and portuguese were selected, and a comprehensive literature review on the interference of oral contraceptive use was conducted using the databases PubMed, Scielo, and Electronic JournalCollection Health. Results: There were a total of 9,316 hospitalizations due tomigraine in the state of São Paulo between 2019-2023, with a total of 2,101 in 2023, and the lowest rate in 2021, with 1,517 hospitalizations. There was a predominance of females and white individuals, corresponding to 68.9% (N=6,424) and 58.7% (N=5,476) of cases, respectively. Additionally, researchfound that around 70% of women in Brazil use some form of contraceptivemethod, with 23% corresponding to COCs and female sterilization. Conclusion: The epidemiological profile highlighted a higher prevalenceamong women and white individuals. The use of combined oral contraceptivesemerged as a contributing factor to the occurrence of migraines in women, attributed to estrogen-induced vasoconstriction triggering migraine attacks. Consequently, women with this medical history face a risk of stroke, necessitating careful consideration of contraceptive options
Epigenetic modulators of migraine: lncRNAs as possible new therapeutic targets
Get PDFLong non-coding RNAs (lncRNA) are major epigenetic regulators of genome expression. They interfere in the development of multiple pathologies, including migraine, which affects 14% of the world\u27s population. This systematic review started in June 2024, following the PRISMA protocol with registration in PROSPERO (CRD42024559621) of the following questions: "Which lncRNAs are involved in the development of migraine? What is their role in the disease?" and using the descriptors "lncRNA" and "migraine" in EMBASE, Scopus, Web of Science and Pubmed. After removing duplicates with the Rayan QRCL platform, 38 out of 66 articles remained. After reading the titles, abstracts and full text, three articles were included. We found eight lncRNAs differentially expressed in migraine: PVT1, MEG3, LINC-ROR, SPRY4-IT1, ADINR, DICER1-AS1, NKILA, uc.48+. The first four act on neuropathic pain pathways in nervous tissue, while the next three interact with NF-κB (increased NF-κB activity probably induces migraine attacks). The last one up-regulates CGPR (a peptide involved in inflammatory pathways that act on migraine, probably through purinergic activation). Patients having migraine with aura present overexpression of PVT1, MEG3, LINC-ROR, and DICER1-AS1, whereas those having migraine without aura overexpress SPRY4-IT and ADINR. Furthermore, migraine patients without aura have lower DICER1-AS1 expression than controls. In addition, we identified eight articles in the Genome-wide Association Studies catalog, reporting associations between headache and genetic variants in 18 other lncRNAs. Among these, five were associated with migraine (LINC01752, ASTN2-AS1, LINC01985, ADAMTSL4-AS2 and UFL1-AS1), but none was mentioned in the articles of the systematic review. They are indeed poorly known, and their roles are best inferred by the neighboring genes whose transcription they probably regulate. The Astrotactin gene (ASTN2-AS1), presents variants associated with migraine in both European and Asian populations. UFM1-specific ligase 1, regulated by UFL1-AS1, is also associated with migraine both in transcriptomic and proteomic studies. In conclusion, we propose a set of lncRNAs that are possibly involved in regulating the production of migraine-associated genes, as potential targets for therapeutic intervention, also suggesting their inclusion in new experimental designs to elucidate their possible pathophysiological mechanisms in migraine
Status migrainosus: an underrecognized and undertreated condition in the emergency department
Get PDFStatus Migrainosus: An Underrecognized and Undertreated Condition in the Emergency Department
INTRODUCTION: Status migrainosus is a severe, debilitating condition that, if left untreated, can lead to serious complications such as ischemic stroke, dehydration, and electrolyte imbalances. This condition\u27s inflammatory nature can progress to vasculitis of small and medium cerebral vessels, causing ischemic stroke. OBJECTIVE: To describe the importance of recognizing status migrainosus for prompt and appropriate treatment to alleviate pain and prevent further complications. CASE REPORT: A 45-year-old female industrial worker from Campina Grande with a history of migraine since the age of 12 presented to the emergency department for the fourth time in seven days. She experienced severe, continuous, pulsatile hemicranial headache associated with intense nausea, vomiting, phonophobia, and photophobia. Intravenous analgesics, anti-inflammatory drugs, oral triptans, and opioids were prescribed during each visit, but her symptoms persisted, consistent with a migraine. Physical examination revealed poor general condition, dehydration, hypoactivity, intense photophobia, and multiple episodes of uncontrollable vomiting. Neurological examination, cranial CT scan, and cerebrospinal fluid analysis were normal. A diagnosis of status migrainosus was made, prompting urgent investigation and treatment. The patient received intravenous hydration, antiemetics, electrolyte replacement, a high-dose corticosteroid, an antipsychotic, simple analgesics, and a triptan. She showed significant improvement within 36 hours, and scheduled for re-evaluation in 15 days. CONCLUSION: Status migrainosus represents a severe and debilitating form of migraine that requires immediate medical attention. Recognizing this condition is crucial to ensure patients receive timely and appropriate treatment, preventing complications and improving their quality of life
Decadal epidemiological profile of hospital admissions for migraines and headaches in Paraná
Get PDFIntroduction: Understanding the epidemiology of a prevalent and disabling disease is essential for shaping healthcare policies and service organizations, identifying associated factors, and assessing the health impacts on the population. Therefore, understanding the epidemiology of headaches in Paraná is crucial for developing strategies and public policies for clinical management and prevention of these conditions. Objectives: To outline the epidemiological profile of hospital admissions for migraines and other headache disorders in Paraná from 2014 to 2023.Methodology: This retrospective and analytical study utilized data from the Brazilian Unified Health System\u27s Hospital Information System concerning hospitalizations due to migraines and other headache disorders in Paraná from 2014 to 2023, having no difference between diagnostic categories of painful syndromes. The study included individuals of both genders, aged 15 to 79 years. Results: 13,287 hospitalizations were reported during the study period. Of these, 12,305 (92.6%) were urgent admissions and 982 (7.39%) were elective, with an average length of stay of 2.6 days, totaling R$7,222,753.27 in healthcare costs. Regarding the demographic profile of hospitalized patients, 8,319 (62.61%) were female and 4,968 (37.38%) were male. Among female patients, 574 (6.9%) were aged 15 to 19 years, 1,556 (18.7%) were aged 20 to 29 years, 1,497 (18%) were aged 30 to 39 years, 1,705 (20.5%) were aged 40 to 49 years, 1,443 (17.35%) were aged 50 to 59 years, 1,022 (12.3%) were aged 60 to 69 years, and 522 (6.3%) were aged 70 to 79 years. For male patients, 265 (5.3%) were aged 15 to 19 years, 741 (14.9%) were aged 20 to 29 years, 844 (17%) were aged 30 to 39 years, 935 (18.8%) were aged 40 to 49 years, 950 (19%) were aged 50 to 59 years, 826 (16.6%) were aged 60 to 69 years, and 407 (8.2%) were aged 70 to 79 years. Conclusion: This study provides a comprehensive overview of hospitalizations due to migraines and headaches in Paraná, highlighting the gender and age distribution of affected individuals over a nine-year period. These findings are crucial for developing targeted healthcare interventions and policies aimed at improving clinical management and prevention strategies for these conditions