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O calibre e o desenho da agulha estão associados ao risco de cefaléia pós-punção dural após punção lombar diagnóstica
No full textIntroduction
Post-dural puncture headache (PDPH) is defined as an orthostatic headache that develops within the first few days after performing a spinal tap and it is related to extravasation of cerebrospinal fluid (CSF) into the epidural space, resulting in CSF hypovolemia and hypotension. The risk factors for PDPH are not yet fully understood.
Objective
To evaluate the risk of spontaneously reported PDPH according to the size and type of spinal tap needle.
Methods
A total of 4589 patients undergoing outpatient lumbar puncture (LP) were included. All CSF collections were performed at Senne Liquor Diagnostico, a laboratory specialized in CSF collection and analysis. Patients were instructed to report by telephone if they had orthostatic headache during the first 7 days after LP to the medical team of the laboratory. Patients with previous headache were instructed to report any change in the headache pattern during the same period. Needle gauge was classified into two groups: 1) 25G or less and 2) greater than 25G. Two types of needles were used and compared: 1) Pencil point and 2) Quincke. Comparisons of the percentages of spontaneous reports of PDPH were made using the chi-square test.
Results
141 patients (3.07%) reported PDPH to the laboratory\u27s medical team. Needles of 25G gauge or less were used in 31.8% of cases. The percentage of patients reporting PHD in the group of 25G or less needles was 1.9% versus 3.6% in the group of larger than 25G needles (P=0.003). Pencil point needles were used in 10.6% of cases. The percentage of PHD among pencil point group was 1.4% versus 3.2% in Quincke group (P=0.026).
Conclusion
25G or finer gauge needles as well as pencil point type needles significantly reduced the risk of spontaneously reported PHD.Introdução
A cefaléia pós-punção dural (CPPD) é definida como uma cefaléia ortostática que se desenvolve nos primeiros dias após a realização de uma punção lombar e está relacionada ao extravasamento de líquido cefalorraquidiano (LCR) para o espaço epidural, resultando em hipovolemia e hipotensão liquórica. Os fatores de risco para CPPD ainda não são totalmente compreendidos.
Objetivo
Avaliar o risco de CPPD relatada espontaneamente de acordo com o tamanho e tipo de agulha de punção lombar.
Métodos
Um total de 4.589 pacientes submetidos à punção lombar (LP) ambulatorial foram incluídos. Todas as coletas de líquor foram realizadas no Senne Liquor Diagnostico, laboratório especializado em coleta e análise de líquor. Os pacientes foram instruídos a relatar por telefone se tiveram cefaléia ortostática durante os primeiros 7 dias após a LP à equipe médica do laboratório. Os pacientes com cefaléia prévia foram instruídos a relatar qualquer alteração no padrão da cefaléia durante o mesmo período. O calibre da agulha foi classificado em dois grupos: 1) 25G ou menos e 2) maior que 25G. Foram utilizados e comparados dois tipos de agulhas: 1) ponta de lápis e 2) Quincke. As comparações das porcentagens de relatos espontâneos de CPPD foram feitas por meio do teste qui-quadrado.
Resultados
141 pacientes (3,07%) relataram CPPD à equipe médica do laboratório. Agulhas de calibre 25G ou menos foram utilizadas em 31,8% dos casos. A porcentagem de pacientes relatando PHD no grupo de agulhas 25G ou menos foi de 1,9% versus 3,6% no grupo de agulhas maiores que 25G (P = 0,003). Agulha ponta de lápis foi utilizada em 10,6% dos casos. A porcentagem de PHD entre o grupo de ponta de lápis foi de 1,4% versus 3,2% no grupo de Quincke (P = 0,026).
Conclusão
Agulhas de calibre 25G ou mais finas, bem como agulhas do tipo ponta de lápis, reduziram significativamente o risco de PHD relatada espontaneamente
The Prevalence of migraine and associated factors among medical students in Ouagadougou (Burkina Faso)
No full textObjective:
To determine the prevalence, clinical characteristics and impact of migraine among medical students in the city of Ouagadougou.
Methods:
This across-sectional study was carried out during a period of 6 months from August 2021 to January 2022. Participants were selected by stratified random sampling according to academic level. Hetero-administered questionnaire was administred to each student. Migraine was diagnosed according to the ICHD 3rd edition criteria and the MIDAS was used to assess the impact of migraine on students\u27 quality of life.
Results:
Two hundred and twenty seven students were selected for this study. The prevalence of migraineurs was 31.8%. Their mean age was 22.20±2.67 years. There was female predominance among the migraineurs (73.9%). More than half of the migraineurs had a family history of headache disorders (53.6%). Migraine without aura was the most frequent subtype (59.4%). Visual aura was predominant (78.2%). Migraine was of moderate intensity in 60.8% of cases. Insomnia and/or lack of sleep was the most common trigger (73.7%) followed by stress and fatigue in 71% of cases. Migraine caused severe disability in 15.9% of migraineurs.
Conclusion:
There was a high prevalence of migraine among medical students in Burkina Faso. Stress and irregular sleep were the most common triggers factors.
Key words: prevalence, impact, migraine, medical student, Burkina Faso
 
B2 or Not B2: A Systematic Literature Review on Migraine Headaches and Riboflavin Deficiency
Get PDFObjectiveTo assess the prevalence of riboflavin deficiency in patients with migraines or headaches.MethodsSystematic review of the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.ResultsTwo articles met the inclusion and exclusion criteria, and neither of these discussed riboflavin deficiency prevalence in those patients who suffer from migraines.ConclusionThe prevalence of riboflavin deficiency in migraineurs and in headache patients is unknown
State-of-the-art in the acute and preventive treatment of migraine from children to adults - a Special Collection
Get PDFPain is a companion of human beings and is part of a system of protection and alarm of possible failures or risks to the organism\u27s normal functioning. In some situations, there is a failure in this system, and pain arises inappropriately, causing great suffering. This occurs in cases of primary headaches, particularly when we consider migraine.
In this Special Collection of articles directed to address the treatment of migraineurs from childhood to adult life, we will address different aspects of preventive and abortive treatment when dealing with an individual who suffers from migraine; particularly worrying is dealing with patients with chronic migraine, medication-overuse headache, or the association of these two conditions.Pain is a companion of human beings and is part of a system of protection and alarm of possible failures or risks to the organism\u27s normal functioning. In some situations, there is a failure in this system, and pain arises inappropriately, causing great suffering. This occurs in cases of primary headaches, particularly when we consider migraine.
In this Special Collection of articles directed to address the treatment of migraineurs from childhood to adult life, we will address different aspects of preventive and abortive treatment when dealing with an individual who suffers from migraine; particularly worrying is dealing with patients with chronic migraine, medication-overuse headache, or the association of these two conditions
Migraine Preventive Treatment Failure: A Cross-Sectional Study in a Tertiary Center in Brazil
Get PDFBackgroundIn Brazil, there is a scarcity of evidence on migraine burden in patients who have experienced previous preventive treatment failure (PPTF). ObjectiveTo evaluate the associations between ≥ 3 PPTF and clinical, psychiatric, and medical history data.MethodsIn a retrospective, cross-sectional study, the medical records of migraine patients who first visited a tertiary specialized clinic were examined. We selected adults of both sexes aged ≥ 18 who attended their first appointment between March and July 2017. Ordinal logistic regression models estimated the associations between number of PPTF (no previous treatment, 1 PPTF, 2, and ≥ 3 PPTF) and chronic migraine, the number of diagnosis exams performed, abortive drugs classes used, and non-pharmacological treatments tried (all categorized as none, 1- 3, and ≥ 4), and severe depression (PHQ-9 ≥ 15) and anxiety (GAD-7 ≥ 15), adjusted for sex, age, and years with disease.ResultsData from 440 patients (72.1 % female) with a mean (SD) age of 37.3 (13.0) years were analyzed. The frequency of no previous treatment was 37.7 % (166/440), while 31.8 % (140/440) showed ≥ 3 PPTF. In patients with ≥ 3 PPTF, 35.7 % (50/140) had episodic, and 64.3 % (90/140) had chronic migraine. Compared to no previous treatment, patients with ≥ 3 PPTF showed higher odds (95 % confidence interval) for chronic migraine [2.10 (1.47, 2.98)], ≥ 4 diagnosis exams [6.59 (3.38, 12.84)], ≥ 4 abortive drug classes [16.03 (9.53, 26.94)], ≥ 4 non-pharmacological treatments [5.91 (3.07,11.35)], and severe depression [1.75 (1.07, 2.88)] and anxiety [1.73 (1.05, 2.85)]. ConclusionPatients first visiting a headache specialist had a high frequency of non-response treatment associated with higher migraine burden in terms of chronification, psychiatric comorbidity, acute medication and non-pharmacological treatment inefficacy, and unnecessary exams.
Introdução: No Brasil, há escassez de evidências sobre o impacto da migrânea em pacientes que experimentaram falha em tratamento preventivo prévio (FTPP). Objetivo: Avaliar as associações entre ≥ 3 FTPP e dados clínicos, psiquiátricos e histórico médico. Métodos: Em um estudo retrospectivo e seccional, os prontuários de pacientes pela primeira vez consultando um especialista em cefaleia foram examinados. Selecionamos adultos de ambos os sexos com idade ≥ 18 anos que fizeram consulta entre Março e Julho de 2017. Modelos de regressão logística ordinal estimaram as associações entre o número de FTPP (nenhum tratamento anterior, 1 FTPP, 2 e ≥ 3 FTPP) e migrânea crônica, o número de exames diagnósticos realizados, classes de medicamentos abortivos utilizados e tratamentos não farmacológicos tentados (todos categorizados como nenhum, 1-3 e ≥ 4), e depressão grave (PHQ-9 ≥ 15) e ansiedade (GAD-7 ≥ 15), ajustados por sexo, idade e anos com a doença. Resultados: Dados de 440 pacientes (72,1% do sexo feminino) com uma média (DP) de idade de 37,3 (13,0) anos foram analisados. A frequência de nenhum tratamento anterior foi de 37,7% (166/440), enquanto 31,8% (140/440) apresentaram ≥ 3 FTPP. Entre esses, 35,7% (50/140) tinham migrânea episódica, e 64,3% (90/140) tinham migrânea crônica. Comparados ao grupo sem tratamento anterior, os pacientes com ≥ 3 FTPP mostraram maior probabilidade (intervalo de confiança de 95%) de migrânea crônica [2,10 (1,47, 2,98)], ≥4 exames diagnósticos [6,59 (3,38, 12,84)], ≥4 classes de medicamentos abortivos [16,03 (9,53, 26,94)], ≥4 tratamentos não farmacológicos [5,91 (3,07, 11,35)], e depressão grave [1,75 (1,07, 2,88)] e ansiedade grave [1,73 (1,05, 2,85)]. Conclusão: Pacientes que consultaram pela primeira vez um especialista tiveram uma alta frequência de não resposta ao tratamento, associada a um elevado impacto em termos de cronificação, comorbidade psiquiátrica, ineficácia de medicamentos agudos e tratamento não farmacológico, e exames desnecessários
Headache in patients with Systemic Lupus Erythematosus: a case- control study
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Case Report - Secondary Headache Due to Idiopathic Intracranial Hypertension
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The Use of Botulinum Toxin in the Treatment of Headache: an Integrative Literature Review
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