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Impactos Do Protocolo PREEMPT Na Migrânea Crônica: Uma Revisão Integrativa
No full textChronic migraine is an important cause of functional disability and quality of life deficits, affecting 12% of the world population. Therefore, more treatment alternatives that promote better pain control are needed. So, botulinum toxin type A presents itself as a therapeutic option for this purpose. This integrative review aimed to analyze the functionality of the PREEMPT protocol applied for the treatment of chronic migraine, analyzing the time of pain control, the frequency of repetition of the treatment and the possible subtypes of pain that benefit most from botulinum toxin. Data were collected from the National Library of Medicine and Lilacs databases, and the research concluded in July 2022. 31 articles were found, of which only 22 publications were considered eligible to compose this study, and those that contemplated the research objectives were selected. above. Botulinum toxin type A presents an effective, safe and well-tolerated preventive profile for patients with chronic migraine, increasing the patient\u27s quality of life and works in pain control.A migrânea crônica é uma causa importante de incapacidade funcional e déficits de qualidade devida na atualidade, incidindo em 12% da população mundial. Para tanto, são necessárias maisalternativas de tratamento que promovam melhor controle da dor. Nesse cenário, a toxina botulínicatipo A se apresenta como uma opção terapêutica para esta finalidade. A presente revisão integrativaobjetivou analisar a funcionalidade do protocolo PREEMPT para o tratamento da enxaqueca crônicano que tange o tempo de controle da dor, a frequência de repetição do tratamento e os possíveissubtipos de dor que mais se beneficiam da toxina botulínica. Os dados foram coletados nas basesde dados National Library of Medicine e Lilacs e a pesquisa finalizada em julho de 2022. Foramencontrados 31 artigos, dos quais apenas 22 publicações foram consideradas elegíveis para comporo presente estudo, sendo selecionados os que contemplavam os objetivos da pesquisasupracitados. A toxina botulínica tipo A apresenta um perfil preventivo eficaz, seguro e bem toleradopara pacientes com enxaqueca crônica,incrementando a qualidade de vida do paciente e atuando nocontrole da dor
CEFALEIA CERVICOGÊNICA
No full textObjective: To contextualize cervicogenic headache describing its etiology, pathophysiology, clinical picture, diagnostic criteria and treatments, to guide medical society in the face of the pathology that is increasing in its incidence. Methods: The study carried out searches in the PubMed, Nature, Scielo and Wiley databases, using the descriptors cervicogenic headache, and works published between the years 1980 and 2022 were analyzed, in all languages, in addition to the respective English translations. As an inclusion factor, it was considered: "works published within the scope of the study within the mentioned time interval and related to cervicogenic headache and as an exclusion factor: "works not related to the study topic and with reports already outdated according to current literature”. Results: 1,319 articles were found, analyzing the articles, 27 articles were selected, and according to their relevance in the subject, they are part of the scope of the work. In relation to cervicogenic headache, it is possible to classify it as a secondary headache, attributed to cervical disorders, with heterogeneous symptomatology, usually presenting as a unilateral, non-throbbing and non-excruciating headache, which may be triggered by trigger points in the cervical region and may still be present themselves with autonomous prodomes. Its etiology and pathophysiology are directly linked to cervical disorders and irritation of C1-C2-C3 afferent fibers, in addition to the convergence to the cervical trigeminal nucleus, increasing the variability of symptoms. Its diagnosis is based on diagnostic criteria and there are a wide variety of treatments with limited effectiveness. Conclusion: Cervicogenic headache can present in heterogeneous forms, making its diagnosis difficult and being underdiagnosed and erroneously treated in up to 50% of cases, its increase as a result of the pandemic alerts to the improvement in the diagnosis and treatment of cervicogenic headache and associated musculoskeletal disorders.Objetivo: Contextualizar a cefaleia cervicogênica descrevendo sua etiologia, fisiopatologia, quadro clínico, critérios diagnósticos e tratamentos, para nortear a sociedade médica diante da patologia que está em crescente aumento de sua incidência. Métodos: O presente estudo realizou buscas nas bases de dados PubMed, Nature, Scielo e Wiley, utilizando os descritores cefaleia cervicogênica, e foram analisados trabalhos publicados entre os anos de 1980 e 2022, em todos os idiomas, além das respectivas traduções em inglês. Como fator de inclusão foi considerado: “trabalhos publicados dentro do escopo do estudo dentro do intervalo de tempo citado e relacionados a cefaleia cervicogênica e como fator de exclusão foi considerado: “trabalhos não relacionados ao tema de estudo e com relatos já ultrapassados de acordo com a literatura atual”. Resultados: Foram encontrados 1.319 artigos, após leitura e análise dos artigos foram selecionados 27 artigos, e de acordo com a relevância no assunto fazem parte do escopo do trabalho. Em relação a cefaleia cervicogênica é possível classifica-la como uma cefaleia secundária, atribuída a transtornos cervicais, com sintomatologia heterogênea, geralmente apresentando-se como uma cefaleia unilateral, não latenjante e não excruciante, podendo ser desencadeada por pontos gatilhos em região cervical podendo ainda se apresentar com pródomos autonômicos. Sua etiologia e fisiopatologia tem ligação direta com transtornos cervicais e irritação das fibras aferentes de C1-C2-C3, além da convergência para o núcleo trigêmeo-cervical aumentando a variabilidade de sintomas. Seu diagnóstico é baseado em critérios diagnósticos e existem uma grande variedade de tratamentos com eficácia limitada. Conclusão: A cefaleia cervicogênica pode se apresentar de formas heterogêneas dificultado seu diagnóstico e sendo subdiagnosticada e tratada erroneamente em até 50% dos casos, seu aumento em decorrência da pandemia alerta para a melhoria no diagnóstico e tratamento da cefaleia cervicogênica e os distúrbios osteomusculares associados.  
Enxaqueca de alta frequência refratária a tratamento farmacológico usual e anticorpo e responsiva a canabidiol de amplo espectro: relato de caso
No full textThe use of derivatives of Cannabis sp. in the treatment of certain medical conditions, such as neuropathic pain, epilepsy and multiple sclerosis, is well known. However, studies on its benefit in headache are low in scope, consisting, in majority, of reports and case series. We report the case of a 74-year-old male patient with high frequency migraine (2 to 3 times/week) for several years, presenting important functional limitation associated with several triggers, and using triptans for headache crisis only. The patient expressed intolerance to 2 prophylactic drugs (topiramate and propranolol). He performed 2 applications of Erenumab 70 mg, wich promoted considerable initial improvement followed by a new increase in attacks’ frequency after the second application, leading to interruption of this therapy. Nutraceuticals were tried for 6 months, but there was not any improvement. After the introduction of cannabidiol oil, migraine attacks reduced in frequency (1 episode/month) and intensity, with a record interval of 30 consecutive days without pain, associated with elimination of triggers. Preclinical studies evaluating the relationship between endocannabinoid system and migraine pathophysiology point to Cannabis sp. derivatives as potential weapons for the treatment of this condition. However, the role of these derivatives as prophylaxis of migraine attacks is still speculative, thus requiring controlled studies for further definition.O uso de derivados da Cannabis sp. no tratamento de certas condições médicas, como dor neuropática, epilepsia e esclerose múltipla já é bem conhecido. Porém, estudos sobre seu benefício em cefaleias ainda são de baixa abrangência, sendo constituídos, em sua maior parte, por relatos e séries de casos. Apresentamos o caso de paciente masculino de 74 anos, portador de enxaqueca de alta frequência (2 a 3 vezes/semana) há vários anos, com importante limitação funcional associada a diversos gatilhos, fazendo uso apenas de triptanos durante as crises. Apresentou intolerância a 2 medicamentos profiláticos (topiramato e propranolol). Realizou 2 aplicações de Erenumabe 70 mg, havendo considerável melhora inicial seguida de novo aumento na frequência das crises após a segunda aplicação, com interrupção do tratamento. Fez uso de nutracêuticos por 6 meses, sem grande melhora. Após introdução de óleo de canabidiol, as crises reduziram em frequência (1 episódio/mês) e intensidade, com intervalo recorde de 30 dias seguidos sem dor, associado a eliminação de gatilhos. Estudos pré-clínicos avaliando a relação entre o sistema endocanabinoide e a fisiopatologia da migrânea apontam para os derivados da Cannabis sp. como potenciais armas para o tratamento dessa condição. No entanto, o papel desses derivados como profilaxia das crises de enxaqueca ainda é especulativo, necessitando de estudos controlados para maior definição
The ambiguity and limit of caffeine in migraine: a literature review
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Migraine is a chronic disease that affects about 15% of world\u27s population. It is the most disabling disease among men and women under 50 years. Studies indicate that the caffeine, which is the most consumed stimulating in the world and present on the daily diet, can be related to the migraine in an ambiguous way.
ObjectiveConsidering the epidemiologic and economic point of view, the disease phisiopatology and the accessibility to caffeine, this study aims to understand if there would be a safe minimum dosage of caffeine for patients with migraine.
MethodsThe words "migraine" and "caffeine" were searched in July 2022 at PUBMED and BVS with predetermined filters and selection of publication in qualis journals A1 and A2. 13 articles were found for this revision.
ResultsCaffeine\u27s effects on the nervous system and its relation with headaches have been target of several studies, mainly for producing symptoms similars to the prodromic phase of migraine e for the existence of the Caffeine Abstinence Syndrome, known as a diagnostic entity by the International Migraine Classification. The sensory hypersensitivity (migraine\u27s characteristic) does not appear at the abstinence syndrome. The lack of information about pre-existing headache at studies shows a gap in the parameter \u27\u27caffeine withdrawal as a trigger per se\u27\u27. It is possible that premonitory symptoms such as yawns, low energy and sleepiness can lead to caffeine intake, bringing forth the wrong idea that it has initiated the migraine.Caffeine, however, induces urinary magnesium loss, reducing its reabsorption. As magnesium affects neuromuscular conduction, nerve transmission and is beneficial in chronic pain conditions and migraines, caffeine, by decreasing magnesium level, can induce headache. Additionally, caffeine contains thiaminases, enzymes that degrade thiamine, which may have protective potential in migraine. (To see the complete abstract, please, check out the PDF).
Assessing the influence of migraine on the prognosis of ischemic stroke: a prospective cohort study
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Introduction
There is controversy as to whether migraine implies a poorer prognosis after the stroke.
Objectives
To assess whether migraine implies a poorer prognosis after the stroke.
Methods
This was a prospective cohort study carried out in a hospital in the city of Recife, Pernambuco, Brazil. We included consecutively hospitalized patients with ischemic stroke within 72 hours of symptom onset. A diagnosis of ischemic stroke was made by the presence of a diffusion restriction pattern on the MRI within a compatible clinical context. Patients were assessed by a neurologist who conducted an interview using a semi-structured questionnaire containing questions regarding sociodemographic data, the presence and characteristics of headaches in their lives and the related clinical condition to ischemic stroke. The headaches presented were classified according to the diagnostic criteria of the third edition of the International Classification of Headache Disorders. The National Institute of Health Stroke Scale and the modified Rankin scale were used. Patients underwent MRI of the brain with diffusion and with perfusion. Patients were assessed by telephone 3 months after the stroke to determine the prognosis.
Results
A total of 221 patients were included, 59.3% of whom were male, and a mean age of 68.2 ± 13.8 years. One hundred and seventy-eight patients (178/221; 81%) were assessed 3 months after the ischemic stroke. Migraine was not associated with the stroke prognosis (logistic regression).
Conclusion
Migraine is not associated with the prognosis of ischemic stroke.
Key-Words: Cerebrovascular Disease, Ischemic Stroke, Migraine, Stroke outcome
Persistent headache attributed to previous ischemic stroke: a prospective cohort study
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Headache is a frequent sign of stroke, occurring both in the acute phase and persisting for 3 months after the stroke. The most recent International Classification of Headache Disorders has included persistent headache attributed to past stroke. Diagnosis depends on the presence of headache in the acute phase of stroke, although the headache persists for more than 3 months after the cerebrovascular event.
Objectives
To assess the incidence, course and impact of persistent headache attributed to a past ischemic stroke. To identify risk factors for the development of persistent headache attributed to a past stroke.
Methods
This was a prospective, observational cohort study. Inpatients with stroke, admitted within 72 hours of the onset of symptoms, were assessed at the Real Hospital Português de Beneficência de Pernambuco. Diagnosis of ischemic stroke occurred through the presence of an area of restricted diffusion in the magnetic resonance examination within a compatible clinical context. A semi-structured questionnaire was applied to characterize the sociodemographic information, the cerebrovascular disease and the headaches according to the diagnostic criteria of the International Classification of Headache Disorders. The NIHSS Stroke Scale and the HIT-6 scale were also used. Patients were assessed in person by the researchers in the acute phase of stroke and by telephone after 1 year to assess persistent headache attributed to past stroke.
Results
Initially, 221 patients were included, most of them male (59.3%) and whose mean age was 68.2 years ± 13.8. One hundred and nineteen patients (53.9%) answered the questionnaire by telephone 1 year after the stroke. Persistent headache attributed to a past stroke presented a frequency of 10.1% in the sample (95%CI: 5.3 to 17.0%) 1 year after the stroke. Headache presented a median frequency of 2.5 (1 – 4) days...
(To see the complet abstract, please, check out the PDF.
Cephalalgia heterotopica: a case series of lower half face migraine
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Migraine is a common and very disabling neurological disease. It typically causes severe throbbing pain or a pulsing sensation, usually on one side of the head. It\u27s often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. According to the definition of headache, the pain should be located in the head or in the face above the orbitomeatal line. Beyond this classical view, recent evidence has shown that it could be an arbitrary boundary, and other clinical features can prevail during the diagnosis process.
Objective
This consecutive case series study aimed to report clinical features, treatment, and outcome of 5 patients with a lower-half facial presentation of migraine.
Materials and Methods
Case series of our Headache Clinic. Data disclosure was authorized by the patients through an informed consent form.
Results
Of the 5 patients, 3 were women and 2 were men. Mean age was 34, 6 (13-56 years). The mean age of symptoms onset was 15,2 (11-29 years).
All patients described a throbbing, moderate to severe pain in the malar area.
Four patients reported frequent phonophobia and photophobia accompanying pain attacks. One patient reported great relief of pain with rizatriptan and another with sumatriptan. Preventive treatment with pizotifen, propranolol, flunarizine, amitriptyline, divalproex sodium, and pregabalin was useful. All patients underwent extensive dental and otolaryngological evaluation and treatment, which were worthless.
Conclusion
Migraine orofacial presentation is a diagnostic challenge. Proper recognition of these cases not only prevents unnecessary examination and treatment trials but directly benefits the patients since effective treatment is already available.
A proper case definition of this rare clinical presentation may provide new insight into our understanding of the migraine mechanisms.
Keywords: Facial pain, Migraine, Lower half-face migraine.
Neurological sequelae in a patient with previous neurocysticercosis
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Teniasis and cysticercosis are caused by the platelminth Taenia solium, a parasite that has in its cycle the pig and man. Teniasis occurs with the ingestion of raw or undercooked contaminated pork containing cysticercus. On the other hand, human cysticercosis occurs through ingestion of T. solium eggs through fresh vegetables, raw meat or contaminated water, in the body, the larvae migrate and acquire the cystic form, usually in the host\u27s muscle tissue.Neurocysticercosis (NCC) develops when the invasion of the larvae occurs in the human central nervous system, found in the nervous tissue or in the intraventricular, subarachnoid, and spinal cord spaces, where there is circulation of CSF, leading to different clinical manifestations and prognosis.
Objective
To report the case of a patient with NCC with neurological complications at IIER.
Case description
Female, 37 years old, carrier of Diabetes Mellitus type 2 (DM2), migraine and structural epilepsy. She has a previous history of rheumatic fever in childhood and NCC since 2001, contracted when she lived in the interior of Bahia where she raised pigs and ate this meat, treated at IIER in May/2019. A headache associated with absence and vertigo crises began in October/2020 as consequences of NCC, reasons for which the patient was hospitalized and later referred to the neurology outpatient clinic, after CSF analysis without evident alterations.The patient was admitted to the IIER with a history of intermittent vertigo for 2 days and shooting headache in the right frontal region of the skull, in addition to the return of absence seizures until then extinct since the last hospitalization in October/2020, accompanied by the neurologist physician who increased valproic acid from 1.25g to 1.5g a day, also reported that this time, presents very significant worsening of vertigo.
(To see the complet abstract, please, check out the PDF.
Conhecimento do médico residente sobre diagnóstico e tratamento de pacientes com cefaleia
No full textIntroduction
Considering the high prevalence of headache, it is necessary a study about the effectiveness of the care of patients with headache by medical resident in Emergency Care Units (EDU) and medical outpatient clinics.
Objective
The objective of this study was to analyze the effectiveness of care in EDUs, outpatient clinics and medical wards and the management of patients with headache complaints.
Method
The study was observational descriptive (cross-sectional cohort) through the application of an online questionnaire answered by the medical residents.
Results
There were 115 residents who answered the survey. In the group of residents who see patients with headache (n=95) the number of visits was 4.87 per week. The resident\u27s idea is that headaches are symptoms of an underlying disease in 49.5% of them. On the question about feeling able to differentiate primary from secondary headaches, 50% of the residents said yes. On the question, "Is Migraine the same as Headache?" 6.1% answered yes. On the question, "Would you use morphine derivatives to treat headache?" 19.1% of the residents answered that they would. On the question about having knowledge about the harms of using morphine derivatives in headache, 60% answered that they did not have in-depth knowledge or that they have no knowledge. In this sample of residents, 74/115 (65%) suffer from headache. Only 36/115 (31%) of the residents sought care because of the headache. Of the residents, 3/115 (2.6%) have chronic daily headache. In the question about knowing what is "chronic daily headache" and from medication overuse, about 35% do not know or did not delve into the concept.
Conclusion
We conclude that there is a lack of teaching about types of headaches, criteria for diagnosis and treatment. Urgent modifications should be made in the medical course to enable newly graduated doctors to diagnose and treat patients with headache.Introdução
Considerando a alta prevalência de cefaleia, faz-se necessário um estudo sobre a efetividade do atendimento de pacientes com cefaleia por médicos residentes em Unidades de Pronto Atendimento (UPA) e ambulatórios médicos.
ObjetivoO objetivo deste estudo foi analisar a eficácia do atendimento em EDUs, ambulatórios e enfermarias e o manejo de pacientes com queixas de cefaléia.
MétodoO estudo foi observacional descritivo (coorte transversal) por meio da aplicação de um questionário online respondido pelos médicos residentes.
ResultadosForam 115 moradores que responderam a pesquisa. No grupo de residentes que atendem pacientes com cefaléia (n=95), o número de atendimentos foi de 4,87 por semana. A ideia do residente é que as dores de cabeça são sintomas de uma doença de base em 49,5% deles. Sobre a questão de se sentir capaz de diferenciar cefaleias primárias de secundárias, 50% dos residentes responderam que sim. Sobre a pergunta "Enxaqueca é o mesmo que dor de cabeça?" 6,1% responderam que sim. Sobre a pergunta "Você usaria derivados da morfina para tratar a dor de cabeça?" 19,1% dos moradores responderam que sim. Sobre a questão de ter conhecimento sobre os malefícios do uso de derivados da morfina na cefaleia, 60% responderam que não tinham conhecimento aprofundado ou que não tinham conhecimento. Nesta amostra de residentes, 74/115 (65%) sofrem de cefaleia. Apenas 36/115 (31%) dos residentes procuraram atendimento por causa da dor de cabeça. Dos residentes, 3/115 (2,6%) têm cefaléia crônica diária. Na questão sobre saber o que é “cefaléia crônica diária” e do uso excessivo de medicamentos, cerca de 35% não sabem ou não se aprofundaram no conceito.
ConclusãoConcluímos que falta ensino sobre os tipos de cefaléia, critérios para diagnóstico e tratamento. Modificações urgentes devem ser feitas no curso de medicina para capacitar médicos recém-formados a diagnosticar e tratar pacientes com cefaléia
Pulsed Radiofrequency for Post-Covid Occipital Neuralgia: An Effective Therapeutic Proposal - Case Report
Get PDFWith the SARS-CoV-2 pandemic and the increased number of cases reported in the literature of post-Covid syndromes, and clinical conditions of rheumatic and cardiovascular diseases, neurological disorders have also been reported, with the description of cases of reduced memory and cerebrovascular complications post-Covid-19 virus infection. Thus, in addition to these conditions, neuropathic pain secondary to cases of novel coronavirus infection have been seen in the literature and have raised questions about the pathophysiology arising from this situation, prognostic factors, and best indications for treatment. Among the neuropathic pain reported, occipital neuralgia is one of the complications faced, characterized by a burning and paroxysmal pain of variable duration. One of the possible treatments for this condition is the use of pulsed radiofrequency on the affected nerves in cases refractory to optimized clinical treatment, being an effective measure for reducing symptoms and improving quality of life