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Bening paraxysmal torticollis is a sensoriomotos trigeminocervical convergence merchanisms? Experimental evidence.
No full textIntroduction
Benign paroxysmal torticollis (BPT) is likely an age-sensitive, childhood periodic syndromes that are commonly precursors of migraine, with atypical postural behavior (torticollis) to start early and self-limited, which of unknown etiology.
Objective
To prove the existence of forms of sensorimotor convergence between the trigeminal nerve and upper cervical roots respectively.
Methods
Ninety-five rats Norvegicus were submitted to infraorbital nerve blockade using botulinum neurotoxin type A (BoNT/A) (n=48) controlled by isotonic saline solution animals (ISS) (n=47). After 84 days the animals were evaluated on their motor functions using open field test and postural behavior.
Results
Of the 48 animals in the BoNT/A group one animal showed the torticollis ipsilateral to BoNT/A injection. The macroscopic analysis showed fasciculations on clavotrapezius muscle. The biopsy with optical and electronic microscopy of this muscle showed changes suggestive of denervation secondary to BoNT/A.
Conclusion
We suggested the existence of a pathway sensoriomotor probably in the brainstem involves the trigeminal system and cervical motoneurons.Introduction
Benign paroxysmal torticollis (BPT) is likely an age-sensitive, childhood periodic syndromes that are commonly precursors of migraine, with atypical postural behavior (torticollis) to start early and self-limited, which of unknown etiology.
Objective
To prove the existence of forms of sensorimotor convergence between the trigeminal nerve and upper cervical roots respectively.
Methods
Ninety-five rats Norvegicus were submitted to infraorbital nerve blockade using botulinum neurotoxin type A (BoNT/A) (n=48) controlled by isotonic saline solution animals (ISS) (n=47). After 84 days the animals were evaluated on their motor functions using open field test and postural behavior.
Results
Of the 48 animals in the BoNT/A group one animal showed the torticollis ipsilateral to BoNT/A injection. The macroscopic analysis showed fasciculations on clavotrapezius muscle. The biopsy with optical and electronic microscopy of this muscle showed changes suggestive of denervation secondary to BoNT/A.
Conclusion
We suggested the existence of a pathway sensoriomotor probably in the brainstem involves the trigeminal system and cervical motoneurons.
Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) responsive to intranasal lidocaine and nerve blockage: a case report
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Background: Trigeminal autonomic cephalalgias comprehend a myriad of headaches with different symptoms, with comprehend short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) or with conjunctival injection and tearing (SUNCT). Current treatment options are limited, and they are based mostly on case reports and small studies. Case Report: We report here the case of a 75 years old man suffering from acutetrigeminal autonomic headache with a satisfying response to intranasal lidocaine and nerve blockage. Conclusion: Intranasal lidocaine and nerve blockage may represent a useful and costeffective treatment for patients with SUNCT/SUNA
Headache and neuroimaging findings in conditions of cerebrospinal fluid (CSF) circulation disorders: in hydrocephalus, pseudotumor cerebri, and CSF hypotension syndrome
Get PDFThe authors wish in this narrative minireview show and comment on some neuroimaging findings encountered in patients with conditions of cerebrospinal fluid circulation disorders, such as in the hydrocephalus, pseudotumor cerebri, and CSF hypotension syndrome. The MRI of a young woman with a clinical diagnosis of post-dural puncture headache, performed on the fourth postpartum day after cesarean delivery, evolving with headache and diplopia, is shown. Non-contrast-enhanced sagittal T1 magnetic resonance imaging shows that the cerebellar tonsils are at the level of the foramen magnum, therefore still within normal limits, but, despite that, the opening of the cerebral aqueduct in the third ventricle is below the imaginary line connecting the anterior clinoid to the vein of Galen, therefore considered abnormally lower than the expected anatomical position. The axial T1-weighted images with post-contrast fat suppression also show impregnation and thickening of the dura mater. There is also mild engorgement of the cerebral venous sinuses, best demonstrated on T1 with post-contrast fat suppression, which is also identified on post-contrast magnetic resonance angiography, with no signs of venous thrombosis. We conclude that the diagnosis of a patient with intracranial hypotension syndrome can be suspected or confirmed with typical neuroimaging findings.The authors wish in this narrative minireview show and comment on some neuroimaging findings encountered in patients with conditions of cerebrospinal fluid circulation disorders, such as in the hydrocephalus, pseudotumor cerebri, and CSF hypotension syndrome. The MRI of a young woman with a clinical diagnosis of post-dural puncture headache, performed on the fourth postpartum day after cesarean delivery, evolving with headache and diplopia, is shown. Non-contrast-enhanced sagittal T1 magnetic resonance imaging shows that the cerebellar tonsils are at the level of the foramen magnum, therefore still within normal limits, but, despite that, the opening of the cerebral aqueduct in the third ventricle is below the imaginary line connecting the anterior clinoid to the vein of Galen, therefore considered abnormally lower than the expected anatomical position. The axial T1-weighted images with post-contrast fat suppression also show impregnation and thickening of the dura mater. There is also mild engorgement of the cerebral venous sinuses, best demonstrated on T1 with post-contrast fat suppression, which is also identified on post-contrast magnetic resonance angiography, with no signs of venous thrombosis. We conclude that the diagnosis of a patient with intracranial hypotension syndrome can be suspected or confirmed with typical neuroimaging findings
Differences in the electrical activity and the clinical performance of superficial neck flexors and extensors during the CCFT in women with migraine
Get PDFIntroductionMusculoskeletal disorders in the cervical spine have been increasingly investigated and observed in patients with migraine. One of them is a poorer cervical muscle performance as assessed by the cranio-cervical flexion test (CCFT). In addition, patients with migraine have alterations in the recruitment of muscle motor units observed by surface electromyography during CCFT.
ObjectiveThe aim was to verify if there are differences in the electrical activity and the clinical performance of superficial neck flexors and extensors during the CCFT in women with migraine considering the presence or absence of concomitant neck pain symptoms.
MethodsA total of 100 women were assessed: 25 with migraine without neck pain, 25 with migraine and neck pain, 25 with mechanical neck pain and 25 pain-free control. Clinical and demographic data were collected, The CCFT was performed in all groups. The test assessed the deep flexors muscle by a pressure unit biofeedback placed in the posterior region of the neck and initially inflated to 20 mmHg composed by 5 stages, with increase pressure by 2 mmHg at each stage, reaching 30 mmHg, keeping the pressure for 10 seconds without resorting to compensation. Electromyography data were collected with TrignoTM Wireless System wireless surface sensors. The sensors were firmly attached bilaterally on: sternocleidomastoid (SCM); splenius capitis, anterior scalene and upper trapezius. Electromyographic activity evaluated during the CCFT was normalized by the average the root mean square (RMS) calculated for the reference voluntary contraction and expressed as a percentage. Groups comparisons were performed with non-parametric tests adopting a level of significance of 0.05. To analyze the between-groups differences on the proportion of clinical targeted performance stages reached by each participant within the CCFT, the chi-square (X2) test was calculated, and the data were submitted to a post-hoc proportion test. (To see the complete abstract, please, check out the PDF).
How does pain influence cervical endurance test performance in migraine patients?
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Migraine sufferers frequently complain of cervical pain during and in-between migraine attacks and studies suggest that chronic neck pain is a risk factor for high-frequency migraine, including chronic migraine. Increased headache frequency and chronic neck pain are, in turn, independently associated with cephalic cutaneous allodynia, a known risk factor for increased headache frequency.
Objective
To verify the influence that pain in migraine patients has on muscle performace during the cervical endurance test and whether the change in performance is due to pain during the test, neck muscle dysfunction or both.
Methods
Were evaluate 100 women stratified by diagnosis (migraine, cervical pain, both and none) and self-reported pain during the cervical muscle endurance test in flexion and extension (with or without headache and / or cervical pain during the endurance test). Pain during the test by numerical rate scale (NPRS, 0-10) and pain pressure threshold were collected for all groups. Migraine patients answered 12-item Allodynia Symptom. We used one-way analysis of variance with the Tukey’s HSD post hoc test analysis to contrast pressure pain threshold and endurance across groups. Differences in flexion and extension times were compared using the Welch T-test and the McNemar Test was used to compare differences in headache and neck pain incidence per study group during flexion and extension endurance tests.
Results
There are significantly differences in mean endurance during flexion between migraine and neck pain [34.4s (25)] relative to neck pain alone [45.2 (18)], migraine [40.2s (29)] and controls [57.5.4s (40)] (p = 0.04). On average, those who experienced headache during the flexion test sustained for significantly less time than those without headache during the test (27.80 versus 46.18 seconds, p<0.01); (To see the complete abstract, please, check out the PDF).
Assessing the influence of migraine on stroke ischemic penumbra
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Introduction
There is controversy as to whether migraine affects the behavior of ischemic penumbra during the acute phase of an ischemic stroke, thereby accelerating the formation of cerebral infarction.
Objectives
To assess whether migraine modifies the existence and volume of the divergence between the areas of diffusion and perfusion in the stroke (the penumbra).
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, the presence and characteristics of headaches related to ischemic stroke 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.
Results: A total of 221 patients were included, 59.3% of whom were male, and a mean age of 68.2 ± 13.8 years. Ischemic penumbra analysis was performed in 118 patients. There was no association between migraine and the absence of ischemic penumbra (OR: 1.22; CI95%: 0.52 – 2.87; p=0.649; Chi-Square Test). There was no difference in the volume of ischemic penumbra between those with and without migraine. There was no difference in stroke volume between those with and without migraine (1.0; 0.38 – 7.9 cm3...
(To see the complet abstract, please, check out the PDF.
Trends in physiopathology research of primary headaches over the last 50 years
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The headache field, mainly migraine, is passing through a transformative era of new treatments. These breakthroughs would not be possible without the evolving knowledge on mechanisms of headaches. However, there are still unmet needs for headaches\u27 understanding and treatments.
Objectives
Assess whether there is a trend in the number of publications regarding physiopathology of each primary headache disorders (PHD) in the past 50 years. Secondarily, we aimed to evaluate how the SARS-CoV-2 pandemics impacted on physiopathology research of PHD.
Methods
PHD were divided hierarchically in first- and second-digit, according to ICHD-3 criteria. PubMed database was searched using both the name of the PHD and MeSH terms related to physiopathology. Each search yielded the number of publications for a determined PHD along the period selected (1971-2021). Data were retrieved and separated in two groups: a) per decades (1971-2020); and b) per year (2011-2021). Ratios between every two timepoints in each group were calculated, as well as a total ratio for the whole interval.
Results
Either divided per decades, or divided annually for the last 10 years, migraine had the highest absolute number of pathophysiology publications, significantly above the other PHD.
Divided per decades, with exception of tension-type headache (TTH), all the other PHD groups have increased their number of publications over time. Meanwhile, TTH in the last decade decreased the total number of mechanisms research.
The number of papers published in 2020 was lower than in 2019 for TTH, trigeminal autonomic cephalalgias (TACs) and group 4 "other PHD" (4.OPHD), migraine kept practically the same number.
Conclusion
There is a clear disparity in the number of publications on mechanisms of each PHD, being migraine well above TTH, TACs and 4.OPHD.
As expected, the recent COVID pandemics has clearly impaired pathophysiologic research in the headache field.
Keywords: Headache, Migraine, Mechanisms, Physiopathology, Research
Dor facial e corpalgia em pacientes com migrânea (Resumo)
Get PDFAbstract: Thesis (Doctorate in Neurosciences). Postgraduation in Neuropsychiatry and Behavioral Sciences. Federal University of Pernambuco, Recife, Brazil. 2013. 120 f. Supervisor: Prof. Dr. Marcelo Moraes Valença.Dor facial e corpalgia em pacientes com migrânea (Resumo
Mnemonic method in Portuguese for headaches in emergency room
Get PDFBackground
It is of crucial importance to quickly stratify the risk of patients with headaches in the emergency setting, and mnemonics can be used to remember the alarm criteria in those cases. Such mnemonics were written in English and Spanish, but none in Portuguese.
Objective
To present the first mnemonic method in Portuguese for alarm criteria in emergency headaches in order to facilitate their identification and diagnosis.
Methods
A search was made through different databases for a mnemonic method regarding alarm criteria in emergency headaches that was written in Portuguese. None were found. Thus, the emergency criteria were gathered and turned into a mnemonic in Portuguese.
Results
We present the mnemonic method “RISADA PEGA”.
Conclusion
We believe this tool can be very useful in teaching and clinical settings
Vascular headache an traumatic brain injury
No full textIn a medical emergency, the most urgent patients at significant risk of death are those witha cerebrovascular accident and those with traumatic brain injury. Many are admitted withdiminished conscience status (coma) and focal neurological deficits. In the evaluation ofthese patients, neuroimaging is indispensable in order to identify the type of lesion andthe location of the brain where it is located.In the case of stroke, we can subdivide it into hemorrhagic and ischemic. Among hemorrhagic hemorrhages, we can mention (1) spontaneous intracerebral hematomasand (2) hemorrhages due to rupture of an intracranial aneurysm, with subarachnoidhemorrhage leading.Patients with head trauma are critical; even those who arrive at the hospital alert andoriented can decrease their level of consciousness in a few hours due to an intracranialhematoma, edema, or cerebral contusion.Thus, the availability of performing neuroimaging evaluations, using computed tomography and magnetic resonance imaging, or even digital angiography, is vital for continuoussupervision of this type of patient. The exams often require repetition several times due tothe rate of evolution of vascular lesions and after head trauma.A warning sign in these types of patients is headache. In the intracranial aneurysmal rupture, we classically have the thunderclap headache, an explosive, sudden pain mentionedas the worst pain the individual has suffered in his or her life. The pericranium and someintracranial structures are sensitive to nociceptive stimuli, such as the dura mater, largearteries, and venous sinuses. The brain is relatively insensitive to painful stimuli.This narrative review aims to inform the importance of neuroimaging assessment of patients with stroke and traumatic brain injury in an emergency department. In conclusion,a neuroimaging evaluation is paramount in addition to a neurological and physicalexamination of the critically ill patient with cerebrovascular disease or who has suffereda traumatic brain injuryIn a medical emergency, the most urgent patients at significant risk of death are those witha cerebrovascular accident and those with traumatic brain injury. Many are admitted withdiminished conscience status (coma) and focal neurological deficits. In the evaluation ofthese patients, neuroimaging is indispensable in order to identify the type of lesion andthe location of the brain where it is located.In the case of stroke, we can subdivide it into hemorrhagic and ischemic. Among hemorrhagic hemorrhages, we can mention (1) spontaneous intracerebral hematomasand (2) hemorrhages due to rupture of an intracranial aneurysm, with subarachnoidhemorrhage leading.Patients with head trauma are critical; even those who arrive at the hospital alert andoriented can decrease their level of consciousness in a few hours due to an intracranialhematoma, edema, or cerebral contusion.Thus, the availability of performing neuroimaging evaluations, using computed tomography and magnetic resonance imaging, or even digital angiography, is vital for continuoussupervision of this type of patient. The exams often require repetition several times due tothe rate of evolution of vascular lesions and after head trauma.A warning sign in these types of patients is headache. In the intracranial aneurysmal rupture, we classically have the thunderclap headache, an explosive, sudden pain mentionedas the worst pain the individual has suffered in his or her life. The pericranium and someintracranial structures are sensitive to nociceptive stimuli, such as the dura mater, largearteries, and venous sinuses. The brain is relatively insensitive to painful stimuli.This narrative review aims to inform the importance of neuroimaging assessment of patients with stroke and traumatic brain injury in an emergency department. In conclusion,a neuroimaging evaluation is paramount in addition to a neurological and physicalexamination of the critically ill patient with cerebrovascular disease or who has suffereda traumatic brain injur