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Intra-rater reliability of pressure pain threshold using a digital algometer
Get PDFBackgroundPressure Pain Thresholds (PPT) has been the main sensory modality studied in headache disorders. It is usually repetitive, leading to potential variability between measurements. Since threshold estimation relies on the observer, patient, body site, and the device used, it is important to assess measurement reliability in the specific clinical and methodological scenario to be studied in order to minimize error.
ObjectiveThe aim of this study is to confirm intra-rater reliability of PPT in the head of adults using a digital algometer device.
MethodsPPT was measured with a digital algometer in 3 consecutive assessments conducted 10 min apart. Eight sites were measured in each time at the occipital, temporal and masseter regions bilaterally, frontal and vertex at midline. The reliability using intra-class variability (ICC) and covariance were calculated between times 1, 2, 3, and all times versus the mean. Scores above 0,75 were considered as having excellent reliability.
ResultsTen healthy volunteers aged (21-55) were studied. The sum of all sites measured in the head was 2182 (+-672) KPa for the first measure, 2085 (+- 626) KPa for the second, 2185 (+-685) for the third, and 2150 (+-685) KPa for the mean. All ICC coefficients calculated were 0,975 or higher in all areas.
ConclusionsWe concluded that one PPT measure in the head with a digital algometer is as reliable as 3 repetitive measures The intra-rater reliability for PPT is considered excellent. Future studies assessing pain vulnerability or predicting headache occurrence can be performed without a significant risk of bias.
Keywords: Pressure PainThreshold, Algometry, Reliability, Intra-class
It is wrong to treat pain in CSF hypotension headache to allow the patient to walk!
No full textIt is wrong to treat pain in CSF hypotension headache to allow the patient to walk!It is wrong to treat pain in CSF hypotension headache to allow the patient to walk
Sensory organization test and motor control test in patients with migraine and vestibular migraine
Get PDFIntroductionIndividuals with migraine have a high prevalence of vestibular symptoms, such as dizziness and balance deficits. The presence of aura and high frequency of attacks are associated with an increased risk of these symptoms. Vestibular migraine is a subtype of migraine described in the appendix of the International Classification of Headache Disorders (ICHD-III) along with the Committee for Classification of Vestibular Disorders of the Bárány Society. However, evidence is still lacking regarding how the balance of individuals with vestibular migraine is affected when compared to individuals with non-vestibular migraine.
ObjectiveTo evaluate balance through Dynamic Computerized Posturography, with the Sensory Organization Test (SOT) and the Motor Control Test (MCT) in migraine subgroups: migraine and vestibular migraine.
MethodsNinety women aged between 18 and 55 years were evaluated, divided by ICHD diagnostic criteria, into two groups: (1) migraine (GM); (2) vestibular migraine (GMV). The Dynamic Computerized Posturography exam was performed with the EquiTest - NeuroCom® software equipment, using the variables SOT and MCT. Clinical characteristics of migraine, presence of vestibular symptoms and number of falls in the last year were also evaluated. For the statistical analysis, mean and standard deviation were used in the comparison between groups, considering a significance of α = 0.05. The migraine and vestibular migraine groups were compared on the SOT for final score and on the MCT for latency during each of the test conditions using multivariate analysis of variance (MANOVA).
ResultsThe GM had the highest composite score on the SOT (M=74.0±9.7; MV=68.1±8.8; p=0.004), the highest score on the visual SOT (M=79.5±17, 9; MV=70.8±16.5); p=0.01] and in vestibular SOT (M=64.4±14.1; MV=54.4±14.4; p=0.02) than the GMV. In addition, all patients in the GMV reported vestibular symptoms, while in the GM, only 48.7% (p<0.001). (To see the complete abstract, please, check out the PDF).
Cephalalgia heterotopica: a case series of extratrigeminal cluster headache
Get PDFIntroduction
Cluster headache is a very disabling neurological disorder that usually presents with unilateral severe headache associated with ipsilateral cranial autonomic symptoms. Even among the typical cases, there is a considerable diagnostic delay and most patients will have seen three general practitioners before being referred to neurology services, some having been to colleagues in dentistry or otorhinolaryngology. The extratrigeminal presentation of this condition poses a great obstacle to a proper diagnostic workup.
Objective
This consecutive case series study aimed to report clinical features, treatment, and outcome of 3 patients with extratrigeminal Cluster Headache.
Materials and Methods
Case series of our Headache Clinic. Data disclosure was authorized by the patients through an informed consent form.
Results
Two males and one female were evaluated. The ages were 53, 64, and 71 years. The mean age of symptoms onset was 50, 60, and 66 years, respectively. Two patients described excruciating shoulder pain and one presents severe pain in the malar area. All patients reported prominent autonomic ipsilateral symptoms such as lacrimation, conjunctival injection, nasal symptoms, and restlessness accompanying pain attacks. Preventive treatment with verapamil and occipital nerve block was useful.
Conclusion
Extratrigeminal cluster presentation is a diagnostic challenge. Proper recognition of these cases prevents unnecessary examination and treatment trials and 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 cluster headache mechanisms.
Keywords: Cluster headache, Extratrigeminal headache, Shoulder pain.
Relato de caso: Olhe nos meus olhos
No full textThe comorbidity of migraine and Autism Spectrum Disorder (ASD) still remain unclear. In spite of plausible evidences of such comorbidity, there is a scarcity of populational studies focusing this hypothesis. The diagnosis of migraine in children with ASD is very challenge due to the large clinical heterogeneity and limited communication skills, particularly verbal abilities in young children and those with intellectual disability. ASD and migraine are chronic prevalent disorders sharing some pathophysiological changes (neurotransmission dysregulation, altered immune response, abnormal findings in the cortical minicolumn organization, and dysfunctions in the gut–brain axis), susceptibility genes (including calcium channel mutations and polymorphisms), and atypical sensory processing. Herein, we take advantage of a prototypical case of an adolescent with episodic migraine transformed to chronic, not responsive to preventive treatment, to explore the diagnostic workup and successful personalized clinical and therapeutical management.A comorbidade entre migrânea e o Transtorno do Espectro Autista (TEA) ainda não é bem estabelecida. Apesar de evidências plausíveis dessa comorbidade, são escassos os estudos populacionais que explorem essa hipótese. O diagnóstico de migrânea em crianças com TEA é muito desafiador devido à grande heterogeneidade clínica e limitadas habilidades de comunicação observadas no TEA, particularmente as habilidades verbais em crianças pequenas e com deficiência intelectual associada. O TEA e a migrânea são condições crônicas prevalentes que apresentam algumas alterações fisiopatológicas comuns (desregulação da neurotransmissão, resposta imune alterada, achados anormais na organização de minicolunas corticais e disfunções no eixo intestino-cérebro), genes de suscetibilidade (incluindo mutações e polimorfismos de canais de cálcio) e processamento sensorial atípico. Aqui, aproveitamos um caso prototípico de um adolescente com migrânea episódica transformada em crônica, não responsiva ao tratamento preventivo, para explorar a investigação diagnóstica e um manejo clínico e terapêutico personalizado bem-sucedido
Avaliação do equilíbrio e da capacidade funcional em pacientes com fibromialgia com e sem migrânea
No full textObjectiveTo evaluate the balance and functional capacity of fibromyalgia patients’ with and without migraine.MethodsObservational study with 60 women, between 20 and 60 years old (47±9 years), who were allocated into the following groups: 1. fibromyalgia and migraine (n=49); 2. only fibromyalgia (n=11). The following were used: Migraine Disability Assessment Test (MIDAS) to analyze the impact of migraine on quality of life; Revised Fibromyalgia Impact Questionnaire (FIQ-R) to assess the impact of fibromyalgia; six-minute walk test (6MWT)to assess functional capacity and Berg Balance Scale (BBE) for balance analysis.ResultsThere was no difference between groups 1 and 2 regarding functional capacity (TC6M: 308.7 m ±107.33 vs. 298.8 m ±153.54; p=0.55) and balance (BBE: 48± 14 vs. 47±16; p=0.68) as well as the impact on quality of life (FIQ: 78.8±14.77 vs. 74.4±13.99; p=0.28 and MIDAS: 31 ±24).ConclusionsOur study showed that there was no difference in functional capacity, balance and quality of life in fibromyalgia patients compared to patients with fibromyalgia associated with migraine.Objetivo: Avaliar o equilíbrio e a capacidade funcional de pacientes fibromiálgicas com e sem migrânea. Métodos: Estudo observacional com 60 mulheres, entre 20 e 60 anos (47±9 anos), que foram alocadas nos grupos: 1. fibromialgia e migrânea (n=49); 2. apenas fibromialgia (n=11). Foram utilizados: Migraine Disability Assessment Test (MIDAS) para análise do impacto da migrânea na qualidade de vida; Revised Fibromialgia Impact Questionare (FIQ-R) para avaliação do impacto da fibromialgia; teste de caminhada de seis minutos (TC6M) para avaliação da capacidade funcional e Escala de Equilíbrio de Berg (EEB) para análise do equilíbrio. Resultados: Não houve diferença entre os grupos 1 e 2 em relação à capacidade funcional (TC6M: 308,7m ±107,33 vs. 298,8m ±153,54; p=0,55) ao equilíbrio (EEB: 48±14 vs. 47±16; p=0,68) bem como no impacto da qualidade de vida (FIQ: 78,8±14,77 vs. 74,4±13,99; p=0,28 e MIDAS: 31±24). Conclusão: Nosso estudo demonstrou que não houve diferença na capacidade funcional, no equilíbrio e na qualidade de vida de pacientes fibromiálgicas quando comparadas à pacientes com fibromialgia associada migrânea
Spontaneous bleeding of an arachnoid cyst: a rare cause of thunderclap headache
Get PDFIntroduction
A thunderclap headache is a severe headache that starts suddenly and may be a sign of a condition that can be life threatening.
Objective
To present a case of a rare cause of thunderclap headache.
Case presentation
A 37-year-old female patient was admitted in the neurological emergence service of a private hospital in the city of São Paulo. She had sudden, explosive, and pulsatile headache, with photophobia and phonophobia. The neurological examination had no focal signs. She had deep vein thrombosis in 2014 in the past and since then she has been irregularly using Warfarin.
She underwent CT and MRI of the skull that showed enlargement of the bilateral retrovermian and retrocerebellar cerebrospinal fluid space, with thin membranes/septations inside, and heterogeneous content, with deposition of hemoglobin degradation products. Such findings are consistent with a retrovermian arachnoid cyst with hemorrhagic content. The INR was 1.
Conservative and symptomatic treatment was started, and control CT was performed on the second day of hospitalization, demonstrating almost complete reabsorption of hematic material.
The patient was discharged after 2 days of hospitalization with complete headache improvement.
Conclusion
Arachnoid cysts are collections of fluid located between the meningeal membranes. They are congenital and are formed due to a valve defect in the arachnoid membranes leading to a collection of cerebrospinal fluid (CSF) in its interior.
Most arachnoid cysts are an incidental finding. About 1 to 2% of the population has an arachnoid cyst and symptoms appear when the cyst increases in size or bleeds.
Our patient had a are complication of and arachnoid cyst not related with the use of anticoagulant.
Keywords:
Thunderclap headache, Arachnoid Cyst Bleeding, Arachnoid Cyst
Ramsay-Hunt syndrome in HIV patient
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Ramsay-Hunt syndrome type (SRH) type II is defined by the combination of herpes zoster oticus to acute peripheral facial nerve paralysis, described in 1907 by James Ramsay Hunt. Reactivation of latent varicella-zoster virus in the geniculate ganglion of the facial nerve will cause SRH, resulting in inflammation, edema, and compression of the VII cranial pair. However, nerve involvement, and in turn the development of SRH, manifests in less than 1% of infected patients. It is the second most common cause of atraumatic peripheral facial palsy (PFP) and has an incidence of 5 cases/100,000 people, with no sex predilection. Currently, SRH is classically described as a triad of otalgia, ipsilateral facial paralysis, and vesicles near the ear and ear canal; however, motor, sensory, and autonomic impairment when combined result in diverse neurological damage and may cause different symptoms, its diagnosis is mainly clinical.
Goal
To report the case of an HIV patient associated with SHR, seen by IIER between May and June/2022.
Case Report
Male, 49 years old, sought care on 05/20/22 in a hospital with complaints of vertigo and intense headache, associated with nausea and vomiting with onset of symptoms one day ago. His personal history was HIV+, diagnosed in 2013 and under regular treatment. On 5/25/22 resurfaced with the same symptoms of vertigo in conjunction with the appearance of an erythematous and painful vesicle in the right auricular region with edema and flushing of the region in association with PFP symptoms. On 05/30/22 he returned to the clinic with the same symptoms as before, and a magnetic resonance imaging of the temporal bones was done, showing an inflammatory process through the contrast at the bottom of the internal auditory canal suggestive of Bell\u27s Palsy.
(To see the complet abstract, please, check out the PDF.