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Obstructive sleep apnea and headache: an integrative review of the last 18 years
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Obstructive sleep apnea (OSA) is a prevalent and underdiagnosed clinical condition, characterized by the presence of repetitive airway collapse during sleep, resulting in oxyhemoglobin desaturation and sleep fragmentation. Among the most frequent reports of patients with OSA, is morning headache or chronic daily headache, which in 2004 received its own classification in the International Classification of Headache Disorders (ICHD-2) as sleep apnea headache.
Objective
The present review aims to evaluate the available scientific literature on the association between OSA and headache after classification, totaling a period of 18 years.
Results
In 8 included studies, 1,637 patients were analyzed, observing a bilateral and frequent association between the two pathologies.
Conclusion
However, there is still no consensus on the mechanism behind this relationship, and the results of studies are divergent
Fibromyalgia in patients with migraine: A literature review in the last 20 years
Get PDFIntroductionPossibly fibromyalgia and migraine share similar pathophysiological mechanisms, generatingan imbalance of neurotransmitters involved in pain modulation, with increased neuronal excitability. The association between these two conditions is frequent, increasing the disability of both.ObjectivesWe aimed to review articles published in the last 20 years about the presence of fibromyalgiain patients with migraine and to analyze the quality of life of these patients.MethodsBased on a literature search in the major medical databases and using the descriptors “migraine” and “fibromyalgia” we include articles published between 2001 and 2021. We found 387 articles, but only five met the inclusion criteria.ResultsIn five articles analyzed, 429 patients with migraine were found, in which fibromyalgiawas present in 31.5% of them, predominantly in women (p<0.0001). In this association, there was a higher risk for depression and worse quality of life.ConclusionsThe association of fibromyalgia in patients with migraine is frequent, increasing the disabilityof these two diseases and generating great social impact. Knowledge of this association and the management of its consequences are necessary in medical practice
A importância da abordagem dos distúrbios do sono no tratamento da enxaqueca
No full textAbstract
Migraine is one of the most common complaints in the clinical practice of neurology. It is multifactorial, with insomnia being a predisposing factor present in almost 50% of cases. The pathophysiology of migraine is complex and involves changes in several areas of the CNS, which find common pathways with sleep disorders. Among them, hypothalamic connections, hormones and neuropeptides such as orexias and monoaminergics. Furthermore, other specific sleep disorders are related to migraine. Currently, treatment is individualized and in addition to medication measures, changes in lifestyle and sleep adjustments are proposed. In view of this, the association between sleep and migraine is a therapeutic opportunity and this can be done based on a detailed clinical approach during the consultation.Resumo
A enxaqueca ou migrânea, é uma das queixas mais comuns na prática clínica da neurologia. É multifatorial, sendo a insônia um fator de predisposição presente em quase 50% dos casos. A fisiopatologia da migrânea é complexa e envolve alterações em diversas áreas do SNC e que encontram vias comuns com os distúrbios do sono. Entre elas, conexões hipotalâmicas, hormônios e neuropeptídeos, como orexias e monoaminérgicos. Além disso, outros distúrbios do sono específicos se relacionam com a migrânea. Atualmente, o tratamento é individualizado e além de medidas medicamentosas, é proposto mudanças nos hábitos de vida e adequações do sono. Diante disso, é uma oportunidade terapêutica a associação entre sono e enxaqueca e isso pode ser feito com base em uma abordagem clínica detalhada durante a consulta
Assessment of cervical muscle strength in women with migraine stratified by the report of neck pain
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Individuals with migraine may have associated cervical musculoskeletal dysfunctions that may influence muscle function ¹,², but we still do not know if the alteration in muscle strength can predict the magnitude of this relationship or if the presence of pain during the tests can influence these results. Therefore, evaluating the muscle strength of migraine patients and the report of pain during the test can elucidate this relationship.
Objective
To clarify the relationship between pain reporting and cervical maximum isometric voluntary contraction (MVIC) in migraine individuals with and without neck pain, neck pain and controls.
Methods
We selected 100 women aged between 18 and 55 years, stratified into 4 groups: asymptomatic controls (n=25), neck pain (n=25), migraine (n=25), and migraine with neck pain (n=25). Patients were diagnosed by a neurologist according to the International Classification of Headache Disorders – III edition, whereas neck pain was included through self-report of chronic neck pain for at least 3 months (mild disability according to the Neck Disability Index). Clinical and demographic data were collected from the participants and they performed the Maximal isometric voluntary contractions (MIVC) test to verify cervical muscle strength for flexion and extension. The analyzes were performed following the division of the four groups by the ANOVA test using software version 9.4 (SAS Institute, Cary, NC, USA).
Results
A higher proportion of participants with migraine and neck pain (44%) and neck pain alone (56%) reported flexion test-induced neck pain compared to the control group (0% p<0.01), and neck pain Test-induced headache was more commonly reported in those with migraine (28%) and migraine with neck pain (28%) vs controls (0% p<0.05). (To see the complete abstract, please, check out the PDF).
Diagnostic challenges in sporadic hemiplegic migraine: a case report
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Female, 62 years old, history previous of hypertension and multiple cavernomatosis, admitted to our service emergency room with hypothesis of stroke. The patient presented headache associated with nausea and phosphenes in the right eye, with evolution for right hemiplegia. However, she showed complete and spontaneous reversal of symptoms, in a few minutes. The patient presented similar symptoms with annual recurrence since 2019, always following migraine attack. She denied familiar history of migraine. Brain MRI showed multiple cavernomatosis, with no signs of old or recent ischemia. Brain and cervical CT angiography and laboratorial tests were normal. She was then diagnosed with sporadic hemiplegic migraine, with no family report of the disease. She received treatment with Amitriptyline 50 mg per day, without further recurrences.
Discussion
Hemiplegic migraine (HM) is a rare form of migraine with motor aura, which includes fully reversible motor weakness. The aura of HM is most probably caused by cortical spreading depression, a self-propagating wave of neuronal and glial depolarization that spreads across the cerebral cortex. Patients who are the first member of their family to have hemiplegic migraine are classified as having sporadic hemiplegic migraine. Some cases of sporadic hemiplegic migraine are caused by one of the genetic variants that cause familial hemiplegic migraine. The treatment of HM is empirical and mainly relies on principles of management of the common types of migraine, except for triptans use, medication historically contraindicated because of vasoconstrictor properties.
Final comments
Hemiplegic migraine is an important differential diagnosis with stroke in patients with migraine. Correct recognition of this condition can be a crucial factor in the treatment and prognosis of the patient in the emergency room.
Keywords: hemiplegic migraine, motor aura, stroke mimics
"Not otherwise specified headache" in emergency department: an analysis of 149,603 visits to nine Upa\u27s 24h in Fortaleza
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Headache is one of the most common neurological symptoms and is almost a universal experience that requires medical attention on many occasions. Patients often seek medical advice for headaches in primary or secondary health care systems. In these scenarios, establishing the correct diagnosis of headache and referring further treatment to a specialist is essential. Hundreds of low-complexity Emergency Care Units (called UPAs 24h) were opened throughout the country in the last decade. Working 24/7, many UPA 24 h are one of the preferred places by patients to treat acute headaches.
Objectives
This study aims to evaluate the frequency of the "Not otherwise specified headache diagnoses" in patients who seek UPA\u27s 24-h for headache.
Methods
We evaluated the ED charts of 149,603 visits motivated by headache to nine UPAs 24h in Fortaleza, Ceará, from January 2017 to April 2022. In addition to the demographic data, the care flow chart, the MTS classification, the times of each step of care (from risk classification to discharge or death), and the final diagnosis coded by the attendant physician using the International Classification of Diseases (ICD-10). Data were analyzed using statistical software, and a p <0.05 was considered for significance.
Results
The 149,603 consultations, which represented 3,5% of the total, were made by men and women (72 and 28% respectively) with 38.2 (± 14.6) years of age, on average. Regarding the diagnosis, only 25,121 (16.8%) patients received the diagnosis of migraine, and 4,671 (3.1%) were diagnosed with “other cephalic algic syndromes”. The remaining 119,811 (80.1%) had the not otherwise specified headache discharge diagnosis in their charts.
(To see the complet abstract, please, check out the PDF.
Fatores desencadeantes e de alívio da enxaqueca entre estudantes universitários: um estudo transversal no Líbano
No full textIntroduction
Migraine is common among university students and can directly affect their daily activities and learning since students with migraine have difficulties attending classes and missed more school days than other students.
Objectives
This study aimed to identify triggering factors of migraine along with factors that relieve headaches associated with migraine episodes among university students.
Methods
An observational cross-sectional study targeted students from different faculties of the public university campus in Lebanon using a survey for data collection.
Results
Feeling hungry (65.9%), fasting (50.7%), and coffee deprivation (22.7%) were the most commonly reported dietary factors inducing headaches among university students. In comparison, climate changes (77.1%), noise and high volumes (73.9%), and hot weather (60.2%) were the most common environmental triggers. Among the psychological factors, anxiety (53.4%) and crying (47.3%) were highly reported and were significantly higher among women. Fatigue (63.2%), studying for exams (59.5%), and neck pain (46.8%) were the most common physical activity-reported factors. Lack of sleep (72%) and changes in sleeping hours (42.7%) were the primarily reported sleeping habits that can trigger headaches, with no statistically significant differences between men and women. Sleeping (66.3%), relaxing (53.4%), avoiding migraine’s trigger factors (42.9%), and having a warm bath (38.5%) were the most reported relieving factors of headache among students. No statistically significant association was noted between any of the factors and the sex of the participants.
Conclusion
The triggering and relieving factors of migraine were comparable between men and women. Some triggering factors such as crying, anxiety, and fatigue were found significant among women, while driving was a higher migraine trigger among men. Lifestyle interventions may provide clues on effective relieving strategies and yield the establishment of different medical services and university programs.IntroduçãoA enxaqueca é comum entre estudantes universitários e pode afetar diretamente suas atividades diárias e aprendizagem, uma vez que os alunos com enxaqueca têm dificuldades de frequentar as aulas e faltam mais dias de aula do que os outros alunos.ObjetivosEste estudo teve como objetivo identificar os fatores desencadeantes da enxaqueca juntamente com os fatores que aliviam as dores de cabeça associadas aos episódios de enxaqueca em estudantes universitários.MétodosUm estudo observacional transversal teve como alvo alunos de diferentes faculdades do campus universitário público no Líbano usando uma pesquisa para coleta de dados.ResultadosEm relação aos fatores desencadeantes de cefaléia não houve diferenças estatisticamente significativas entre homens e mulheres, exceto jejum e tabagismo ou inalação de fumaça, que foram mais relatados por mulheres do que por homens. Além disso, entre os fatores psicológicos e físicos a ansiedade, fadiga e choro foram significativamente maiores nas mulheres do que nos homens, enquanto dirigir um carro foi um maior indutor de dor de cabeça nos homens. Quanto aos fatores reviver, dormir, relaxar, evitar fatores desencadeantes e tomar banho morno foram os fatores mais relatados por ambos os sexos, sem diferenças estatísticas entre eles.ConclusãoO acompanhamento de grupos vulneráveis é essencial na prevenção e tratamento da enxaqueca entre universitários. Muitas intervenções no estilo de vida podem fornecer pistas sobre estratégias eficazes de alívio e resultar no estabelecimento de diferentes serviços e programas médicos em universidades
Headache Medicine: updates and bibliometric analysis
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Headache Medicine is the official scientific journal of the Brazilian Headache Society that has been publishing clinical and experimental, qualitative, and quantitative research on headaches and orofacial pain for 28 years, as well as aspects related to pain that may have implications for headaches. In constant updating, Headache Medicine demonstrates commitment and scientific ethics following the international criteria for publication in the medical field.
Objective
Describe updates made in 2020 to the management and editorial process and bibliometric data from Headache Medicine publications and accesses to demonstrate their impact on headache science.
Methods
Data on the quantity and location of accesses until September 2022 were obtained from Google Analytics. The most accessed and read articles (originals, reviews, or case reports) were identified through the statistical reports of the Open Journal Systems (OJS). The journal\u27s H5 index and the citations of each published paper were consulted in Publish or Perish and Google Scholar, respectively.
Results
In 2020, Headache Medicine obtained ISSN online, migrated its management to OJS, registered a Digital Object Identifier (DOI) on all articles published, linked the authors\u27 ORCiD to the publication, and updated the publication of the numbers of each issue. Google Analytics has been monitoring Headache Medicine for just 2 years and has already accounted for more than 38,000 accesses from 150 countries. Brazil (29,282 accesses), the United States (2,186 accesses), Portugal (1,434 accesses) and China (377 accesses) are the 4 countries with the most access. Headache Medicine has published 202 original articles, reviews or case reports since 2010. The three most accessed articles with abstract and full article are literature review: Topiramate and cognitive function: review (Santos et al., 2005) with 1,152 accesses, Pizotifen for the treatment of migraine.
(To see the complet abstract, please, check out the PDF.
Cefaléia e disfunção de nervos cranianos secundários a aneurisma de artéria carótida: relato de dois casos e revisão da literatura
No full textThe cavernous sinus is a venous plexus located at the base of the skull. Several pathologies, such as inflammatory, aneurysmal, or metastatic processes, can affect this plexus. Cavernous sinus syndrome occurs when the nerves are involved in this region (cranial nerves III, IV, VI, and divisions of V). These anatomical relationships explain that diplopia and pain are these patients\u27 most common onset symptoms. Carotid cavernous aneurysms (CCAs) account for 2% to 9% of aneurysms. We report two patients who showed cavernous sinus syndrome resulting from carotid artery aneurysms. The recognition of the etiology of this distinguished clinical picture is vital to avoid complications and address the best approach for each patient.O seio cavernoso é um plexo venoso localizado na base do crânio. Várias patologias, como processos inflamatórios, aneurismáticos ou metastáticos, podem afetar esse plexo. A síndrome do seio cavernoso ocorre quando os nervos estão envolvidos nessa região (nervos cranianos III, IV, VI e divisões do V). Essas relações anatômicas explicam que a diplopia e a dor são os sintomas iniciais mais comuns nesses pacientes. Os aneurismas carotídeos cavernosos (CCAs) representam 2% a 9% dos aneurismas. Relatamos dois pacientes que apresentaram síndrome do seio cavernoso decorrente de aneurismas da artéria carótida. O reconhecimento da etiologia desse quadro clínico diferenciado é fundamental para evitar complicações e direcionar a melhor conduta para cada paciente
