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Dialysis-related headache: prevalence and clinical features in patients on hemodialysis and after kidney transplantation
Get PDFIntroductionHeadache is a common symptom among patients on hemodialysis, occurring in up to 70%. Dialysis headache is defined by the International Classification of Headache Disorders (ICHD-3) as a headache with no specific characteristics, occurring during and caused by hemodialysis, and which resolves spontaneously within 72 hours after the session has ended. There is no consensus on its pathophysiology or triggering factors.
ObjectiveTo evaluate the prevalence, clinical features and factors associated with dialysis headache in patients with chronic kidney disease on renal replacement therapy.
MethodsCross-sectional observational study with a quantitative approach. Participants were divided into two groups: (1) 25 patients on hemodialysis and (2) 25 patients on early post kidney transplantation. All participants were interviewed with a structured questionnaire, the Hospital Anxiety and Depression Scale, and the Epworth Sleepiness Scale. Blood pressure, weight, urea, glucose and electrolytes were evaluated before and after one hemodialysis session. Control groups were classified within the headache-free patients in each group. Numerical variables were expressed as mean and standard deviation and evaluated using Student\u27s t test (two-tailed) or Mann-Whitney U test. Categorical variables were expressed as percentage and evaluated using Pearson\u27s chi- squared test. The p value was considered statistically significant when lower than 0.05.
ResultsIn group (1), 8 patients (32%) were diagnosed with dialysis headache, predominantly pulsatile (n=6, 75%), accompanied by photophobia (n=6, 75%), phonophobia (n=4, 50%) and nausea or vomiting (n=6, 75%), with a mean pain score of 7.75 ± 1.58. Individuals with headache had higher scores for anxiety (7.00 ± 3.93 vs. 3.82 ± 3.23, p=0.03) and sleepiness (9.13 ± 3.94 vs. 4.76 ± 3, 85, p=0.01). (To see the complete abstract, please, check out the pdf).
Brain volumetry by voxel-based-morphometry in migraineurs: comparison between groups and clinical correlations
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Migraine was previously interpreted as “benign” disease since the major part of patients were asymptomatic between attacks and brain lesions are absent in primary headaches. Advances in structural neuroimaging have changed this point of view. Voxel-based-morphometry is an accurate technique to evaluate objectively structural brain damage. Our hypothesis was that some clinical features of migraine, as aura and attack frequencies, are more related to volumetric changes in migraineurs brains.
Objectives
To compare brain lobes volumetry between migraine patients (episodic migraine, with and without aura, chronic migraine) and healthy controls. To evaluate the correlations of brain volumetric variables with clinical variables.
Methods
This is a cross-sectional study performed with 60 female volunteers, aged between 18 and 55 years old, equally allocated into four groups: episodic migraine without aura, episodic migraine with aura, chronic migraine and controls. The sample was clinically characterized by the following variables: age, number of days with headache in the last month, number of days with aura in the last month, average pain intensity in the last month, disease duration calculated in number of years from the migraine diagnosis to the MRI performance, and the use of prophylactic drugs for migraine. Volunteers underwent brain MRI, and Free Surfer software was used to perform volumetric studies. Statistical analyses included Mann-Whitney test, Kruskal-Wallis test, Dunn test and Spearmann correlations.
Results
No statistically relevant differences were found in cerebral lobe volumes and supratentorial white matter in the comparison between groups. Regarding to clinical correlations, age influenced the brain lobes volumetric reduction, as expected, except for the parietal lobe, for which the correlation was not important. The disease duration was correlated with the reduction of the frontal (p<0.001 / r=-0.531), temporal (p=0.003/r=-0.433), parietal (p=0.004/r=-0.431) lobes; when adjusted by age...
(To see the complet abstract, please, check out the PDF.
Anxiety and depression associated with migraine features
Get PDFIntroductionMigraine is the most common primary headache in medical care, being the cause of migraine in more than 10% of the population, directly impacting the quality of life and working capacity of those affected. Recently, studies have indicated a close association between migraine and anxious and depressive disorders mediated by mechanisms such as alterations in monoamines (serotonin and dopamine) and neurotransmitter peptides such as endorphins and enkephalins, immune dysfunction, and genetic factors, causing symptoms and common characteristics among patients.
ObjectiveInvestigate the association between anxiety and depression with migraine features and accompanying symptoms.
MethodsCross-sectional study based on 466 patients with migraine, which were submitted to a structured interview in which demographic, clinical, anthropometric data and data related to migraine and its characteristics were obtained. Besides that, patients answered validated forms regarding the impact of migraine (HIT-6), allodynia (ASC-12), depression (IDB – inventário de Beck), anxiety (STAI Y-1 and Y-2) and hyperacusis scale. Categorical variables were evaluated using the chi-square test and numerical variables were analyzed using the Mann Whitney test. Statistical difference was considered when p≤0.05.
Results466 patients participated in the study, of which 86.1% were women, the median age was 33 years, 55.5% of the individuals had episodic migraine and 61.8% reported absence of aura. Regarding the patients with anxiety, 93.30% reported association of osmophobia with migraine attack (p=0.03) and 46.70%, association with diarrhea (p=0.001). Patients with anxiety scored higher on the impact of migraine questionnaire (p=0.046), allodynia (p=0.005) and the hyperacusis scale (p=0.029).
(To see the complete abstract, please, check out the PDF)
Trigeminal autonomic cephalalgias and intranasal lidocaine: a symptomatic management option
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Trigeminal Autonomic Cephalalgias (TAC) are excruciating headaches with limited treatment options. In addition to drug therapy, there are some studies regarding nerve blocking and nerve stimulation with acceptable results. We had a sequence of three difficult to treat patients because of the disease or some associated condition that made us try something not so usual. Lidocaine, by blocking voltage-gated Na+ channels can reduce the excitability of neurons and thus prevent or reduce the sensation of pain, which can relieve neuropathic pain, hyperalgesia, and complex regional pain syndrome.
Objective
Observe if intranasal lidocaine could be effective and safe for patients with TAC.
Methods and Results
The three patients signed a consent permission form. (1) 29-year-old pregnant woman with a history of headaches for about 3 years. Pain was localized in the right periorbital region with the severity of about 7 out of 10. Attacks of excruciating pain associated with ipsilateral tearing 5–8 times a day - Paroxistic Hemicrania. She was diagnosed with prolactinoma two years ago. The management of the tumor had resolved the pain. With the pregnancy, Bromocriptine has been stopped. So, 1 month later, the pain returned. As indomethacin could not be used in this situation, we opted to prescribe intranasal lidocaine. After the first dose, the patient had control of the pain. It was prescribed lidocaine 2%, 2mL intranasal (IN) until four times a day. (2) 56-year-old man with a history of headaches for about 4 months. Pain was localized in the right periorbital region with the severity of about 10 out of 10. Attacks of excruciating pain associated with ipsilateral tearing and conjunctival injection lasting for 30-90 seconds and occurring as single stabs 30-50 times a day - Short-lasting unilateral neuralgiform headache attacks with conjunctival...
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Effect of melatonin on degranulation of dura mater mast cells in Wistar rats
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Migraine is a highly prevalent neurological disorder that affects about 15% of the world\u27s population. Involved in migraine pain, the cranial dura mater is a richly vascularized and innervated membrane, where we also find mast cells, and immune cells that help in the formation of the inflammatory process. As one of the treatments for migraine, we have melatonin, a hormone produced in the pineal gland and with properties such as circadian cycle control and antioxidant action. Capsaicin, a bioactive compound found in peppers and with a pungent and burning effect, also has an action in the painful process and serves as a tool in the study of physiopathogenic processes.
Objectives
To evaluate the degranulation of dura mater mast cells from Wistar rats stimulated in situ with capsaicin and synthetic interstitial fluid (SIF) and previously treated with melatonin.
Methods
Twenty-five male Wistar rats were used, obtained from the Department of Antibiotics - Danti of the Federal University of Pernambuco - UFPE and with use authorized by the Ethics Committee in the Use of Animals - CEUA of UFPE, according to protocol nº 0084/2019. During the adaptation period, the animals were acclimatized under standard laboratory conditions, with water and food ad libitum. After this period, they were separated into two groups: a control group (CG) (n = 12) and a melatonin group (GM) (n = 13), and underwent a daily treatment for 10 days with the intraperitoneal application. The GM received a dosage of 10 mg/kg of the animal weight of melatonin diluted in a saline solution at 0.9% and the GC was treated only with the vehicle. After the treatment, the animals were anesthetized and submitted to an experimental surgery...
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Prevalence of postpartum depression in patients with migraine
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Migraine is a disease of the central nervous system characterized by moderate or severe headache. Migraine is considered the third most prevalent disease and the seventh specific cause of incapacity in the world.
The prevalence of migraine in women increase after menarche compared with the prevalence of migraine in men.
According to previous population-based studies, during reproductive years, a woman who has the diagnosis of menstrual migraine experiences the same symptoms throughout pregnancy and postpartum.
Childbirth is a major event in a woman’s life. However, some mothers might present symptoms of postnatal depression. Postpartum depression is a mental disorder that reflects on the maternal role. Thus, it has negative consequences for them and their children. Postpartum depression is associated with increased risk for cognitive BB impairment, emotional difficulties and behavioral problems.
Clinically, headache influences the mental and physical health of pregnant and postpartum women. Studies reported that anxiety and depression disorders are two to ten times more common in migraineurs than in the general population. Therefore, it can be a risk for postpartum depression development.
Objective
To verify postpartum depression in migraine and non-migraine parturients.
Methods
Data was collected from a sample of 155 women, older than 18 years old, in the obstetric center of Santa Casa de Misericórdia de Barbacena, between October 2021 and August 2022, in the first 24 hours after labor by the members of the research. Clinic and concomitant disorders were collected from the patient\u27s record. Parturients who did not agree to participate in the study and those with cognitive impairment were excluded.
All the patients signed an informed consent form to participate in the study.
All the patients answered the Edinburgh Postnatal Depression Scale (EPDS) and the ID-Migraine...
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Headache in patients with systemic lupus erythematosus: a pilot study
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Headache is a symptom frequently reported by patients with Systemic Lupus Erythematosus (SLE), but it remains controversial as to whether the prevalence is higher than in the those without the disease and if there is an association with disease activity.
Objectives
1) to compare the prevalence, monthly frequency and impact of headaches between patients with SLE and a control group without the disease and 2) to compare the prevalence, monthly frequency and impact of headaches between patients with active SLE and those without disease activity
Methods
This is a case-control study. The case group consisted of patients diagnosed with SLE in regular follow-up at the Rheumatology outpatient clinic of the Hospital das Clínicas, UFPE, excluding those with a previous diagnosis of secondary headache or overlapping autoimmune diseases. A control group, matched for sex and age, consisted of hospital staff and friends and relatives of patients who had no previous diagnosis of secondary headache or autoimmune disease. Data on SLE and headache were collected through interviews and questionnaires administered by a neurologist. Headache impact was assessed using the Headache Impact Test (HIT-6) scale, anxiety and depression symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS) and disease activity was evaluated using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)-2K modified scale, considering clinical and laboratory data from the last 30 days. All participants who reported at least one headache attack in the last year were considered as having headache and specific diagnoses were made based on the 3rd edition of the International Classification of Headache Disorders. SLE patients with SLEDAI-2K ≥ 6 were considered as having disease activity. Statistical analyzes were performed in SPSS 28.0 with significance defined as p < 0.05....
(To see the complet abstract, please, check out the PDF.
Residents: how is headache care in general, including emergency
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Headaches are pains in any region of the head with variable intensity, as well as its location. They can be localized or diffuse, acute or chronic, associated or not with other symptoms and have numerous causes.More than 90% of people report a history of headache during their lifetime. In addition, an overload is observed in emergency units and outpatient clinics due to inadequate initial care for a headache.
Objective
1) Conduct an epidemiological survey of headache care in emergency care units, analyzing the conduct of resident physicians. 2) Estimate the resolvability of headache cases in the emergency room and provide actions through continuing education if a deficiency in the care provided by professionals is demonstrated.
Methods
This is a descriptive observational study (cross-sectional cohort) in which we applied an online questionnaire to resident physicians who will be providing treatment in general to the patients in the city of Catanduva and neighboring cities. This is a semi-structured interview aided with self-administrated questionnaire (annexed in online in private cloud to guarantee confidentiality) which was sent via email and WhatsApp. Before joining the study, the participants filled out the informed consent form. After applying the forms, Excel spreadsheet was generated in order to process the statistical analysis. The inclusion criteria was: be a resident physician in any area of activity. The exclusion criteria: resident withdrawal at any time during the study. Number of the project in the ethics committee: 44857315.5.0000.5430
Results
A total of 115 residents physicians answered the questionnaire. The average age is 27,6 years and the majority are specializing in Clinical Surgery, Internal
Medicine and Clinical Specialties. Twenty residents reported they didn\u27t see any headache patient and the other 95 cared weekly for an average of 4,87 patients with...
(To see the complet abstract, please, check out the PDF.
Clinical characteristics of children and adolescents with primary and secondary headaches attended at the tertiary service in Brazil
Get PDFIntroductionChildhood headache is one of the most common neurological symptoms that affects about 60% of children (CR) and adolescents (AD) and its prevalence increases with age. Primary and secondary childhood headache have different characteristics and prevalence, but also have similarities, such as the diagnostic and treatment method. However, the data available in the literature do not take into account the level of complexity at healthy service where these children and adolescents are treated.
ObjectivesTo analyze the clinical characteristics of children (CH) and adolescents (AD) with primary and secondary headaches of tertiary-level headache outpatient clinic.
MethodsRetrospective study, based on review of medical records of CH and AD with primary or secondary headaches between the years 2016 and 2021. Sociodemographic data, medical history, clinical history, and daily routine of the child were obtained. The proportion of primary and secondary headaches in the CH and AD groups was also calculated. For continuous variables and categorical data, the chi-square test was used, considering p<0.05.
ResultsA total of 386 medical records were included, of which 206 were CH (n=112; 54.8% girls) and 178 AD (n=118; 66.8% girls). Headaches were episodic in CH (57.3%) and chronic in AD (49.7%), [X2(2)=10.001; p=0.007], of mild intensity in CH (64.1%), strong in AD (48.5%), [X2(3)=25.802; p=0.000]. In CH, the mostprevalent type of headache was in pressure (64.3%) and pulsatile in AD (52.8%), [X2(5)=14.595; p=0.012]. (To see the complete abstract, please, check out the PDF).
Genetic variants IL1B +3954C>T and -511C>T associated with incapacity and allodynia in migraine
Get PDFIntroductionThe main mechanisms in the physiopathology of migraine are cortical spreading depression and trigeminal activation with the release of CGRP. Neurogenic inflammation and neuroinflammation can exert an influence over both these mechanisms, but there are still a number of gaps in our understanding. Interleukin (IL)- 1β is a pro-inflammatory cytokine whose levels of plasma increase during the attack phase of migraine. Thus far, its genetic variants have not been well studied.
ObjectiveTo investigate the association between the genetic variants IL1B +3954C>T (rs1143634) and -511C>T (rs16944) and susceptibility to migraine and its clinical characteristics.
Subjects and MethodsCase control study comprising 307 participants, of whom 152 had a diagnosis of migraine and 155 were healthy controls, paired by sex, age, ethnicity and BMI. The clinical and demographic data were evaluated. The patients with migraine were interviewed using a structured form containing information about the type of migraine (with or without aura, episodic or chronic), age at onset of the disease, frequency of attacks, accompanying symptoms that triggered headaches. The patients also answered validated questionnaires to evaluate incapacity (Migraine Disability Assessment - MIDAS) and impact (Headache Impact Test - HIT-6) for migraine, the presence of allodynia (ASC-12), as well as symptoms of anxiety (State Anxiety Inventory - STAI 1 and 2), depression (Beck Depression Inventory) and a hyperacusis scale.The genetic variants IL1B +3954C>T (rs1143634) and -511C>T (rs16944) were identified using polymerase chain reaction (PCR) and the fluorescence levels of PCR products were evaluated using a Step One thermocycler (Applied Biosystems). The analyses were conducted using the dominant, codominant, recessive and over- dominant genetic models. Categorical data were evaluated via the chi-squared test or Fisher’s exact test, and continuous data were evaluated using the Mann-Whitney test. (To see the complete abstract, please, check out the PDF)