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Boundaries of visual phenomena in migraine: the charles bonnet’s syndrome - report of two cases
Full text linkIntroduction: Two patients were referred to a tertiary headache center due to complex visual phenomena that might be related to migraine aura. Eventually, it turned out that they were Charles Bonnet syndrome (CBS) patients. The syndrome is characterized by vivid visual hallucinations in the absence of other psychiatric symptoms, often in patients with optical morphophysiological disorders. The pathophysiology of CBS remains uncertain, and the syndrome lacks robust diagnostic criteria. So far, reports on CBS are scarce in Brazilian neurological literature, leading to challenges in identification and diagnosis. The condition is primarily recognized through anamnesis and clinical examination.
Objective: To report two cases of CBS in order to draw the attention of headache specialists about this syndrome.
Case reports: The first case involves a 93-year-old male patient, retired, who reported experiencing vivid hallucinations sometimes of an old white car and sometimes a group of children. Despite the clarity of these visions, the patient remained aware that they weren\u27t real. In the second case, a 70-year-old male farmer began experiencing hallucinations involving scratches, scribbles, letters, stones, and women in his visions.
Conclusion: Here two cases of CBS were report concern to a not so rare condition, but for sure very uncommon to headache specialists
Risk factors associated with headache prevalence among adolescents
Full text linkBackground: Headache prevalence among adolescents has raised growing concerns due to its association with various risk factors in their lifestyle habits.
Objective: This literature review aims to identify and analyze the main determinants related to headache prevalence among adolescents.
Methods: This study consists of a systematic review of literature published in the last ten years in the Virtual Health Library (BVS) and PubMed, using the descriptors "headache," "adolescent," and "risk factors." The inclusion criteria were articles that address risk factors for headache in adolescents, published in Portuguese or English.
Results: A higher prevalence of headache was observed in older adolescents (16-19 years) compared to younger adolescents (12-15 years). This difference may be related to biopsychosocial factors in younger adolescents, such as stress and/or divorce in the family environment. Among headache types, migraine and tension headaches were the most frequent. Tension headaches were more prevalent in females, with women reporting more frequent headache complaints than men. This difference may be associated with hormonal factors. The study also found a significant relationship between excessive technology use and headache occurrence, especially migraine-type headaches. This association can be explained by inadequate posture habits, visual fatigue, and auditory symptoms during the use of electronic devices.
Conclusion: This study highlighted a higher prevalence of headache in older adolescents and a lower prevalence among younger ones, possibly due to family stress. Migraine and tension headaches were more common in this group, with tension headaches predominant among girls. Excessive use of digital technologies was associated with headache, especially migraine-type headaches, due to inadequate postures, visual fatigue, and auditory symptoms
Morbidade e Mortalidade do CID: Enxaquecas e Outras Síndromes de Algias Cefálicas, por Faixa Etária e Sexo nas Regiões Brasileiras
No full textIntroduction: Headaches are the third most common complaint in outpatient services, with a prevalence of 10.3%, second only to respiratory tract infections and dyspepsia. Understanding hospitalizations and deaths related to headaches is essential for studying their etiology, treatment, and prevention.
Objective: Analyze hospitalization and death rates due to headaches in different Brazilian regions from 2019-2023, providing epidemiological data to aid in developing strategies to combat the disease.
Methods: Longitudinal observational epidemiological study covering Brazil\u27s demographic regions from 2019-2023. Data were sourced from the SUS Informatics Department (DATASUS) and the Hospital Information System (SIH/SUS) based on hospitalizations and deaths recorded by ICD-10 (G43; G43.0; G43.1; G43.8), considering sex and age variables.
Results: Migraines and similar conditions, despite high outpatient demand, accounted for only 0.086% of hospitalizations over the past five years. The Southeast and Northeast showed stable rates between 2019-2023 (<0.01 amplitude), while the South and Center-West exhibited greater fluctuations (>0.01). The North recorded a continuous increase in hospitalizations (from 0.0601% to 0.1081%), reflecting higher disease rates requiring hospitalization. Specific ICD mortality rate for hospitalizations in Brazil was 0.95%, with the North region showing a higher average (around 2.87%). The Northeast showed a gradual increase (1.07%-2.30%), while other regions remained below 0.7%, indicating possible variations in regional health policies, medical infrastructure, and disease prevalence. The were a female predominance in hospitalizations, with regional averages from 2.20 (Southeast) to 1.82 (North). The highest hospitalization rates were among the age groups 20-29 and 30-39 years (1739,6; 1860,2 national means respectively), decreasing gradually after age 40 (1730,2) onwards, which menopause and work-related stress may have influenced. Hospitalizations for children and adolescents were higher in the Northeast, Southeast, and South (regional means: 330,4; 339,4 339,4) regions compared to North and Center-West (62,2; 64).
Conclusion: During the analyzed period hospitalization and death rates due to headaches in Brazil remained a stable overall. Data showed significant variations concerning region, gender and age, indicating the need to consider regional and demographic differences in developing public health plans and policies to minimize public spending and reduce patient suffering.
 
Relação entre COVID-19 longa e prevalência de cefaleia: uma revisão narrativa
No full textIntroduction
COVID-19, an infectious disease caused by the SARS-CoV-2 virus first identified in China, has precipitated a pandemic of unprecedented scale since 2020. While the primary impact of COVID-19 is on the respiratory system, its clinical manifestations are extensive and can endure for weeks post-infection, leading to what is termed post-COVID or long COVID. This condition is characterized by the persistence of symptoms, signs, or clinical parameters for two or more weeks beyond the acute phase, without returning to a pre-infection healthy state. Among the most prevalent symptoms in this context is headache. Although the precise mechanisms remain under investigation, it is hypothesized that SARS-CoV-2 might infiltrate trigeminal nerve endings by compromising the blood-brain barrier, activate the trigeminovascular system via endothelial cells expressing ACE2, or stimulate perivascular trigeminal nerve endings through the release of cytokines and pro-inflammatory mediators. These processes could lead to headache as a primary symptom, alongside fatigue, myalgia, anosmia, dysgeusia, and behavioral disturbances.
Objective
To review the literature on the prevalence of headache among individuals who have fully or partially recovered from COVID-19 symptoms (post-COVID/long-COVID).
Methods
A comprehensive search was performed in the PubMed database for articles categorized as clinical trials, meta-analyses, randomized controlled trials, and systematic reviews, using the descriptors “COVID OR COVID-19,” AND “headache OR migraine,” AND “long term OR post-COVID.” Only studies that systematically analyzed data on post-COVID neurological sequelae were included.
Results
The search yielded 86 articles, of which 24 met the inclusion criteria deemed pertinent to the review\u27s objective. The findings revealed variability in the definition of post-COVID, with durations ranging from two weeks to three months post-infection. There was also inconsistency in headache assessment methodologies, but most studies identified headache among the top three sequelae, with prevalence rates varying from 8% to 91%, and a median prevalence of 40%.
Conclusion
Headache is a prominent symptom of COVID-19, persisting as a neurological sequel in post-COVID cases and significantly affecting recovered individuals. Further rigorous studies are necessary to identify risk factors, vulnerable populations, and effective prophylactic measures
Efficacy of craniosacral therapy in cervicogenic headache: a literature review
Full text linkBackgroundNeck discomfort is a frequent problem that can impair quality of life and make it difficult to perform daily tasks. Pain from neck strain is not limited to the cervical spine; it can also radiate into the skull and result in a headache of cervical origin, known as cervicogenic headache. Craniosacral can cure a wide array of musculoskeletal and neurological conditions, including headaches, but there is little evidence in the literature of its efficacy, particularly regarding cervicogenic headaches.ObjectiveTo determine the effectiveness of craniosacral therapy (CST) for cervicogenic headache and improve our understanding of cervicogenic headache.MethodsA review of the literature was performed using the following electronic search bases: PubMed, Google Scholar, Scopus and The Cochrane library. To perform the search, these MeSH terms were used: “Cervicogenic headache” AND “Neck pain” AND “Craniosacral therapy” AND ‘Headache’ between the date 2020 to 2022.ResultsEleven articles were included in the literature review. Overall, the results of published articles indicate 97.5–100% of the patients thought the treatment program was satisfactory. No adverse effects were reported. It has been demonstrated that CST is particularly safe and effective in lowering the intensity of neck pain. It may also enhance the quality of life and functional impairment for up to three months following the intervention. In addition to the conventional medical therapy, CST may be a beneficial therapeutic option for persistent and recurrent neck discomfort.ConclusionThis review shows that CST is very effective for the treatment of cervicogenic headaches. CST evaluation is feasible in randomized controlled trials and may offer insightful results to enhance therapeutic decision-making
SHOULD ANTI-CGRP MONOCLONAL ANTIBODIES ALWAYS BE THE DRUG OF FIRST CHOICE FOR MIGRAINE PROPHYLAXIS IN BRAZIL? - A PHARMACOECONOMIC STUDY
Full text linkEfficacy (success of therapy under ideal conditions), efficiency (the relationship between the costs and outcomes of a specific intervention), and effectiveness (the balance between efficacy and efficiency in clinical practice) are measures used to evaluate health interventions. Thus, in private practice and the public health system, the knowledge of these pharmacoeconomic data should influence the appropriate treatment choice. Migraine prophylaxis falls within this context. Traditional medications are available in the public health system, while galcanezumab is not routinely available. The present study aims to analyze the efficacy and effectiveness of galcanezumab and traditional therapeutic alternatives (amitriptyline, divalproex sodium, and topiramate). Efficacy data were obtained from the relevant literature (PubMed) and cost values from the ABCFarma magazine. The economic impact analysis considered the cost of living for an economically active adult in Brazil based on the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística, IBGE) and the Institute for Applied Economic Research (Instituto de Pesquisa Econômica Aplicada, IPEA). Efficacy: amitriptyline: 40%; divalproex sodium: 30%; topiramate: 31%; galcanezumab: 50%. Their annual costs were: amitriptyline R 876.00; topiramate R 13,992.00. Efficiency: amitriptyline 200%; divalproex sodium 41.1%; topiramate 62%; galcanezumab 4%. Ultimately, effectiveness is amitriptyline 120%; divalproex sodium 35.7%; topiramate 46.5%; galcanezumab 27%. Galcanezumab is the most effective; however, in a broader analysis, where payers, availability, and patient conditions are considered, evaluating efficacy alone may not be feasible in practical contexts and, therefore, anti-CGRP antibodies will not always be the first-line medications in migraine prophylaxis.Efficacy (success of therapy under ideal conditions), efficiency (the relationship between the costs and outcomes of a specific intervention), and effectiveness (the balance between efficacy and efficiency in clinical practice) are measures used to evaluate health interventions. Thus, in private practice and the public health system, the knowledge of these pharmacoeconomic data should influence the appropriate treatment choice. Migraine prophylaxis falls within this context. Traditional medications are available in the public health system, while galcanezumab is not routinely available. The present study aims to analyze the efficacy and effectiveness of galcanezumab and traditional therapeutic alternatives (amitriptyline, divalproex sodium, and topiramate). Efficacy data were obtained from the relevant literature (PubMed) and cost values from the ABCFARMA magazine. The economic impact analysis considered the cost of living for an economically active adult in Brazil based on the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística, IBGE) and the Institute for Applied Economic Research (Instituto de Pesquisa Econômica Aplicada, IPEA). Efficacy: amitriptyline: 40%; divalproex sodium: 30%; topiramate: 31%; galcanezumab: 50%. Their annual costs were: amitriptyline R 876.00; topiramate R 13,992.00. Efficiency: amitriptyline 200%; divalproex sodium 41.1%; topiramate 62%; galcanezumab 4%. Ultimately, effectiveness is amitriptyline 120%; divalproex sodium 35.7%; topiramate 46.5%; galcanezumab 27%. Galcanezumab is the most effective; however, in a broader analysis, where payers, availability, and patient conditions are considered, evaluating efficacy alone may not be feasible in practical contexts and, therefore, anti-CGRP antibodies will not always be the first-line medications in migraine prophylaxis
Headache Medicine: 30 years advancing headache science
Full text linkEditorial Headache Medicine: 30 years advancing headache scienc
Ansiedade,Depressão e DTM. Terapia Multidisciplinar
No full textAbstract
Introduction
Temporomandibular disorder (TMD) affects the jaw and muscles, often linked to stress, anxiety, and sleep issues. Comprehensive care addressing physical and psychological factors improves outcomes.
ObjectiveThis study proposed a multidisciplinary approach (psychologists, dentists, and physical therapists) to treat these conditions with non-pharmacological techniques, aiming for a more effective and personalized treatment.
MethodThe research was conducted at the Sacomã Basic Health Unit in São Paulo, Brazil, and included 12 healthcare professionals in an active intervention and 6 patients as a control group during 1 month. The intervention consisted of four weekly one-hour sessions and home therapies sent via WhatsApp, utilizing stretching, mindfulness, thermotherapy, self-massage, and cognitive-behavioral therapy. Participants completed pre- and post-intervention questionnaires on depression (PHQ-9), anxiety (GAD-7), bruxism (OBC), and pain (GCPS and Pain Drawing).
ResultsThe interventions resulted in significant reductions in the PHQ-9 (p=0.028), GAD-7 (p=0.039), OBC (p=0.015), and PD (p=0.016) scales, demonstrating the positive impact of group dynamics. Additionally, there was a decrease in pain and an improvement in the quality of life of the participants.
ConclusionDespite sample limitations, the data indicate that multidisciplinary interventions can effectively manage TMD, resulting in reduced pain and associated symptoms. The approach showed potential to improve patients\u27 quality of life, highlighting the importance of integrated and personalized treatment. Future studies with larger samples and extended follow-up are necessary to validate these findings and expand the applicability of theIntrodução
A pandemia de COVID-19 aumentou o estresse, a ansiedade e o sofrimento psicológico, especialmente entre profissionais de saúde, resultando em condições como disfunção temporomandibular (DTM) e bruxismo.
Objetivo
Este estudo propôs uma abordagem multidisciplinar (psicólogos, dentistas e fisioterapeutas) para tratar essas condições com técnicas não medicamentosas, visando um tratamento mais eficaz e personalizado.
Método
A pesquisa foi conduzida na Unidade Básica de Saúde Sacomã, em São Paulo, Brasil, e incluiu 12 profissionais de saúde em uma intervenção ativa e 6 pacientes como grupo controle. A intervenção consistiu em quatro sessões semanais de uma hora e terapias domiciliares enviadas por WhatsApp, utilizando alongamentos, mindfulness, termoterapia, automassagem e terapia cognitivo-comportamental. Os participantes preencheram questionários pré e pós-intervenção sobre depressão (PHQ-9), ansiedade (GAD-7), bruxismo (OBC) e dor (GCPS e Pain Drawing).
Resultados
As intervenções resultaram em reduções significativas nas escalas PHQ-9 (p=0,028), GAD-7 (p=0,039), OBC (p=0,015) e PD (p=0,016), evidenciando o impacto positivo das dinâmicas grupais. Além disso, houve diminuição da dor e melhora na qualidade de vida dos participantes.
Conclusão
Apesar das limitações da amostra, os dados indicam que intervenções multidisciplinares podem gerenciar efetivamente a DTM, resultando na redução da dor e dos sintomas associados. A abordagem demonstrou potencial para melhorar a qualidade de vida dos pacientes, ressaltando a importância de um tratamento integrado e personalizado. Estudos futuros com amostras maiores e acompanhamento prolongado são necessários para validar esses achados e ampliar a aplicabilidade das intervenções
Translation and validation of MIDAS for Brazilians
Full text linkBackground and objective: The Migraine Disability Assessment (MIDAS) is a widely used tool for evaluating disability associated with migraines. However, although a translated version exists in Brazil, its adaptation did not follow the methodological standards recommended by guidelines. Therefore, this study aimed to translate and validate MIDAS for the Brazilian population. Methods: This is a methodological study conducted in two stages: translation and adaptation, following the recommendations of the Professional Society for Health Economics and Outcomes Research, and measurement properties analysis, including intra-rater reliability using the Intraclass Correlation Coefficient (ICC), internal consistency with Cronbach\u27s alpha, content validity through the Content Validity Index (CVI), criterion validity using Spearman\u27s correlation, and content validity evaluated through the CVI based on the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN). A total of 149 individuals participated, comprising both sexes, with a mean age of 38 ± 12 years, all diagnosed with migraine according to the ICHD-3 criteria. Results: During translation and cultural adaptation, minimal changes were made to the original MIDAS structure. The measurement properties demonstrated moderate intra-rater reliability (ICC = 0.612; 95% Confidence Interval = 0.312–0.803; F (25, 25) = 4.286; p < 0.001), internal consistency with a Cronbach\u27s alpha of 0.655, and a weak positive correlation between MIDAS and HIT-6. The global CVI was 0.78, considered satisfactory for content validity. Conclusion: The MIDAS instrument adapted to Brazilian Portuguese is valid for measuring migraine-related disability.CONTEXTO E OBJETIVO: O Migraine Disability Assessment (MIDAS) é uma ferramenta amplamente utilizada para avaliar incapacidade associada a migrânea. No entanto, embora exista uma versão traduzida no Brasil, sua adaptação não seguiu os padrões metodológicos recomendados por guidelines., portanto o objetivo deste estudo foi traduzir e validar o MIDAS para a população do Brasil. MÉTODO: É um estudo metodológico, realizado em duas etapas: Tradução e adaptação, conforme as recomendações Professional Society for Health Economics and Outcomes Research, e análise das propriedades de medida: confiabilidade intra-avaliador pelo Coeficiente de Correlação Intraclasse (ICC), consistência interna pelo alfa Cronbach, Índice de validade de conteúdo (IVC) validade de critério pela correlação de Spearman e validade de conteúdo pelo Indice de Validade de Conteúdo (IVC) conforme Consensus-based Standards for the selection of health Measurement Instruments. Participaram 149 indivíduos, de ambos os sexos, com idade média de 38土12 anos, com diagnóstico de migrânea pela ICHD-3. RESULTADOS: Na tradução e adaptação cultural, foram realizadas alteração mínima na estrutura original do MIDAS. As propriedades de medida apresentaram concordância moderada intra-avaliador (ICC = 0,612; Intervalo de Confiança 95% = (0,312 - 0,803); F (25, 25) = 4,286; p <0,001), consistência interna com alfa de Cronbach de 0,655 e correlação fraca e positiva, entre MIDAS e HIT6. O IVC global foi de 0,78, considerado satisfatório para a validade de conteúdo. CONCLUSÃO: O instrumento MIDAS adaptado para o português do Brasil, é válido para medir a incapacidade relacionada à migrânea
Dissecção da artéria carótida interna associada à infecção aguda pelo vírus da dengue: relato de caso
No full textCervical artery dissections (CAD) can occur spontaneously or as a direct result of significant trauma. Viral infections, such as SARS-CoV2, influenza, and Epstein Barr, are risk factors for spontaneous CAD. Dengue virus infections have dramatically increased in recent decades, and Brazil is one of the endemic areas. The dengue virus can cause headache and neurological complications such as encephalitis, myelitis, Guillain-Barré syndrome, and myositis. No report has yet been found in the literature of dissection of the internal carotid artery secondary to dengue infection. Our objective is to report the case of a patient with dissection of the internal carotid artery associated with acute dengue virus infection.As dissecções das artérias cervicais (DAC) podem ocorrer espontaneamente ou como resultado direto de trauma.Infecções por SARS-CoV2, influenza, Epstein Barr, entre outros são fatores de risco para DAC. As infecções pelo vírus da dengue vêm aumentando dramaticamente e o Brasil é uma área de alta prevalência. A dengue cursa com cefaleia e manifestações neurológicas tais comoencefalite, mielite, síndrome de Guillain-Barré e miosite. Não há relato prévio de dissecção da artéria carótida interna associada a essa infecção. Nosso objetivo é relatar o caso de um paciente com quadro de dissecção da artéria carótida internaassociada a infecção aguda pelo vírus da dengue.