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Correlação entre bruxismo do sono e cefaleias avaliadas pela Polissonografia
No full textObjective - This aims to investigate a potential correlation between sleep bruxism (SB) and patients complaining of primary headaches whose previous diagnose was polysomnography (PSG) with electrodes positioned in the masseter region.
Background - Sleep bruxism is an abnormal repetitive activity of masticatory muscles. It occurs during sleep for short or long periods, with or without dental contact. Several studies have deemed it as possible causative and/or aggravating factors of primary headaches.
Method - The sample consisted of observing 91 electronic records of patients (65 females and 26 males) diagnosed with some type of primary headache. The adopted criteria were those of the International Classification of Headache Disorders, 3rd edition (ICHD-3 Beta). All patients underwent polysomnography with electrodes on the masseters to assess the presence of sleep bruxism. Data were analyzed using Chi-square test and Student t test, with a confidence interval of 95%, adopting p < 0.05 as level of significance. The JASP software, version 0.17.2.1, was used for analyses.
Results: There were no statistically significant differences regarding the correlation between different types of primary headaches and the presence of sleep bruxism.
Conclusion: The results suggest that the presence of sleep bruxism identified by polysomnography does not point to a significantly high incidence of primary headaches compared to individuals in whom the absence of bruxism was confirmed by the same method.
Objetivo - Este estudo foi desenvolvido para avaliar a possível correlação entre o Bruxismo do Sono e pacientes portadores de cefaleia primária. Background - O Bruxismo do Sono é uma atividade repetitiva anormal dos músculos mastigatórios de curta ou longa duração, com ou sem contato dentário, que vem sendo associada em muitos estudos como uma das possíveis fontes causadoras e/ou agravantes de cefaleias primárias. Método - A amostra consistiu na observação de 91 prontuários eletrônicos de pacientes (65 mulheres e 26 homens) que foram diagnosticados com algum tipo de cefaleia primária, utilizando critérios estabelecidos pela International Classification of Headache Disorders, 3ª edição. Todos os pacientes haviam realizado o exame de polissonografia com eletrodo em masseteres para avaliar a presença de Bruxismo do Sono. Os dados foram analisados pelos testes qui-quadrado e teste T de Student, com intervalo de confiança de 95% e adotando p < 0,05 como nível de significância, utilizando o software JASP versão 0.17.2.1. Resultados - Foram verificados os sintomas de Bruxismo do Sono por meio do exame de polissonografia do paciente, não se constatou uma diferença estatisticamente significante (p>0,05) em comparação entre os diferentes tipos de cefaleia e ter ou não ter bruxismo. Conclusão - O estudo revelou que indivíduos com bruxismo não apresentaram maior incidência de cefaleia em comparação com aqueles sem bruxismo.
Palavras chaves: Bruxismo do Sono, Polissonografia, Cefaleia, Cefaleia de Tipo Tensional, Transtornos de Enxaqueca
Myofascial pain with referred pain and its relation to headache attributed to temporomandibular dysfunction
Full text linkMyofascial pain with referred pain refers to any type of pain in the craniofacial region that is perceived in an anatomically different location from the original site of pain. This non-odontogenic pain is typically referred from the masticatory and cervical muscles and can manifest in the teeth, ear, face, anterior region of the head, jaw, and temporomandibular joint (TMJ). According to the ICHD-3 classification (2018), headache attributed to temporomandibular joint is considered a secondary headache, where jaw movement or pressure applied to the TMJ or surrounding musculature often exacerbates the headache. The objective of this study was to investigate the correlation between myofascial pain with referred pain and headache attributed to TMJ dysfunction in patients from a temporomandibular dysfunction clinic. An observational cross-sectional study was conducted using data from patients at the professional master\u27s program in temporomandibular dysfunction (TMD) and orofacial pain at São Leopoldo Mandic University – Campinas, from 2015 to 2021, with a sample of 1059 clinical records. Collected data included patient gender, age group, and clinical diagnosis based on the TMD diagnostic criteria (DC). Results showed that the highest prevalence of headache attributed to TMJ dysfunction occurred in females aged 41 to 60 years old, and a significant correlation was detected between age and diagnosis of headache attributed to TMJ dysfunction, which was inversely proportional. Among the classifications, myofascial pain with referred pain stood out, affecting 425 participants. Of these, when data were analyzed in paired form, it was found that 152 participants were also diagnosed with headache attributed to TMJ dysfunction. Testing the correlation between the variables of presence of myofascial pain with referred pain and headache attributed to TMJ dysfunction revealed a significant directly proportional correlation. It is crucial for healthcare professionals to be aware of clinical possibilities, such as the formation of myofascial trigger points, with myofascial pain with referred pain being a trigger for headache attributed to TMJ dysfunction. This awareness can help avoid unnecessary treatments for pain management
Individuals with headache present increased peripheral cefhalica and extracephalic sensitivity
Full text linkIntroduction: Individuals with headache present changes in the pain threshold due to pressure in the cervical region, however the literature remains controversial regarding the reduction of this parameter in the masticatory muscles. Objective: To evaluate peripheral sensitization of cephalic and extracephalic regions in individuals with and without headache. Materials and methods: Case-control study, with young adult individuals with and without headache, aged between 18 and 30 years old and excluding those with other chronic pain such as fibromyalgia, temporomandibular disorder and who had undergone previous orthognathic surgery, treatment for TMD or suffered trauma on the face. The Headache Screening Questionnaire was used to assess the frequency, intensity and duration of attacks and possible diagnosis of headache, and the Fonseca Anamnestic Index was used to verify the presence of temporomandibular disorder, considered as without TMD those who obtained <45 points, which pressure pain threshold was used to verify peripheral sensitization, using the digital algometer (Kratos®, model A-30), in the temporal muscles, masseter, tibialis anterior and thenar region,in a randomized way, three measurements were collected and the average was used.The difference between groups was compared using analysis of variance (ANOVA). The level of statistical significance was p≤ 0.05. Result: The sample consisted of 79 volunteers, n=45 belonging to the headache group (GCC), with n=13 (28.8%) diagnosed with episodic migraine and n= 32 (71.1%) tension-type headache en= 34 for the control group (CG). homogeneous values were observed regarding age, sex and height p=0.67, except for weight, which was higher in the GCC p=0.053. A significant difference was observed between the groups, for the cephalic, temporal (p=0.001) and masseter (p=0.04) and extracephalic anterior tibial muscles (p=0.002). Conclusion: Individuals with headache have a reduced pain threshold in the cephalic and extracephalic regions, especially those with migraine, pointing to the need for evaluation and treatment of this condition in patients with headache
Cefaleia hípnica em um paciente jovem (35 anos): uma entidade rara.
No full textINTRODUCTION: Hypnic Headache (HH), known as "Alarm Clock Headache," is a rare primary headache disorder characterized by recurrent episodes that predominantly occur during nighttime sleep. Initially described by Raskin, who reported six cases over nine years, the condition was initially noted to be more prevalent in men. However, current evidence suggests a higher prevalence in women. Though typically associated with patients over 50, there are reports of its occurrence in younger individuals. OBJECTIVE: This case report aims to document and describe the clinical presentation, management, and treatment response of a young patient with HH. The case is significant due to the patient\u27s relatively young age and the intensity and frequency of nocturnal headache episodes. The effective treatment response highlights a promising therapeutic approach for similar cases, enhancing clinical understanding and personalized management of HH in younger patients. CASE REPORT: A 35-year-old female smoker with mild depression has experienced recurrent episodes of headache awakening her from sleep for approximately 14 months. The headaches are diffuse, non-pulsatile, moderate to severe in intensity, lasting 30 to 45 minutes, and resolve spontaneously. There are no associated autonomic changes or focal neurological signs on general, neurological, or imaging examinations (MRI and CT). Treatment with lithium carbonate and melatonin resulted in a significant improvement of approximately 90% in pain intensity within 4 weeks. CONCLUSION: This case underscores the importance of recognizing and managing HH in younger patients, where the condition may be less common but equally impactful on quality of life. Further studies are essential to expand our understanding of this rare neurological condition and explore additional therapeutic options. This report aims to provide valuable insights into the clinical presentation and effective management of HH in younger patients.INTRODUÇÃO: A cefaleia hípnica (CH), conhecida como "Alarm Clock Headache", é um distúrbio raro de cefaleia primária caracterizado por episódios recorrentes que ocorrem predominantemente durante o sono noturno. Inicialmente descrita por Raskin, que relatou seis casos ao longo de nove anos, a condição foi inicialmente observada como sendo mais prevalente em homens. No entanto, evidências atuais sugerem uma maior prevalência em mulheres. Embora tipicamente associada a pacientes com mais de 50 anos, há relatos de sua ocorrência em indivíduos mais jovens. OBJETIVO: Este relato de caso visa documentar e descrever a apresentação clínica, manejo e resposta ao tratamento de uma paciente jovem com CH. O caso é significativo devido à idade relativamente jovem da paciente e à intensidade e frequência dos episódios de cefaleia noturna. A resposta eficaz ao tratamento destaca uma abordagem terapêutica promissora para casos semelhantes, aprimorando a compreensão clínica e o manejo personalizado da CH em pacientes mais jovens. RELATO DE CASO: Uma mulher de 35 anos, fumante e com depressão leve, apresentou episódios recorrentes de cefaleia que a despertavam do sono por aproximadamente 14 meses. As cefaleias são difusas, não pulsáteis, de intensidade moderada a severa, duram de 30 a 45 minutos e se resolvem espontaneamente. Não há alterações autonômicas associadas ou sinais neurológicos focais nos exames gerais, neurológicos ou de imagem (RM e TC). O tratamento com carbonato de lítio e melatonina resultou em uma melhora significativa de aproximadamente 90% na intensidade da dor dentro de 4 semanas. CONCLUSÃO: Este caso destaca a importância de reconhecer e manejar a CH em pacientes mais jovens, onde a condição pode ser menos comum, mas igualmente impactante na qualidade de vida. Estudos adicionais são essenciais para expandir nossa compreensão dessa rara condição neurológica e explorar opções terapêuticas adicionais. Este relato visa fornecer insights valiosos sobre a apresentação clínica e o manejo eficaz da CH em pacientes mais jovens
A scientometric analysis of CGRP and CGRP receptors in migraine research: trends, impact, and therapeutic potential
Full text linkCalcitonin gene-related peptide (CGRP) and CGRP receptors, present in the trigeminovascular system, are found in high concentrations in the jugular plasma during headache attacks. Therefore, the use of CGRP antagonists is being evaluated as a treatment for migraines. In this context, this study aimed to outline information on the state of the art about the relationship between CGRP and CGRP receptors with headaches, as well as the therapeutic approaches that explore this relationship through a scientometric analysis. Published literature from Web of Science database (webofscience.com/wos) was screened following the PRISMA protocol, and 1127 publications that matched the descriptors “headache” or “migraine” and “calcitonin gene-related peptide” in their title and/or abstract were selected. We excluded all review papers, all studies prior to 2014, and those that were not in English or outside this research\u27s scope, leaving 314 original articles. For the analysis of the information, the number of publications in the last decade, country, research areas, journal of publication, and the journal\u27s impact factor were evaluated. In this perspective, there has been an increase in relevance on the subject since 2020, as 215 out of the 314 selected articles, representing 68.5% of the publications in the last 10 years, were published during this period. Additionally, of 166 articles that provided the first author\u27s institutional address, 62 were published in the USA (19.7% of the total publications). This finding suggests a special contribution of this country in this subject, followed by Italy and Denmark, the second and third largest producers, respectively. The research areas most interested in the relationship between CGRP and headache are neuroscience and pharmacology, with 54.1% and 17.9% of the studies, respectively. The average impact factor of all journals analyzed was 8.346, ranging from 0,20 to 202.73, indicating the significance of the CGRP receptors in further knowledge and development of new treatments for migraines. 
Physiopathology of Peripheral Sensitization and Mechanism of Action of Gabapentin in Occipital Neuralgia
Full text linkIntroduction
Peripheral sensitization (PS) characterized by hypersensitivity of nociceptors is a key process in the pathophysiology of occipital neuralgia (ON). PS amplifies neuronal excitability and pain perception due to upregulation of ion channels and receptors. Gabapentin seems to treat ON by mitigating PS and providing analgesic relief in neuropathic pain.
Objectives
This study aims to summarize the literature regarding the physiopathology of PS in ON and to comprehend gabapentin’s mechanism of action in ON.
Methods
In May 2024, three searches were conducted in MEDLINE, LILACS, and PubMed databases. Using the descriptors "peripheral sensitization" AND "Physiology" 227 results were obtained; "Gabapentin" AND "Pharmacology" OR "Neuralgia" yielded 756 results; and "Occipital Neuralgia" AND "Physiology" OR "Physiopathology" 380 results. After applying inclusion criteria for analysis, 33 articles were analyzed, resulting in 4, 14, and 15 articles for each subtheme respectively.
Results
ON is characterized by severe paroxysmal attacks of headaches, throbbing or stabbing in quality, at the suboccipital region. Other symptoms include scalp tenderness and trigger points. The pronociceptive functions involved in the pathogenesis of pain result from damage to the occipital nerves causing PS, where primary inflamed afferent neurons become hyperresponsive. Inflammatory mediators like prostaglandins and cytokines sensitize nociceptors, while nerve injuries alter ion channels, increasing neuronal excitability. The inflammatory-sensitive receptor TRPV1 upregulates, and damaged nerve fibers release nerve growth factor (NFG), further amplifying sensitivity. Underlying mechanisms of ON include the role of calcitonin gene-related peptide (CGRP) in maintaining hypersensitivity and contributing to pain perception. Gabapentin\u27s efficacy in ON is attributed to its interaction with the α2δ subunit of voltage-gated calcium channels, reducing the influx of calcium and diminishing neurotransmitter release. As a result, it reduces neuronal excitability and mitigates pain.
Conclusion
PS is crucial to understanding ON’s pathophysiology. The hypersensitivity and increased pain perception are influenced by inflammatory mediators and receptors, such as TRPV1 and CGRP. Gabapentin indirectly manages ON and provides analgesic relief by modulating calcium channels and reducing neuronal excitability. Further research is needed into gabapentin\u27s mechanisms and potential applications in ON to enhance therapeutic strategies
Hospitalization and thrombolysis or dual antiplatelet therapy in hemiplegic migraine patients: a cohort of 21 patients from a tertiary headache center
Full text linkIntroduction: Hemiplegic migraine (HM) is a rare form of migraine that closely mimics stroke, often leading to hospitalizations. In resource-limited settings, distinguishing between HM and stroke is crucial to avoid unnecessary and costly treatments such as thrombolysis (TICI) and dual antiplatelet therapy (DAPT) and their risks. Typically, with clinical and laboratory evaluations alongside computed tomography (CT), the incidence of stroke mimic admissions can be reduced to 4-6.5%. This study aimed to evaluate the hospitalization rates and use of TICI and DAPT in HM patients followed up in a tertiary headache service.
Methods: A retrospective cohort study was conducted on 21 patients diagnosed with HM at our Headache Outpatient Clinic in Fortaleza, Brazil. Data collected included demographics, clinical history, hospitalization status, and treatment details. Statistical analyses were performed to identify correlations between hospitalization and stroke treatments.
Results: The study included 21 HM patients (mean age 37.67 years, SD 9.65; 95.2% female). Hospitalization was required for 66.7% (14/21) of the patients due to suspected acute cerebrovascular events. Among hospitalized patients, 9.5% (2/21) received thrombolysis, and 14.3% (3/21) were administered DAPT, exceeding the typical stroke mimic admission rates of 4-6.5% after CT evaluation. The decision for hospitalization was strongly correlated with suspected stroke (r = 0.90) but the option to perform thrombolysis or prescribe DAPT did not correlate with any of the other variables studied.
Conclusions: Hospitalization due to suspected stroke is common among HM patients. The administration of thrombolysis and DAPT, though limited, exceeds typical rates seen in stroke care. This underscores the need for precise diagnostic criteria and cautious use of costly, risky unnecessary treatments to manage HM effectively especially in resource-limited settings.
 
English
No full textINTRODUCTION: Orgasmic headache (OH) is a rare, sudden and severe headache that occurs at the time of or shortly after an orgasm. This type of primary headache associated with sexual activity typically lasts from 1 minute to 24 hours with severe pain and up to 72 hours with mild pain. OH can manifest at any sexually active age and is more common in men than in women. Studies have shown that up to 40% of cases of primary headache associated with sexual activity exhibit a chronic pattern lasting over a year. When diagnosing, it is crucial to meticulously rule out other serious conditions such as subarachnoid hemorrhage, arterial dissection, and reversible cerebral vasoconstriction syndrome. OBJECTIVE: Describing and recognizing a rare pathology. CASE REPORT: We present the case of a 38-year-old female university professor from Campina Grande, Paraíba, with no significant medical history. The patient complained of sudden, severe, explosive headache during sexual activity, characterized as holocranial and of high intensity, accompanied by nausea and vomiting. The headache persisted for up to 24 hours post-activity but with reduced intensity. The patient reported partial relief with over-the-counter analgesics. She experienced 6 similar episodes over the last 3 months, which caused fear and led to sexual abstinence. General and neurological physical examinations were unremarkable. Diagnostic tests including cranial CT scan, cranial MRI, angiotomography, and ambulatory blood pressure monitoring (ABPM) showed normal results. Based on the clinical presentation and investigative findings, a diagnosis of orgasmic headache was made. Prophylactic treatment with indomethacin before sexual activity was initiated. CONCLUSION: Accurate diagnosis of orgasmic headache is crucial to distinguish it from serious conditions like spontaneous subarachnoid hemorrhage (sSAH). Excluding secondary causes ensures appropriate treatment, involving adjustments in sexual behavior and prophylactic medications based on headache frequency and severity, thus avoiding unnecessary interventions for more severe conditions
Cefaleia primária em punhaladas em pacientes portadores de migrânea crônica ou episódica: Prevalências, correlações e características
No full textIntroduction: Headache is one of the five most common disorders affecting humans, impacting quality of life, personal costs, and the healthcare system. Primary Stabbing Headache (PSH) is characterized by a lancinating pain lasting fractions of a second that occurs spontaneously in the absence of organic disease of the underlying structures or cranial nerves and is one of the least studied headaches to date.
Objective: This study evaluated the prevalence and clinical characteristics of PSH, correlating it with differences between chronic migraine (CM) and episodic migraine (EM).
Methods: This was a descriptive observational cross-sectional case-control study conducted between September 2023 - June 2024. Patients from the UFPR headache clinic with CM/EM and healthy controls (HC) were included. Data were collected through anamneses guided by specific questionnaires containing: semiological aspects of migraine, characteristics of PSH, allodynia, depression (PHQ-9) and anxiety (GAD-7).
Results: Patients with EM (n=49), CM (n=89), and HC (n=48) were evaluated. PSH was present in 31% of EM cases and 49% of CM cases (p=0.036); no patients in the HC group presented PSH. Pain intensity in the CM group was 8.3 points on the VAS, and 6.5 points in the EM group (p<0.001). The duration of the stabbing pain ranged from fractions of a second to seconds in 73% of cases, with subsequent discomfort lasting a few minutes. The frontal location of the stab was the most prevalent and equally common in both migraine groups (71.4%). Patients with PSH in the CM group compared to the EM group revealed more prevalent premonitory symptoms such as emotional stress (97.6%) and fatigue (50%) with p=0.006/0.044, respectively. These patients had a higher proportion of visual difficulties and other aura symptoms, including tingling, loss of strength, balance/coordination difficulties and weaker arm - all with p<0.05. Depression and anxiety questionnaire scores showed higher average scores in CM patients with PSH.
Conclusion: PSH is more prevalent and intense in CM patients, possessing some specific features that suggest shared neurobiological mechanisms. Despite the contributions, limitations include cross-sectional design and self-reporting.Introdução: A cefaleia é umas das cinco mais comuns desordens que acometem o ser humano, trazendo impacto sobre a qualidade de vida, custos pessoais e ao sistema de saúde. Cefaleia Primária em Punhaladas (CPP), caracteriza-se por uma dor penetrante/lancinante com duração de frações de segundo que ocorrem espontaneamente na ausência de doença orgânica das estruturas subjacentes ou dos nervos cranianos e é uma das cefaleias menos estudadas até o momento.
Objetivo: Avaliou-se a prevalência e as características clínicas da CPP, correlacionando-a com diferenças entre migrânea crônica (MC) e episódica (ME).
Métodos: Estudo observacional descritivo de corte transversal, modalidade caso-controle, conduzido de setembro de 2023 a junho de 2024. Pacientes do ambulatório de cefaleia da UFPR com MC/ME e controles sadios (CS) do banco de sangue do CHC foram incluídos. Dados foram coletados por anamneses guiadas por questionários específicos contendo: aspectos semiológicos da migrânea, características da CPP, alodinia, depressão (PHQ-9) e ansiedade (GAD-7).
Resultados: Foram avaliados pacientes portadores de ME (n=49), MC (n=89) e CS (n=48). Os pacientes com ME apresentaram CPP em 31% dos casos e os com MC 49% (p=0,036), nenhum paciente do grupo CS apresentou CPP. A intensidade da dor no grupo MC foi de 8,3 pontos na VSA e ME de 6,5 pontos (p<0,001). A duração da punhalada foi de fração de segundos a segundos em 73%, o desconforto subsequente durou alguns minutos. A localização frontal da punhalada foi a mais prevalente e percentualmente igual em ambos os grupos de migrânea (71,4%). Os pacientes com CPP do grupo MC quando comparados com os ME revelaram sintomas premonitórios mais prevalentes como estresse emocional (97,6%) e fadiga (50%) com p=0,006 e p=0,044, respectivamente. Falar ou emitir sons piorou a dor em 78,6% dos pacientes com CPP. Os pacientes apresentaram maior proporção de dificuldades visuais e outros sintomas de aura, incluindo formigamento, perda de força, dificuldade de equilíbrio, dificuldade de coordenação e sensação do braço estar mais fraco - todos com p<0,05. A pontuação nos questionários de depressão e ansiedade mostraram uma média de pontuação maior nos pacientes MC com CPP.
Conclusão: A CPP é mais prevalente e de maior intensidade em pacientes com MC, possuindo algumas especificidades próprias, o que sugere mecanismos neurobiológicos compartilhados. Apesar das contribuições, limitações incluem delineamento transversal e auto-relato
english english: english
No full textIntroduction: Intracranial hypertension is a rare condition in pregnant women, which can result in severe complications if not diagnosed and treated appropriately. When idiopathic in nature, it becomes more challenging, as there is no clear cause for its onset. Its pathophysiology is still not completely understood, but neuroendocrine and neurovascular alterations have been described as a possible cause. Such pathology, with its classic signs and symptoms, highlights the challenges of clinical management.
Objective: To report a case and management of idiopathic intracranial hypertension in a 24-week pregnant woman.
Case Report: A 32-year-old pregnant woman at 24 weeks gestation was referred by her obstetrician with complaints of mild to moderate holocranial headache, most intense in the occipital region, accompanied by photophobia and phonophobia, with episodes of vomiting and worsening with physical effort. She also reports pulsatile tinnitus and bilateral visual blurring when lying down. The patient denies previous episodes of headache, diplopia, dysarthria, weakness, sensory changes, imbalance, or any other neurological symptoms. She denies excessive weight gain beyond what is expected for pregnancy. She has had hypothyroidism since adolescence. Examinations: No increase in blood pressure and negative COVID-19 test. Retinography confirmed bilateral papilledema. Lumbar puncture with manometry showed an opening pressure >50 cmH2O. Brain MRI and intracranial venous MR angiography indicated signs of intracranial hypertension without cerebral venous thrombosis (CVT). Venous blood gas analysis: pH 7.32; pCO2: 33; HCO3: 17; BE: -8.4. She is taking Levothyroxine 112mcg/day; Diamox 500mg 3 times daily; Bicarbonate 2g 3 times daily. After 2 months, at the follow-up appointment, she reports that headache episodes have decreased, but pulsatile tinnitus still persists. At a trimestral reassessment, she reports that delivery was via cesarean section, denies headache, pulsatile tinnitus, and visual blurring. She returned to pre-pregnancy weight. Complete remission of symptoms.
Conclusion: This case illustrates the complexity of managing idiopathic intracranial hypertension in pregnant women. Early diagnosis and immediate intervention are crucial to avoid complications for both the mother and the fetus. Regular follow-up and monitoring were essential for a favorable outcome, with complete symptom remission after cesarean section.Introdução: A hipertensão intracraniana é uma condição rara em mulheres grávidas, podendo resultar em complicações graves se não diagnosticada e tratada adequadamente. Quando idiopática, torna-se mais desafiadora, pois não há uma causa clara para seu aparecimento. Sua fisiopatologia ainda não é completamente compreendida, mas alterações neuroendócrinas e neurovasculares têm sido descritas como possíveis causas. Essa patologia, com seus sinais e sintomas clássicos, destaca os desafios no manejo clínico.
Objetivo: Relatar um caso e o manejo de hipertensão intracraniana idiopática em uma mulher grávida de 24 semanas.
Relato de Caso: Uma mulher grávida de 32 anos, com 24 semanas de gestação, foi encaminhada por seu obstetra com queixas de cefaleia holocraniana leve a moderada, mais intensa na região occipital, acompanhada de fotofobia e fonofobia, com episódios de vômitos e piora com esforço físico. Também relata zumbido pulsátil e embaçamento visual bilateral ao deitar. Nega episódios anteriores de cefaleia, diplopia, disartria, fraqueza, alterações sensoriais, desequilíbrio ou outros sintomas neurológicos. Nega ganho excessivo de peso além do esperado na gravidez. Tem hipotireoidismo desde a adolescência. Exames: Sem aumento da pressão arterial e teste negativo para COVID-19. Retinografia confirmou papiledema bilateral. Punção lombar com manometria mostrou pressão de abertura >50 cmH2O. Ressonância magnética cerebral e angiografia por ressonância magnética venosa intracraniana indicaram sinais de hipertensão intracraniana sem trombose venosa cerebral (TVC). Análise venosa de gases sanguíneos: pH 7,32; pCO2: 33; HCO3: 17; EB: -8,4. Ela está tomando Levotiroxina 112 mcg/dia; Diamox 500 mg 3 vezes ao dia; Bicarbonato 2 g 3 vezes ao dia. Após 2 meses, na consulta de acompanhamento, ela relata que os episódios de cefaleia diminuíram, mas o zumbido pulsátil ainda persiste. Em uma reavaliação trimestral, relata que o parto foi por cesariana, nega cefaleia, zumbido pulsátil e embaçamento visual. Retornou ao peso pré-gravidez. Remissão completa dos sintomas.
Conclusão: Este caso ilustra a complexidade do manejo da hipertensão intracraniana idiopática em mulheres grávidas. O diagnóstico precoce e a intervenção imediata são cruciais para evitar complicações tanto para a mãe quanto para o feto. Acompanhamento regular e monitoramento foram essenciais para um desfecho favorável, com remissão completa dos sintomas após cesariana