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No full textIntroduction:
Attention Deficit with Hyperactivity Disorder (ADHD) and migraine are neurological conditions that significantly impact quality of life. ADHD is a neurodevelopmental disorder characterized by inattention and hyperactivity or impulsivity, while migraine is a primary headache disorder, marked by recurrent episodes of severe headache. Evidence suggests a potential comorbidity between ADHD and migraine, raising questions about pathophysiological mechanisms and risk factors.
Objectives:
This summary elucidates findings of an integrative review, evaluating research on the potential correlation between ADHD and migraine. It assesses whether ADHD increases the risk of migraine, explores potential pathophysiological mechanisms, risk factors and clinical practice implications.
Methods:
A comprehensive search of MEDLINE, LILACS and PubMed databases in June 2024, using the descriptors "Attention Deficit Disorder with Hyperactivity" AND "Migraine Disorders" yielded 96 articles, of which 23 met the inclusion criteria for analysis.
Results:
All analyzed studies indicate a significant association between ADHD, in which the diagnoses were based on DSM-5 criteria, and migraine, which evaluations were conducted clinically by physicians. One study found that ADHD nearly triples the risk of migraine, while another noted higher polygenic risk scores in individuals with both conditions. Severe ADHD correlates with poorer migraine outcomes, particularly in pediatric patients with refractory migraine. While identified risk factors for ADHD include male sex, prenatal tobacco exposure, frequent headaches, and poor academic performance, migraine is more prevalent in women with ADHD.
Even though six studies called for pathophysiological research, evidence suggests that ADHD and migraine share etiology through dopamine dysregulation. Authors propose that low dopamine environments cause hypersensitized dopamine receptors in migraines and increased presynaptic dopamine transporters in ADHD. This could explain ADHD symptoms in migraine sufferers and vice versa. Stimulant treatment for ADHD, noted to cause headaches, actually reduces headache prevalence by restoring the dopamine-norepinephrine balance. Multidisciplinary treatment is recommended by approximately 22% of studies, emphasizing the need for holistic care.
Conclusion:
The evidence confirms a relevant association between ADHD and migraine, advocating for multidisciplinary treatment strategies and further studies into shared pathophysiological mechanisms. The findings highlight the need for comprehensive management to improve outcomes for patients with comorbid ADHD and migraine
Headache: a multifaceted public health challenge
Full text linkBackground: Headaches pose a significant public health concern, affecting the quality of life of the global population and ranking among the top medical complaints. They manifest as symptoms of underlying structural or organic alterations, resulting from lifestyle factors, or as primary headaches with unknown etiopathogenesis. This multifaceted nature drives the problematic issue of self-medication, a practice that can lead to dependency and mask underlying conditions.
Objectives: To understand the importance of addressing headaches to prevent exacerbations, mitigate public health burdens in Brazil, and preserve the well-being of patients presenting with this complaint.
Methods: A search was conducted using the BVS (Virtual Health Library) with the descriptors "headache" and "symptom." Exclusion criteria included: (1) studies conducted in other countries; (2) articles that treated headache as a secondary topic; (3) non-article publications. Eight articles were selected after analyzing the results.
Results: Six articles highlight the prevalence of headaches in medical practice, affecting up to 90% of the global population at some point in their lives and requiring urgent care in at least one episode. Thorough investigation is warranted when associated with meningitis, focal neurological symptoms of oculomotor paresis, cranial nerve palsy, hemiparesis, or loss of consciousness. The personal impact on academic performance, lost workdays, and public health consequences, such as healthcare costs and self-medication, are also discussed. Two additional articles address the inconclusive correlation between headache and temporomandibular joint dysfunction (TMJ), while acknowledging it as a common symptom. Finally, the importance of identifying red flags to rule out serious illnesses is emphasized.
Conclusions: This study aimed to underscore the importance of attention to patients presenting with headache complaints. It concludes that due to the diversity of causes and effects, a comprehensive clinical examination should be performed for early detection of treatable conditions and to rule out serious illnesses. Non-pharmacological approaches are valuable allies in achieving favorable outcomes, and encouraging appropriate treatment seeking should be promoted to reduce self-medication practices associated with this condition
Association between chocolate intake and migraine
Full text linkBackground: Migraine, affecting over a billion people globally, necessitates an understanding of its triggers among primary care providers.
Objective: This study aims to elucidate the relationship between chocolate intake and migraine attacks.
Methods: A literature review was conducted across the PubMed, SciELO, and BvSalud databases using the descriptors "migraine," "trigger," and "chocolate intake." Full-text articles in English or Portuguese were included.
Results: Observational studies demonstrate an association between chocolate consumption and migraine attacks. However, randomized controlled trials show no difference between chocolate and placebo in the primary outcome. The high risk of bias in these studies, stemming from questionnaire-based data collection, susceptible to recall and reporting biases, warrants mention.
Conclusion: While observational studies suggest an association, robust evidence from randomized controlled trials does not support chocolate intake as a migraine trigger. Further investigation into the chocolate-migraine relationship is crucial, considering the possibility of chocolate cravings being a prodromal symptom of migraine
NON-PHARMACOLOGICAL THERAPIES IN THE MANAGEMENT OF CERVICOGENIC HEADACHE: A LITERATURE REVIEW
Full text linkINTRODUCTION Cervicogenic headache (CGH) is a secondary headache with a prevalence of 17.8% among headaches. It impacts quality of life, causing disability in social activities. CGH manifests as unilateral headache accompanied by nausea, neck pain, phonophobia, and photophobia. Differential diagnosis includes migraine, cervical spondylosis, and tension-type headache. Treatment combines pharmacological approaches with non-drug therapies, although there is controversy in the literature regarding which non-pharmacological options are most effective.
OBJECTIVES Analyze the most effective non-pharmacological therapies for improving the quality of life of patients with cervicogenic headache.
METHODOLOGY This is a literature review using the Medline database via PubMed, with the descriptors "Cervicogenic headache" and "Quality of life," combined with the Boolean operator "AND." A search filter was applied for "title/abstract," and articles published in the last 5 years were included. The inclusion criteria were articles with meta-analysis and literature reviews, resulting in 9 articles in English. The exclusion criteria were articles which were not available for reading and those dealing with neck pain, leaving 7 articles for analysis.
RESULTS Physical therapy is the first-line treatment for CGH. Sustained Natural Apophyseal Glides (SNAG) mobilizations lead to favorable outcomes and improve the cognitive-affective aspect of pain. Spinal manipulative therapy reduces the intensity and frequency of pain, though its effects are small and short-term. Cervical decompression surgery has shown positive results in patients with CGH associated with cervical spondylotic myelopathy, indicating a neuropathic pain mechanism for CGH. Dry-needling reduces the frequency of CGH in the short term. However, it is recommended not to apply this therapy in isolation, but to combine it with pharmacological treatment to obtain better results.
CONCLUSION Therapies with a pharmacological and non-pharmacological approach, such as physiotherapy, dry needling, and even surgery, constitute the current relief practices for cervicogenic headache. Therefore, the heterogeneity of techniques does not allow the most effective one to be chosen, but it does allow them to be combined for the individual management of each patient in order to improve quality of life, aiming to reduce the intensity and frequency of episodes.INTRODUCTION Cervicogenic headache (CGH) is a secondary headache with a prevalence of 17.8% among headaches. It impacts quality of life, causing disability in social activities. CGH manifests as unilateral headache accompanied by nausea, neck pain, phonophobia, and photophobia. Differential diagnosis includes migraine, cervical spondylosis, and tension-type headache. Treatment combines pharmacological approaches with non-drug therapies, although there is controversy in the literature regarding which non-pharmacological options are most effective.
OBJECTIVES Analyze the most effective non-pharmacological therapies for improving the quality of life of patients with cervicogenic headache.
METHODOLOGY This is a literature review using the Medline database via PubMed, with the descriptors "Cervicogenic headache" and "Quality of life," combined with the Boolean operator "AND." A search filter was applied for "title/abstract," and articles published in the last 5 years were included. The inclusion criteria were articles with meta-analysis and literature reviews, resulting in 9 articles in English. The exclusion criteria were articles which were not available for reading and those dealing with neck pain, leaving 7 articles for analysis.
RESULTS Physical therapy is the first-line treatment for CGH. Sustained Natural Apophyseal Glides (SNAG) mobilizations lead to favorable outcomes and improve the cognitive-affective aspect of pain. Spinal manipulative therapy reduces the intensity and frequency of pain, though its effects are small and short-term. Cervical decompression surgery has shown positive results in patients with CGH associated with cervical spondylotic myelopathy, indicating a neuropathic pain mechanism for CGH. Dry-needling reduces the frequency of CGH in the short term. However, it is recommended not to apply this therapy in isolation, but to combine it with pharmacological treatment to obtain better results.
CONCLUSION Therapies with a pharmacological and non-pharmacological approach, such as physiotherapy, dry needling, and even surgery, constitute the current relief practices for cervicogenic headache. Therefore, the heterogeneity of techniques does not allow the most effective one to be chosen, but it does allow them to be combined for the individual management of each patient in order to improve quality of life, aiming to reduce the intensity and frequency of episodes
English
No full textIntroduction
Cervicogenic headache (CGH) is a secondary headache arising from cervical spine disorders that must be distinguished from tension type headache. CGH may be managed through various therapeutic interventions aimed at alleviating pain and improving function.
Objective
This summary aims to evaluate the available treatments for cervicogenic headache, their indications and the level of evidence supporting them.
Methodology
A comprehensive literature review was conducted, focusing on studies that investigated the treatment of CGH. The search across MEDLINE, WPRIM, and PubMed databases used "cervicogenic," "headache," and "treatment" as search terms, yielding 64 results. After screening for relevance, 37 articles were included.
Results
Multiple treatment options are available for CGH, including cervical epidural steroid injection (CESI), acupuncture, manipulation and mobilization (manual therapy), radiofrequency ablation, deep cervical plexus block, and botulinum toxin injections. High-level evidence supports CESI, acupuncture and manual therapy. CESI is recommended for moderate to severe CGH, refractory to conservative treatments, showing improvements in pain scores. Acupuncture is suitable for patients seeking non-pharmacological treatment, reducing pain and improving functionality. Manual therapy is considered first-line treatment, with randomized controlled trials showing that combining cervical manipulation and exercises is more effective than mobilization alone.
Radiofrequency ablation and deep cervical plexus block are indicated for CGH that does not respond to other interventions, showing high efficacy and prolonged pain relief, with moderate evidence . Deep cervical plexus block is applied for short-term pain management in refractory cases, with short-term effectiveness, though its long-term benefits are limited. Botulinum toxin injections, considered when other treatments fail, have low to mixed levels of evidence (3 and 4) as they are not consistently superior to placebo in controlled trials.
Conclusion
Options ranging from conservative therapies like manual therapy and acupuncture to interventional approaches are available. The choice of treatment depends on the severity of symptoms, patient preference, and response to initial therapies. High-quality evidence supports the use of CESI, acupuncture, and radiofrequency ablation for significant and sustained pain relief, while treatments like botulinum toxin injections require further research to establish consistent efficacy. Future studies with long-term follow-up and comparative effectiveness of these interventions are needed
The relationship between screen exposure and the increase in headache rates: a narrative review
Full text linkIntroduction: Over the years, there has been a noticeable increase in the daily use of electronic devices among citizens. Due to the new lifestyle adopted by the population, various health consequences have emerged, among which the increase in the incidence of headaches is one of the most noticeable. The possibility that headaches related to screen use can impair health is a current reality with impacts and damages aren’t yet fully understood, making it essential to study the relationship between them in greater depth.
Objective: To correlate high exposure to electronic device screens with the onset of headaches.
Method: This is a narrative review conducted in the Medline database via PubMed and SciELO databases using the descriptors “headache”, "headache disorders", “computer”, "smartphone", “cellphone” and “screen time” between 2019 and 2024 in English.
Results: A direct relationship was observed between screen exposure time and higher rates of headaches, as individuals who reduced their use of digital devices showed a decrease in headache occurrences. Individuals exposed to screens for 4 to 6 hours daily are the most affected group. An exacerbating factor for increased screen time was the COVID-19 pandemic, which induced greater use of electronic devices due to online classes and remote work. The brightness and frequency of the light were the factors that most impacted the occurrence of headaches. Age group is correlated with the risk of headaches, with adults being more affected compared to children; however, the age at which exposure to digital devices begins is also a significant factor.
Conclusion: A strong correlation between screen exposure and a higher incidence of headaches was commonly observed among the researched articles. The main factors triggering this increase include longer exposure time, brightness and frequency of the light, age at which exposure to digital devices begins, and the user\u27s age. These findings demonstrate the importance of the subject matter and highlight the urgency of further studies to understand the long-term health impacts on individuals
Indicadores de eficiência para cuidados com pacientes atendidos com cefaleia no serviço de emergência
No full textIntroduction: Headache is among the routine complaints in emergency services. It is estimated that 1 to 4% of visits are due to this cause, which directly impacts hospital resources and logistics. Indicator management allows for a detailed analysis of patient flow, presenting itself as an important tool for healthcare service management.
Objective: To evaluate efficiency indicators for the care of patients with headaches in the emergency department of a private hospital in Recife.
Method: A cross-sectional study was conducted in a private hospital in Recife. Data from the Electronic Patient Record from January to June 2024 were used, extracted using a Business Intelligence-based tool. Visits with International Classification of Diseases codes R51, G44.2, G43.0, G43.1, and G43.8 were included, and patient age and sex, as well as emergency visit outcomes, were evaluated. Indicators analyzed included time of care, performance of exams, evasion, and variation of visits between shifts and days of the week.
Results: The sample included 2,304 patients, representing 4.7% of emergency visits. Most patients with headaches were female (1,726/2,304; 74.9%), with an average age of 39 years (minimum: 18; maximum: 95). Neuroimaging exams were performed on 831 (36%) patients, with cranial tomography being the most common (723/928; 77.9%). The evasion rate was 4.6%, and the hospitalization rate was 4.2%. The average care time was 2 hours and 58 minutes, increasing to 7 hours for patients who were hospitalized. Among those who underwent neuroimaging, the time was 3 hours and 41 minutes. The highest number of visits (40%) occurred in the afternoon, from 1 PM to 7 PM, and the shortest care time (2 hours and 46 minutes) was recorded at night.
Conclusion: The prevalence of headache visits occurred among women in the afternoon. The high utilization of imaging exams points to the need for developing clinical protocols to optimize resources, reduce care time and evasion rates, and improve service efficiency and patient satisfaction.Introdução: a cefaleia está entre as queixas rotineiras nos serviços de emergência. Estima-se que 1 a 4% dos atendimentos sejam por esta causa, o que impacta diretamente nos recursos e na logística hospitalar. O gerenciamento de indicadores possibilita análise detalhada do fluxo de pacientes, apresentando-se como importante ferramenta para a gestão do serviço de saúde.
Objetivo: avaliar indicadores de eficiência para cuidados com pacientes atendidos com cefaleia na emergência de um hospital privado da cidade do Recife.
Método: estudo transversal, realizado em hospital particular da cidade do Recife. Foram utilizados dados do Prontuário Eletrônico do Paciente no período de janeiro a junho de 2024, extraídos por meio de ferramenta baseada em Business Intelligence. Incluíram-se atendimentos com Código Internacional de Doenças: R51, G44.2, G43.0, G43.1 e G43.8, sendo avaliadas idade e sexo dos pacientes, bem como como os desfechos dos atendimentos na emergência. Foram analisados os indicadores: tempo de atendimento, realização de exames, evasão e variação dos atendimentos entre os turnos e dias da semana.
Resultados: a amostra contou com 2.304 pacientes, representando 4,7% dos atendimentos da emergência. A maioria dos pacientes com cefaleia era do sexo feminino (1.726/2.304; 74,9%), com média de idade de 39 anos (mínimo: 18; máximo: 95). Exames de neuroimagem foram realizados por 831 (36%) pacientes, sendo a tomografia de crânio a mais comum (723/928; 77,9%). A taxa de evasão foi de 4,6% e a de internamento 4,2%. O tempo médio de atendimento foi de 2 horas e 58 minutos, aumentando para 7 horas entre os pacientes que evoluíram para internamento. Entre aqueles que realizaram neuroimagem, o tempo foi de 3 horas e 41minutos. O maior número de atendimentos (40%) ocorreu à tarde, das 13 às 19 horas e o menor tempo de atendimento (2 horas e 46 minutos) foi registrado à noite.
Conclusão: a prevalência de atendimentos por cefaleia aconteceu com mulheres, no período vespertino. A elevada utilização de exames de imagem aponta para a necessidade de elaboração de protocolo clínico para otimizar recursos, reduzir tempo de atendimento e a taxa de evasão a fim de melhorar a eficiência do serviço e a satisfação dos pacientes
Brazilian Headache Congress 2024 Between Socrates and Silicon: The odyssey of knowledge
Full text linkChronicle about the latest Brazilian Headache Congress, held in Foz do Iguaçu in August 2024.Crônica sobre o último Congresso Brasileiro de Cefaleia, realizado em Foz do Iguaçu, em agosto de 2024.
 
Patients´ beliefs and headache-related disability
Full text linkAbstract
There is a lack of studies investigating the associations between modifiable psychological factors in migraine more comprehensively. The present study aimed to investigate the associations between self-efficacy and locus of control beliefs, cognitive distortions, depression, anxiety, psychopathological symptoms, headache headache-related disability, headache frequency, and severity in migraine patients. In addition, we compared study measures between chronic and episodic migraine patients. One hundred forty-seven (147) migraine outpatients from three Brazilian specialized headache hospital services completed measures of self-efficacy, locus of control, psychopathological symptoms, cognitive distortions, depression, anxiety, and headache-related disability. Headache-related cognitive distortions were positively correlated with psychopathological symptoms, depression, anxiety, pain catastrophizing, headache-related disability, headache frequency, and headache intensity. Self-efficacy beliefs correlated negatively with all psychological and clinical measures. Chance locus of control correlated positively with depression, anxiety, psychopathological symptoms, pain catastrophizing, headache-related disability, and headache intensity. Compared to episodic migraine patients, those with chronic migraine showed significantly higher levels of cognitive distortions and chance locus of control but lower levels of self-efficacy in headache management. The results brought evidence that patients\u27 cognitive and emotional responses to their headaches are associated with headache-related disability and chronicity. Furthermore, they reinforce the need to evaluate and treat those modifiable psychological factors in daily clinical practice.Resumo
Há uma escassez de estudos que investiguem de forma mais abrangente as associações entre os fatores psicológicos modificáveis na enxaqueca. O objetivo do presente estudo foi investigar as associações entre autoeficácia e crenças de locus de controle, distorções cognitivas, depressão, ansiedade, sintomas psicopatológicos, incapacidade relacionada à cefaleia, frequência e gravidade da cefaleia em pacientes com enxaqueca. Além disso, o presente estudo visa comparar as medidas entre pacientes com enxaqueca crônica e episódica. Cento e quarenta e sete (147) pacientes ambulatoriais com enxaqueca de três serviços hospitalares especializados em cefaleia no Brasil completaram medidas de autoeficácia, locus de controle, sintomas psicopatológicos, distorções cognitivas, depressão, ansiedade e incapacidade relacionada à cefaleia. As distorções cognitivas relacionadas à cefaleia foram positivamente correlacionadas com sintomas psicopatológicos, depressão, ansiedade, catastrofização da dor, incapacidade relacionada à cefaleia, frequência e intensidade da cefaleia. As crenças de autoeficácia correlacionaram-se negativamente com todas as medidas psicológicas e clínicas. O locus de controle correlacionou-se positivamente com depressão, ansiedade, sintomas psicopatológicos, catastrofização da dor, incapacidade relacionada à cefaleia e intensidade da cefaleia. Comparados aos pacientes com enxaqueca episódica, aqueles com enxaqueca crônica apresentaram níveis significativamente mais altos de distorções cognitivas e locus de controle, e níveis mais baixos de autoeficácia no manejo da cefaleia. Os resultados trouxeram evidências de que as respostas cognitivas e emocionais dos pacientes à sua cefaleia estão associadas à incapacidade e cronicidade relacionadas à cefaleia. Além disso, eles reforçam a necessidade de avaliar e tratar esses fatores psicológicos modificáveis na prática clínica diária
Funções executivas e atencionais no paciente com enxaqueca
No full textAbstract
Introduction: Migraine is a disease that affects the overall performance of the patient (especially Executive and attention functions) with a direct impact on the person\u27s functionality, highlighting the importance of studies in order to minimize its damage. Objective: This study aimed to relate Executive and Attentional Functions with migraine, through neuropsychological tests. Methodology: Cross-sectional study (44 subjects; 29 migraineurs and 15 non-migraineurs) on attentional and executive changes in migraine. Subjects over 18 years of age were included in the study, regardless of gender, recruited for convenience at CAM FAME, FAME and Centro AMA, following the criteria of the International Classification of Headache Disorders (ICHD-3). The subjects underwent neuropsychological tests that estimated executive and attentional functioning. For attention, the Psychological Attention Assessment Battery (BPA) was used, and for Executive functions, the Five-Digit Test (FDT) was used. Student\u27s T test, ANOVA, Mann-Whitney and/or Kruskal-Wallis U test were used, whose analyzes fixed the type I error at 0.05. Results: All BPA subtests pointed to a reduction in the attentional potential in migraine patients when compared to the control group. The FDT showed lowering in the group of subjects with migraine, when compared with the non-migraine group (inhibition = 0.3092; flexibility = 0.2323). Multivariate analysis identified a relationship between EF, Attention and migraine (p<0.05). Conclusion: Individuals with migraine present a decrease in EF and Attentional Skills and an increase in execution time when compared to non-migraine individuals.
Keywords: Headache, Migraine, Executive Functions, Attention. RESUMO
Introdução: A migrânea é uma doença que afeta o desempenho global do paciente (sobretudo Funções Executivas e atencionais) com impacto direto na funcionalidade da pessoa, evidenciando a importância de estudos, a fim de minimizar seus danos. Objetivo: Este estudo objetivou relacionar as Funções Executivas e atencionais com a migrânea, através de testes neuropsicológicos. Metodologia: Estudo de corte transversal (44 sujeitos; 29 migranosos e 15 não-migranosos), sobre alterações atencionais e executivas na migrânea. Foram incluídos no estudo, independentemente do sexo, sujeitos acima de 18 anos, recrutados por conveniência no CAM FAME, FAME e Centro AMA, seguindo os critérios da Classificação Internacional da Cefaleia (ICHD-3). Os sujeitos foram submetidos a testes neuropsicológicos que estimaram o funcionamento executivo e atencional. Para a atenção foi utilizada a Bateria Psicológica de Avaliação da Atenção (BPA) e para as funções Executivas foi utilizado o Teste dos Cinco Dígitos (FDT). Foram utilizados Teste T de Student, ANOVA, Teste U de Mann-Whitney e/ou Kruskal-Wallis, cujas análises fixaram o erro do tipo I em 0,05. Resultados: Todos os subtestes da BPA apontaram redução do potencial atencional nos migranosos quando comparados ao grupo controle. O FDT mostrou rebaixamento no grupo de sujeitos com migrânea, quando comparado com o dos não migranosos (inibição = 0, 3092; flexibilidade = 0, 2323). A análise multivariada identificou relação entre FE, Atenção e migrânea (p<0.05). Conclusão: Indivíduos com migrânea apresentam rebaixamento nas FE e nas Habilidades Atencionais e aumento no tempo de execução quando comparados com indivíduos não migranosos.
Palavras-chaves: Cefaleia, Migrânea, Funções Executivas, Atenção.