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Prevalência de compulsão em migranosos e sua associação com uso excessivo de analgesia
No full textIntroductionMigraine, is one of the most prevalent types of headaches, affects around 15% of people world wide, more common among women, causes a great effect in the quality of life of the individual. With the purpose to ease phonophobia, photophobia, nausea followed by vomiting, unilateral, pulsatile and intense, headache crisis the patients have a drug overuse. The medication-overuse headache (MOH) is an emerging problem, due to the possibility of developing psychiatric disorders like obsessive compulsive disorder (OCD). ObjectiveDetermine a prevalence of OCD in migraine patients, evaluating different scopes of it, including the association or not with drug abuse.MethodsA cross-sectional study with 117 patients of both sexes, older than 18 years old. Three questionnaires were used: Barratt Impulsiveness Scale (BIS-11); Obsessive Compulsive Inventory-Revised (OCI-R) and the Migraine Disability Assessment (MIDAS). The data collected was placed in an electronic worksheet and processed in Software SPSS Statistics 22.0. There was an assumption of a p value of 0,05 to all cases with the intention to reject the null hypothesis.ResultsFindings suggest that individuals with a medication-overuse profile have a higher tendency to develop compulsive symptoms and the seriousness of the migraine symptoms is extremely related to medication-overuse headache.ConclusionThe study showed that patients with medication-overuse headache have a higher tendency to develop compulsive behavior.IntroduçãoA migrânea ou enxaqueca, dentre as diversas formas clínicas das cefaleias, é uma das apresentações mais comuns, acometendo cerca de 15% da população mundial, predominantemente mulheres, causando intenso impacto na qualidade de vida do indivíduo. Com o objetivo de aliviar a fonofobia, fotofobia, vômitos precedidos de náuseas, crises unilaterais, pulsáteis e intensas, seus portadores fazem uso excessivo de analgésicos. O uso excessivo de medicação é um problema crescente que depende de controle e manejo, visto que existe a possibilidade do desenvolvimento de transtornos psíquicos como a compulsão nesses pacientes.ObjetivoAvaliar a presença de comportamento compulsivo em pacientes migranosos, observando diferentes âmbitos dessa prevalência, como sua relação com o uso excessivo ou não de analgésicos. MétodosTrata-se de estudo de corte transversal e descritivo com 117 pacientes de ambos os sexos, maiores de 18 anos. Foram aplicados três questionários: Escala de impulsividade de Barratt (BIS-11); o Inventário de Obsessões e Compulsões (OCI-R) e o MIDAS (Migraine Disability Assessment). Os dados dos questionários aplicados foram transcritos para uma planilha eletrônica e processados em Software SPSS Statistics 22.0. Assumiu-se, em todos os casos, o valor crítico de p de 0,05 para rejeição de hipóteses nulas. ResultadosOs achados sugerem que indivíduos com perfil de uso excessivo de analgésicos apresentam maior tendência a apresentarem sintomas compulsivos e que a gravidade dos sintomas migranosos se configura como outro fator extremamente associado ao uso excessivo de analgésicos.ConclusãoO estudo evidenciou que pacientes migranosos em uso excessivo de analgésicos apresentam uma maior tendência a desenvolver comportamento compulsivo
Prevalence of pain in other topographies in individuals with headache - preliminary data from a Brazilian cohort
Full text linkIntroduction: Studies show the existence of comorbidity between headaches and other painful conditions. Patients with headaches are twice as likely to report musculoskeletal pain than those without headaches. Another study showed that 83% of headache patients have neck pain, with high frequency and moderate intensity. The factors involved in the comorbidity between painful conditions are obesity, physical inactivity, anxiety, depression, stress, occupational factors, and genetic factors. Objective: To verify the prevalence of pain in another topographies (PAT) in individuals with headache, whether there is an association between PAT and the presence/frequency (episodic/chronic) of headache, and to check if there is correlation between the frequencies of headache and PAT. Methods: An analytical and descriptive study from a cohort of live births (1978/79) in Ribeirao Preto/SP. The variables of interest were: presence/frequency of headache in the last three months. PAT and the place of greatest pain considering the last three months. The regions were separated: cervical, dorsal, lumbar, upper limbs, lower limbs, abdomen, thorax and pelvis. Results: 1775 individuals attended this interviewed (average age:38.13±0.579, 52.3% female). Sixty three percent reported headache in the last 3 months (16.3% chronic headaches). Among patients with headaches, 51% had PAT. Among patients with headache and PAT, pain in the cervical region was observed in 12.1%, dorsal region in 8.7%, lumbar region in 37.4%, upper limbs in 8.7%, lower limbs in 24.6%, abdomen in 3.2%, chest in 0.9% and pelvis in 4.4%. There was an association between headache and PAT [X2(1)= 21.743, p= 0.001], with the cervical (82.9% versus 17.1%) and dorsal (79% versus 21%) regions being more prevalent among individuals with headache [X2(7)=17.778, p=0.013]. There was an association between PAT and chronic headache [X2(1)= 5.079, p= 0.024]. There was no correlation between the frequencies of headache and PAT (rs= 0.165, p< 0.001). Conclusion: In individuals with headaches in the last three months, the prevalence of PAT was 51%. An association was observed between headaches and chronic headaches with PAT. Pain in the cervical and dorsal regions was significantly more prevalent in individuals with headaches. There was no correlation between the frequencies of headache and PAT
Preditores de recuperação visual rápida na hipertensão intracraniana idiopática: um estudo de coorte
No full textIntroduction
Idiopathic intracranial hypertension (IIH) is characterized by increased intracranial pressure without a discernible cause, often leading to visual impairment and papilledema. Understanding the factors influencing visual outcomes in IIH patients is crucial for improving management strategies. This study aimed to identify predictors of satisfactory visual outcome (SATISF) defined as the resolution of reduced visual acuity and/or disappearance of papilledema.
Objective
To evaluate the factors associated with satisfactory visual outcomes in female patients with IIH.
Methods
This retrospective cohort study included female patients diagnosed with IIH. The potential predictors of a satisfactory visual outcome evaluated were age, initial body mass index (BMI), cerebrospinal fluid (CSF) opening pressure (Pi), duration of symptoms, and the need to discontinue acetazolamide. Visual outcomes were categorized as SATISF or non-satisfactory (NAOSATISF). Independent sample t-tests were used for comparing means, and chi-square tests were employed for comparing proportions. The average interval between the first and second visual assessments was 55.4±48.4 days.
Results
The study involved the following comparative results:
Age: NAOSATISF 32.2±12 years, SATISF 35.9±18.8 years, P=0.3
BMI: NAOSATISF 33.4±4.3, SATISF 33.7±4.3, P=0.8
Pi: NAOSATISF 41.7±12.5 cmH2O, SATISF 39.3±13.2 cmH2O, P=0.5
Duration of symptoms: NAOSATISF 352.25±566.5 days, SATISF 317.2±815.7 days, P=0.9
Acetazolamide discontinuation: NAOSATISF 4.7%, SATISF 15.7%, P=0.24
None of the evaluated factors showed a statistically significant association with satisfactory visual outcomes.
Conclusion
This study did not identify any significant predictors of satisfactory visual outcomes in IIH patients. The results suggest that age, BMI, CSF opening pressure, duration of symptoms, and the need for acetazolamide discontinuation do not significantly impact visual recovery. Further research is needed to better understand the factors contributing to the rapid neuro-ophthalmological recovery in IIH patients
English
No full textIntroduction: There is a high prevalence of neck pain in patients with migraine, which when reported can show a worse clinical presentation of the disease, such as more prominent signs and symptoms and a worse psychological burden, reinforcing its impact. However, the way it is interpreted by patients is still little explored and known.Objective: To understand the relevance of neck pain for patients with migraine, observing their perception, beliefs and strategies for dealing with this symptom.
Methods: This is a qualitative, descriptive and exploratory study, developed in accordance with the COREQ and SRQR, approved by the CEP (CAAE: 58915822.1.0000.5440). Twenty-four individuals aged between 18 and 55 diagnosed with migraine according to the 3rd edition of the International Classification of Headache Disorders and with self-reported neck pain took part in a semi-structured interview. The transcripts were subjected to thematic analysis and inductive coding.
Results: Four themes emerged from the analysis: 1) Pain characteristics; 2) Pain beliefs; 3) Coping strategies; 4) Emotional aspects. Patients describe their pain as something rigid and locking, being an uncomfortable and very painful sensation. There is a diversity of opinions on the cause, some relating it directly to migraine and others to emotions and their body positioning. With regard to management, as the main prevention strategy, patients reported stretching and exercising. The coping strategies mentioned were active movements, self-massage and medication, such as common painkillers and muscle relaxants when the pain is strongest. These patients also reported not allowing neck pain to affect their routine activities. Emotions such as anxiety, sadness and frustration were mentioned.
Conclusion: This study provides important insights into the views of patients with migraine regarding neck pain and their management strategies, but there is still a diversity of opinions regarding the understanding of the cause of neck pain. Professionals should include this condition in their clinical assessments, giving due attention to the craniocervical system, so that they can individually advise patients about this condition and how it should be managed, thus encouraging better choices
Sphenopalatine Ganglion Block in Refractory Cluster Headache: A Case Report
Full text linkIntroduction: Cluster headache is a severe and debilitating trigeminal-autonomic headache. It is often underdiagnosed, has few therapeutic options, and in 10-20% of cases, patients can be refractory to acute and prophylactic medications.
Objective: To describe a difficult to manage cluster headache responsive only to sphenopalatine block
Case Report A 58-year-old woman presented with intense, right-sided orbital pain, with 60-minute duration attacks occurring 1-2 times a day, mostly at night. These were associated with right-sided ptosis, conjunctival hyperemia, lacrimation, and rhinorrhea. The patient had previously tried prophylactic treatment with verapamil 320 mg/day, achieving only partial reduction in attacks. Valproic acid and lithium were added at different times to optimize treatment but were discontinued due to adverse reactions. Initially, the cluster headache responded to prednisone 1 mg/kg; however, due to long-term effects, the medication was tapered off, leading to a return of attacks shortly after.
Acute treatment with sumatriptan (oral and subcutaneous) resulted in poor responses, providing only mild relief. In most cases, complete relief was achieved only with oxygen therapy in the emergency department. Due to the refractory nature of the condition, bilateral occipital nerve block with lidocaine and dexamethasone was performed while maintaining verapamil at 320 mg/day. However, the patient still experienced severe headaches, responsive only to oxygen therapy.
Finally, an alternative approach using a sphenopalatine ganglion block was performed. The patient showed significant improvement on the same day of the procedure, with complete resolution of attacks and no need for any medications. This improvement was maintained in the subsequent days, allowing her to return to normal daily activities.
This case highlights the complexity of cluster headaches management and underscores the importance of an individualized approach in treatment. Although occipital nerve block is evidenced to be effective for many patients, therapeutic response can vary. In this case, the sphenopalatine ganglion block proved to be a safe and effective alternative, providing complete symptom relief.
Conclusion: Thus, it is crucial to consider individual characteristics when choosing treatment, recognizing that the sphenopalatine ganglion block can be a viable and highly effective option for patients with refractory cluster headaches. 
Medication-Induced headaches: a literature review on epidemiology
Full text linkIntroduction: Migraine has various triggering factors, whether environmental, psychological, or biological, commonly reported during early childhood and adolescence. Despite the high prevalence of underdiagnoses, treatments, when administered, demonstrate low adherence due to their complexity. The interaction of various drugs, which can be ineffective or contraindicated, as well as triggering unpleasant side effects, can lead to other complications such as the chronicization of headaches and medication overuse. Therefore, non-pharmacological measures have been considered in recent years.
Objective: to analyze the different non-pharmacological approaches in the treatment of migraine, their indications, and to understand which ones have the greatest clinical efficacy.
Methods: the present study is a literature review, where scientific articles were searched in the PubMed and Google Scholar databases, addressing the management of migraine and its non-pharmacological treatments. Randomized clinical trials and systematic reviews from the last 7 years were included in the research.
Results: the biofeedback technique increased the efficacy of pharmacological treatment, leading to a reduction in the use of analgesics and the frequency of migraines. Mindfulness meditation as a prophylactic treatment was as effective as prophylactic medication in reducing the frequency of migraine attacks. Aerobic exercises combined with amitriptyline reduced migraine attacks more than amitriptyline alone. Acupuncture demonstrated efficacy comparable to botulinum toxin A and topiramate. Vagus nerve stimulation and transcranial magnetic stimulation were effective in reducing the frequency and intensity of migraines. The use of nutraceuticals such as magnesium and riboflavin showed efficacy in the treatment of migraine.
Conclusion: this study highlighted the significant impact of non-pharmacological therapies in the treatment of migraine patients, making it clear that drugs are not the only treatment options for pain management. Understanding these alternatives is important for reducing polypharmacy and improving patients\u27 quality of life
The CGRP receptor-associated protein RAMP1 gene variant rs3754701 determines medication use and analgesic overuse in patients with chronic migraine
Full text linkIntroduction: Migraine is a debilitating neurological illness that causes severe headaches and other unpleasant symptoms on a regular basis. Although some people are more predisposed to migraines than others, there are many variables that might bring on an episode or modify disease prognosis. Research has shed light on the fact that migraine susceptibility is influenced by gene variants. RAMP1 protein is involved in the terminal glycosylation, maturation, and presentation of the CGRP receptor onto the cell surface. RAMP1 rs3754701 is a single nucleotide variant, located in the promoter region, where a change in A to T allele may impact a transcription binding site, and affect RAMP1 and CGRP receptor expression. Objectives: Compare the allele frequencies of RAMP1 rs3754701 in migraine patients and controls and investigate the influence on clinical parameters of disease. Methods: In a retrospective study, 177 migraine patients and 177 healthy controls were genotyped using a real-time polymerase chain reaction allelic discrimination assay. After adjusting for potential confounding variables, logistic regression analysis was used to assess the connection between gene variant and clinical parameters. Results: No evidence of risk association was found between the RAMP1 variant and disease susceptibility nor clinical presentation, except for the presence of sensitive aura for T allele carriers (odds ratio [OR] 5.75; 95% confidence interval [CI] 1.62 – 18.7; p= 0.008). In addition, T allele carriers were more likely of using topiramate (OR 4.6; 95%CI 1.24 – 17.3; p= 0.02). T allele carriers with chronic migraine were more likely of using prophylactic drugs (OR 3.55; 95%CI 1.28 – 10.3; p= 0.01), and topiramate (OR 21.3; 95%CI 1.80 – 27.1; p= 0.005). Notably, carriers of RAMP1 rs3754701 AA genotype displayed a higher risk of analgesic overuse (vs T allele carriers, OR 3.77; 95%CI 1.06 – 13.1; p= 0.04). Conclusion: These findings indicate that RAMP1 rs4752701 may play an important role in drug responsiveness and medication overuse in patients with chronic migraine. Identifying patients with certain RAMP1 genotypes may improve therapy options for headache episodes. Larger population studies are required to validate these prominent results.Introdução: A migrânea é uma doença neurológica debilitante que causa dores de cabeça intensas e outros sintomas desagradáveis de forma regular. Embora algumas pessoas sejam mais predispostas a migrânea do que outras, existem muitas variáveis que podem desencadear um episódio ou modificar o prognóstico da doença. Pesquisas têm revelado que a suscetibilidade à doença é influenciada por variantes genéticas. A proteína RAMP1 está envolvida na glicosilação terminal, maturação e apresentação do receptor para CGRP na superfície celular. O rs3754701 do RAMP1 é uma variante de nucleotídeo único, localizada na região promotora, onde uma mudança do alelo A para T pode afetar um sítio de ligação de fatores de transcrição e influenciar a expressão do RAMP1 e do receptor para CGRP. Objetivos: Comparar as frequências alélicas do rs3754701 do RAMP1 em pacientes com migrânea e controles, além de investigar a influência nos parâmetros clínicos da doença. Métodos: Em um estudo retrospectivo, 177 pacientes com migrânea e 177 controles saudáveis foram genotipados usando um ensaio de discriminação alélica de reação em cadeia da polimerase em tempo real. Após ajuste para variáveis de confusão potenciais, análise por regressão logística foi utilizada para avaliar a conexão entre a variante genética e os parâmetros clínicos. Resultados: Não foi encontrada evidência de associação de risco entre a variante do RAMP1 e a suscetibilidade à doença nem à apresentação clínica, exceto para a presença de aura sensível em portadores do alelo T (razão de chances [OR] 5,75; intervalo de confiança [IC] de 95% 1,62 – 18,7; p= 0,008). Além disso, portadores do alelo T tinham maior probabilidade de usar topiramato (OR 4,6; IC de 95% 1,24 – 17,3; p= 0,02). Portadores do alelo T com migrânea crônica tinham maior probabilidade de usar medicamentos profiláticos (OR 3,55; IC de 95% 1,28 – 10,3; p= 0,01) e topiramato (OR 21,3; IC de 95% 1,80 – 27,1; p= 0,005). Notavelmente, portadores do genótipo AA do RAMP1 rs3754701 apresentaram maior risco de uso excessivo de analgésicos (em comparação com portadores do alelo T, OR 3,77; IC de 95% 1,06 – 13,1; p= 0,04). Conclusão: Esses achados indicam que o RAMP1 rs4752701 pode desempenhar um papel importante na responsividade a medicamentos e no uso excessivo de medicamentos em pacientes com migrânea crônica. A identificação de pacientes com determinados genótipos do RAMP1 pode melhorar as opções terapêuticas para os episódios de cefaleia. Estudos populacionais maiores são necessários para validar esses resultados proeminentes
Headaches and sleep disorders: a literature review on bidirectional connections
Full text linkIntroduction: Sleep disorders occupy an important position among the pathologies that can precede the onset of headaches. Studies indicate that patients with chronic headache have a high prevalence of insomnia, daytime sleepiness, and snoring.
Objective: To understand the pathophysiological relationship between headaches and sleep disorders and to recognize the concomitant characteristics of these health and well-being issues.
Methods: This study is a literature review, using PubMed and Scopus as databases, where articles published between 2003 and 2024 were selected, containing the following descriptors: headache; sleep disorders; bidirectional relationships; insomnia; literature review. Inclusion criteria highlighted publications in English, Spanish, or Portuguese, and peer-reviewed articles, including systematic reviews, meta-analyses, clinical trials, and observational studies containing the aforementioned descriptors. Exclusion criteria included publications that do not address the proposed theme, studies in languages other than those mentioned above, and duplicate articles.
Results: Sleep disorders, such as insomnia, are risk factors for migraine and its chronification, with migraine attacks acting as triggers for sleep disorders. Chronic paroxysmal hemicrania and cluster headache are related to REM sleep. Insomnia affects about 50% to 66% of patients with migraine. Hypothalamic dysfunctions and sleep apnea are relatively common in headaches. Snoring increases the propensity for headaches, and poor sleep quality exacerbates daily headaches. Patients with chronic headache have a prevalence of morning sleepiness, insomnia, and snoring. Patients with obstructive sleep apnea are more frequently diagnosed with headaches compared to those without apnea. The most frequent sleep disorder in headache patients is obstructive sleep apnea. Night awakenings, insomnia, bruxism, and restless legs syndrome are regularly observed in patients with headache.
Conclusion: There is a prevalence of insomnia, hypothalamic dysfunctions, and sleep apnea as frequent sleep disorders in chronic migraine and tension-type headache. The bidirectionality between disorders and headaches is noted, affecting each other concomitantly, with comorbidities such as anxiety and depression influencing the perpetuation of these problems
Analise das características e distribuição dos tipos de cefaleia relatados nas redes sociais
No full textIntroduction
The diagnosis of headaches is primarily based on clinical characteristics reported by patients regarding the occurrence of their headaches. There is an inherent bias that depends on the patient\u27s ability to verbally report their experience and the doctor\u27s ability to extract this information during the clinical history. With the growing presence of society on social media, those who suffer from headaches share their experiences, but few studies have been conducted using this data.
Objective
To explore the use of social media as a data source for analyzing how patients describe their headaches.
Methodology
The diversity of nomenclatures used by users in an Instagram post was evaluated, where followers were asked to describe in the comments section the type of pain they felt. The data were collected and entered into a spreadsheet, anonymized. A descriptive analysis of the various words used was conducted.
Results
175 comments were identified, of which the reports from 129 individuals were considered for analysis. Despite being asked to describe the type and characteristics of their pain, users reported other characteristics not asked about, such as intensity and location. A total of 58 different words were observed to describe the type of pain. The most common were throbbing (12%), pulsating (7%), pressure (6%), constant (5%), and continuous (5%). 70% reported more than one word or phrase to describe their headache experience.
Conclusion
Understanding the terminology used to describe the types of headaches reported by patients is crucial for effective diagnosis and treatment.IntroduçãoO diagnóstico de cefaleias é baseado principalmente nas características clínicas relatadas pelos pacientes em relação à ocorrência de suas dores de cabeça. Existe um viés inerente que depende da capacidade do paciente de relatar verbalmente sua experiência e da habilidade do médico em extrair essa informação durante a anamnese. Com a crescente presença da sociedade nas redes sociais, aqueles que sofrem de cefaleias compartilham suas experiências, mas poucos estudos foram realizados utilizando esses dados.
ObjetivoExplorar o uso das redes sociais como fonte de dados para analisar como os pacientes descrevem suas dores de cabeça.
MetodologiaA diversidade de nomenclaturas usadas pelos usuários em uma postagem no Instagram foi avaliada, onde os seguidores foram convidados a descrever na seção de comentários o tipo de dor que sentiam. Os dados foram coletados, inseridos em uma planilha e anonimizados. Foi realizada uma análise descritiva das diversas palavras utilizadas.
ResultadosForam identificados 175 comentários, dos quais os relatos de 129 indivíduos foram considerados para análise. Apesar de terem sido solicitados a descrever o tipo e as características de sua dor, os usuários relataram outras características não solicitadas, como intensidade e localização. Um total de 58 palavras diferentes foi observado para descrever o tipo de dor. As mais comuns foram latejante (12%), pulsante (7%), pressão (6%), constante (5%) e contínua (5%). 70% relataram mais de uma palavra ou frase para descrever sua experiência com dor de cabeça.
ConclusãoCompreender a terminologia usada para descrever os tipos de cefaleia relatados pelos pacientes é crucial para um diagnóstico e tratamento eficazes
Migralepsy: from hypotheses to controversies
Full text linkThe review aims to clarify what is known or assumed about migralepsy, from its causes to its controversial classification, as well as providing a clearer and more critical understanding of migralepsy, helping to distinguish between migraine with aura and epileptic seizures.
A revisão pretende esclarecer o que se sabe ou se supõe sobre a migralepsia, desde as suas causas até à sua classificação controversa, bem como proporcionar uma compreensão mais clara e crítica da migralepsia, ajudando a distinguir entre enxaqueca com aura e crises epilépticas