Asunto(s)
Humanos , Salud Pública , Cefalea/terapia , Chile , Atención al Paciente/métodos , Atención al Paciente/normasRESUMEN
INTRODUCTION: Headache is the second most frequent cause of neurological consultations in the pediatric emergency department. Patients become frequent visitors per year due to headaches, evidence-based treatment should be used. METHODS: A search of publications within the last 5 years was conducted in different databases. DISCUSSION: Strategies for a systematic approach in the evaluation of red flags, and recommendations for a rational use in neuroimaging studies are presented. Primary headaches are frequently seen in the emergency department. Migraine evidence-based treatment in the emergency department is reviewed.
Introducción: Las cefaleas son la segunda causa de consultas neurológicas en la sala de emergencia pediátrica. Muchos pacientes realizan varias visitas al año por este mismo problema, debemos conocer el tratamiento basado en evidencia. Métodos: Se realizó una búsqueda de publicaciones realizadas en los últimos 5 años en diferentes bases de datos. Discusión: Se presentan recursos para investigar sistemáticamente signos de alarma, recomendaciones para el uso racional de estudio de imágenes. Las cefaleas primarias son causa frecuente de consulta en la sala de emergencia. Se presenta tratamiento que cumple el respaldo científico para su utilización en pacientes con cefaleas primarias de tipo migraña en sala de emergencia. Palabras clave: signos de alarma, migraña, tratamiento basado en evidencia, Sala de emergencia pediátrica.
Asunto(s)
Cefalea , Trastornos Migrañosos , Niño , Humanos , Cefalea/diagnóstico , Cefalea/terapia , Servicio de Urgencia en Hospital , Neuroimagen , Derivación y ConsultaRESUMEN
Pituitary apoplexy refers to a rare clinical syndrome consisting of signs and symptoms that occur due to rapid expansion of the contents of the sella turcica. It can occur spontaneously or associated with pituitary tumors. It can have a broad clinical spectrum, but usually presents with severe headache, visual impairment and hypopituitarism. Sudden onset of symptoms associated to imagiologic confirmation makes the diagnosis. Surgical treatment is advised when there is important compression of the optic tract. We present a case report and a review of the literature on pituitary apoplexy in pregnancy. The cases were reviewed to obtain information on maternal characteristics, clinical presentation, diagnostic studies, therapeutic modalities and maternal and fetal outcomes. Our review found 36 cases of pituitary apoplexy in pregnancy. Most of the cases occurred in the second trimester of pregnancy and headache was the most frequent symptom at presentation. Surgical therapy was required in more than half of the patients. In what respect maternal and fetal outcomes, there were 3 cases of preterm delivery and one case of maternal death. Our clinical case and literature review reinforces the importance of an early diagnosis to avoid potential adverse consequences.
Asunto(s)
Muerte Materna , Apoplejia Hipofisaria , Neoplasias Hipofisarias , Embarazo , Femenino , Recién Nacido , Humanos , Apoplejia Hipofisaria/diagnóstico , Apoplejia Hipofisaria/terapia , Apoplejia Hipofisaria/complicaciones , Neoplasias Hipofisarias/complicaciones , Neoplasias Hipofisarias/patología , Neoplasias Hipofisarias/cirugía , Atención Prenatal , Cefalea/complicaciones , Cefalea/terapiaAsunto(s)
Cefalea , Salud Pública , Humanos , Cefalea/terapia , Chile , Atención al Paciente/normas , Atención al Paciente/métodosRESUMEN
BACKGROUND: Idiopathic Intracranial Hypertension (IIH) is a secondary headache with a steadily growing incidence. Currently, there is little evidence to guide the treatment of IIH. OBJECTIVE: To review the pathophysiology of IIH, with focus on the role of obesity as a risk factor, and the implications for new therapeutic perspectives. METHODS: in this narrative review, we summarized the current knowledge on treatment options highlighting available evidence for managing intracranial hypertension, obesity, and headache. RESULTS: Clinical Presentation: headache is the most common symptom and a significant cause of quality-of-life impairment. Visual loss is common in the diagnosis. Pathophysiology: there is no unified theory able to explain all symptoms and the evolution of the disease. There is growing data pointing to metabolic changes and obesity with a central role in IIH pathophysiology. Treatment: most published data on IIH treatment is related to pressure control and protection from visual loss. Acetazolamide and cerebrospinal fluid diversion are the best options available. Optic nerve sheath fenestration might be useful to temporally control the pressure over the optic nerve and thus protect from visual deterioration. Recently, venous sinus stenting has proven to be a safe option in selected cases. Finally, bariatric surgery has proven to effectively control elevated intracranial pressure. CONCLUSION: IIH is a potential cause of high disability. Early recognition is important, and treatment should be tailored to the needs of each case. There is a lack of research on headache management, which might persist after ICP control.
Asunto(s)
Hipertensión Intracraneal , Seudotumor Cerebral , Acetazolamida/uso terapéutico , Cefalea/complicaciones , Cefalea/terapia , Humanos , Hipertensión Intracraneal/etiología , Obesidad/complicaciones , Obesidad/terapia , Seudotumor Cerebral/diagnóstico , Seudotumor Cerebral/terapia , Trastornos de la Visión/etiología , Trastornos de la Visión/terapiaRESUMEN
OBJECTIVE: To review data regarding the epidemiology, pathophysiology, characteristics, and management of COVID-19-associated headache. The persistence of headache after the acute phase of COVID-19 was also reviewed. BACKGROUND: Headache is a frequent symptom of COVID-19, and understanding its management is important for health-care professionals involved in treating the disease. METHOD: This is a narrative review. A literature review was conducted in the PubMed database with the following terms: "headache" and "COVID-19." All articles written in English that were considered relevant were included. RESULTS: Half of the patients who have COVID-19 present with headache, which occurs more frequently in younger patients; in those with previous primary headache or with previous migraine; and in those who have concomitantly presented with anosmia, ageusia, and myalgia. The headache usually begins early in the symptomatic phase, is bilateral, moderate to severe, and has a similar pattern to tension-type headache. All studies found the migraine pattern and the tension-type headache pattern to be frequent patterns. The possible pathophysiological mechanisms include direct viral injury, the inflammatory process, hypoxemia, coagulopathy, and endothelial involvement. Common analgesics and nonsteroidal anti-inflammatory drugs are the most commonly used drugs for headache in the acute phase of COVID-19. The headache may persist beyond the acute phase, and in such cases, there is an improvement over time. However, not all patients' headaches improve. It seems to be a greater proportion of patients whose headache improves in the first 3 months after the acute phase of the disease than after this period. COVID-19 may trigger new daily persistent headache. CONCLUSIONS: Headache is a clinically significant symptom of COVID-19. Although its characteristics in the acute phase of the disease are already well known, there is a need for studies on its management and persistence.
Asunto(s)
COVID-19 , Trastornos Migrañosos , Cefalea de Tipo Tensional , COVID-19/complicaciones , COVID-19/epidemiología , Cefalea/epidemiología , Cefalea/terapia , Humanos , SARS-CoV-2RESUMEN
OBJECTIVE: To evaluate the current status of specialized headache care and research in Latin America. BACKGROUND: Latin America corresponds to about 9% of the global population. There is considerably limited access to headache services, and very few resources are allocated to headache research in this region. METHODS: The study consisted of two parts. First, in order to evaluate headache-related scientific output from Latin American countries we performed a 10-year bibliometric analysis and contrasted the results with a human developmental index-adjusted projection model. Secondly, we conducted a survey addressing different aspects of headache research, education, clinical practice, and awareness among members of the Latin American Headache Society. RESULTS: During the last 10 years 70% of Latin American countries published less than three articles regarding headache disorders. This contrasts with an average expected publication rate of 889 scientific papers. Indeed, none of the countries fulfilled their human developmental index - adjusted projected scientific output, with Brazil being the closest reaching 84.1% of what would be considered optimal according to the model. From the 86 headache-dedicated professionals that responded to the survey, most (64%) reported not having a headache specialization programme of any kind available in their countries. The biggest impediments towards conducting research observed by participants were the lack of time (39%), resources (22%), and training (21%). CONCLUSIONS: Latin American countries have a considerable gap in headache-related scientific production, and also in formal education, research, and implementation of multidisciplinary services. Access to specialized headache care is particularly limited for patients with lower economic income.
Asunto(s)
Bibliometría , Cefalea , Brasil , Cefalea/epidemiología , Cefalea/terapia , Humanos , América Latina/epidemiologíaRESUMEN
PURPOSE: To systematically review the evidence about the effectiveness of manual therapy (MT) on pain intensity, frequency and impact of headache in individuals with tension-type headache (TTH). METHODS: Medline, Embase, Scopus, Web of Science, CENTRAL, and PEDro were searched in June 2020. Randomized controlled trials that applied MT not associated with other interventions for TTH were selected. The level of evidence was synthesized using GRADE, and Standardized Mean Differences (SMD) were calculated for meta-analysis. RESULTS: Fifteen studies were included with a total sample of 1131 individuals. High velocity and low amplitude techniques were not superior to no treatment on reducing pain intensity (SMD = 0.01, low evidence) and frequency (SMD = -0.27, moderate evidence). Soft tissue interventions were superior to no treatment on reducing pain intensity (SMD = -0.86, low evidence) and frequency of pain (SMD = -1.45, low evidence). Dry needling was superior to no treatment on reducing pain intensity (SMD = -5.16, moderate evidence) and frequency (SMD = -2.14, moderate evidence). Soft tissue interventions were not superior to no treatment and other treatments on the impact of headache. CONCLUSION: Manual therapy may have positive effects on pain intensity and frequency, but more studies are necessary to strengthen the evidence of the effects of manual therapy on subjects with tension-type headache.Implications for rehabilitationSoft tissue interventions and dry needling can be used to improve pain intensity and frequency in patients with tension type headache.High velocity and low amplitude thrust manipulations were not effective for improving pain intensity and frequency in patients with tension type headache.Manual therapy was not effective for improving the impact of headache in patients with tension type headache.
Asunto(s)
Punción Seca , Manipulaciones Musculoesqueléticas , Cefalea de Tipo Tensional , Cefalea/terapia , Humanos , Manipulaciones Musculoesqueléticas/métodos , Dolor , Cefalea de Tipo Tensional/terapiaRESUMEN
OBJECTIVE: To evaluate the quality of existing clinical practice guidelines for headache management and their main recommendations. BACKGROUND: Evidence-based clinical practice guidelines have been developed to support the clinical decision-making. However, to achieve this goal, the quality of these guidelines must be ensured. METHODS: A systematic search for clinical practice guidelines for headache management was conducted in the PubMed database, in websites of known guideline developers and in websites of known headache associations. The quality appraisal was performed through the Appraisal of Guidelines for Research and Evaluation II method. RESULTS: Twelve guidelines were evaluated. The domains of rigor of development, applicability, and editorial independence, which most influence the overall quality of guidelines, had the lowest average scores and the highest standard deviation rates (61% ± 23; 37% ± 20; 53% ± 31). The main recommendations regarding medication use for acute treatment of episodic tension-type headache and migraine in adult patients consisted of paracetamol, acetylsalicylic acid, and other nonsteroidal anti-inflammatory drugs in all guidelines. CONCLUSIONS: The statistical results indicate that the appraised guidelines have room for both individual and collective improvement. In addition, there is a well-established medication recommendation pattern among all guidelines evaluated.
Asunto(s)
Trastornos Migrañosos , Cefalea de Tipo Tensional , Adulto , Cefalea/terapia , Humanos , Trastornos Migrañosos/terapia , Guías de Práctica Clínica como AsuntoRESUMEN
OBJECTIVE: To assess the effects of three 8-week exercise programs on the frequency, intensity, and impact of headaches in patients with headache attributed to temporomandibular disorder (TMD). METHODOLOGY: Thirty-six patients diagnosed with headache attributed to TMD participated in the study and were divided into three groups of 12 patients: a therapeutic exercise program (G1, mean age: 26.3±5.6 years), a therapeutic and aerobic exercise program (G2, mean age: 26.0±4.6 years), and an aerobic exercise program (G3, 25.8±2.94 years). Headache frequency and intensity were evaluated using a headache diary, and the adverse headache impact was evaluated using the Headache Impact Test (HIT-6). The intensity was reported using the numerical pain rating scale. These parameters were evaluated twice at baseline (A01/A02), at the end of the 8-week intervention period (A1), and 8-12 weeks after the end of the intervention (A2). RESULTS: At A1, none of the G2 patients reported having headaches, in G1, only two patients reported headaches, and in G3, ten patients reported headache. The headache intensity scores (0.3 [95% CI: -0.401, 1.068]), (0.0 [95% CI: -0.734, 0.734]) and HIT-6 (50.7 [95% CI: 38.008, 63.459]), (49.5 [95% CI: 36.808, 62.259]), significantly decreased in G1 and G2 at A1. At A2 headache intensity scores (0.5 [95% CI: -0.256, 1.256]), (0.0 [95% CI: -0.756, 0.756]) and HIT-6 (55.1 [95% CI: 42.998, 67.268]), (51.7 [95% CI: 39.532, 63.802]) in G1 and G2 haven't change significantly. The effects obtained immediately after the completion of the intervention programs were maintained until the final follow-up in all groups. CONCLUSION: The programs conducted by G1 (therapeutic exercises) and G2 (therapeutic and aerobic exercise) had significant results at A1 and A2.
Asunto(s)
Cefalea , Trastornos de la Articulación Temporomandibular , Adulto , Ejercicio Físico , Cefalea/etiología , Cefalea/terapia , Humanos , Trastornos de la Articulación Temporomandibular/terapia , Adulto JovenRESUMEN
BACKGROUND: Headache is a common, yet challenging symptom to evaluate given its wide range of clinical presentations and different etiologies. For centuries, conceptual understanding of headache causation has been attributed to anatomic abnormalities of the nose and paranasal sinuses. METHODS: Structured literature review. RESULTS: The number of cases, categorized as migraines or other primary headaches, misdiagnosed as a "sinus headache" is high in the literature, ranging from 50 to 80%. The potential mechanisms for rhinogenic headaches were classically described as pain secondary to prolonged mucosal contact points, hypoxia in the paranasal sinuses secondary to poor ventilation, or pressure caused by the growth of nasal polyps. Additionally, other mechanisms were described and are still being studied. Corrective surgery for mucosal contact points in the nasal cavity is deemed necessary for relieving the headache, although patient outcomes are variable. CONCLUSION: Delay in proper diagnosis and treatment negatively impact patient quality of life. Most cases of "sinus headache" or "rhinogenic headache" seen in clinical practice are in fact misdiagnosed as either primary headaches or migraines. Because of increased misdiagnoses, Otolaryngologists should establish a direct and precise diagnosis congruent with a chief complaint being a headache. Vital information such as a good clinical history, well-performed nasal endoscopy, and occasional CT scan may decrease misdiagnosis probability.
Asunto(s)
Cefalea/etiología , Cefalea/terapia , Errores Diagnósticos/prevención & control , Endoscopía , Cefalea/diagnóstico , Cefalea/patología , Humanos , Trastornos Migrañosos , Cavidad Nasal/anomalías , Pólipos Nasales/complicaciones , Senos Paranasales/anomalías , Tomografía Computarizada por Rayos XRESUMEN
Coronavirus SARS-CoV-2 is responsible for the COVID-19 pandemic, and headache is reported in 6.5% to 34% of all cases. There is little published evidence on the pharmacological treatment of COVID-19 headache. This case series presents six COVID-19 infected patients with refractory headache in which intranasal bedside Sphenopalatine Ganglion Block was performed for analgesia. All patients had a reduction in headache intensity from severe to mild or no pain after the procedure with minor transient side effects. Proposed mechanisms of action include reduction of local autonomic stimuli, intracranial vasoconstriction, and reduction of vasoactive substances release in the pterygopalatine fossa.
Asunto(s)
COVID-19 , Bloqueo del Ganglio Esfenopalatino , Cefalea/etiología , Cefalea/terapia , Humanos , Pandemias , SARS-CoV-2RESUMEN
The incidence of primary brain tumors during pregnancy is uncommon. The etiology of these can range from different genetic syndromes such as Li Fraumeni, neurofibromatosis type I, and hormonal associated tumors. The number of meningiomas gradually tends to increase during pregnancy, suggesting a relationship between non-malignant meningiomas and hormonal changes. Clinical features are non specific or can be misinterpreted with pregnancy symptoms such as headache, vomiting and dizziness. It is worth mentioning that the symptoms due to intracranial tumors are no different in pregnant compared with non pregnant patients. However, retrospective studies in glioma behavior suggested that both tumor volume and growth, increased during pregnancy. These changes were correlated with clinical worsening and increased frequency of seizures. The diagnosis requires a proper neurologic exploration and the support of imaging studies. Treatment of tumors is very controversial since we look for the preservation of both mother and fetus. In theory, the best therapy for the mother will also be the best therapy for the fetus. During pregnancy, ideally the treatment is symptomatic, to preserve the fetus, and definite treatment may be performed after birth; the latter is not always accomplished since patients may present with impending herniation or a malignant tumor for which immediate management is necessary. We intend to give an updated review in the literature on the adequate treatment of brain tumors during pregnancy and the anesthetic management during the definite treatment. Literature data was obtained from Pubmed using the search terms: "Pregnancy", "Brain", "Tumors". A total of forty-three articles were selected.
Asunto(s)
Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/terapia , Complicaciones Neoplásicas del Embarazo/diagnóstico por imagen , Complicaciones Neoplásicas del Embarazo/terapia , Femenino , Feto/diagnóstico por imagen , Feto/fisiología , Glioma/complicaciones , Glioma/diagnóstico por imagen , Glioma/terapia , Cefalea/diagnóstico por imagen , Cefalea/etiología , Cefalea/terapia , Humanos , Neoplasias Meníngeas/complicaciones , Neoplasias Meníngeas/diagnóstico por imagen , Neoplasias Meníngeas/terapia , Meningioma/complicaciones , Meningioma/diagnóstico por imagen , Meningioma/terapia , Embarazo , Estudios Retrospectivos , Convulsiones/diagnóstico por imagen , Convulsiones/etiología , Convulsiones/terapia , Vómitos/diagnóstico por imagen , Vómitos/etiología , Vómitos/terapiaRESUMEN
La cefalea tensional constituye una patología de gran prevalencia, que tiene impactos no solo a nivel de la salud física de las personas sino también a nivel laboral y social. Considerando lo anterior, desde Medicinas complementarias existan diferentes herramientas terapéuticas, entre ellas la Homeopatía. El presente trabajo describe el reporte de un caso exitoso de un cuadro de cefalea tensional manejado homeopáticamente con el medicamento Nux vómica en el Centro de Atención de Salud a Estudiantes (CASE), dentro de la consulta de Medicina Alternativa de la Universidad Nacional de Colombia- Sede Bogotá, durante los años 2018-2019. (Texto tomado de la fuente).
Asunto(s)
Strychnos nux-vomica , Cefalea/terapia , Terapias Complementarias , Salud del Estudiante , Colombia , Atención a la Salud , HomeopatíaRESUMEN
Abstract Objective To assess the effects of three 8-week exercise programs on the frequency, intensity, and impact of headaches in patients with headache attributed to temporomandibular disorder (TMD). Methodology Thirty-six patients diagnosed with headache attributed to TMD participated in the study and were divided into three groups of 12 patients: a therapeutic exercise program (G1, mean age: 26.3±5.6 years), a therapeutic and aerobic exercise program (G2, mean age: 26.0±4.6 years), and an aerobic exercise program (G3, 25.8±2.94 years). Headache frequency and intensity were evaluated using a headache diary, and the adverse headache impact was evaluated using the Headache Impact Test (HIT-6). The intensity was reported using the numerical pain rating scale. These parameters were evaluated twice at baseline (A01/A02), at the end of the 8-week intervention period (A1), and 8-12 weeks after the end of the intervention (A2). Results At A1, none of the G2 patients reported having headaches, in G1, only two patients reported headaches, and in G3, ten patients reported headache. The headache intensity scores (0.3 [95% CI: -0.401, 1.068]), (0.0 [95% CI: -0.734, 0.734]) and HIT-6 (50.7 [95% CI: 38.008, 63.459]), (49.5 [95% CI: 36.808, 62.259]), significantly decreased in G1 and G2 at A1. At A2 headache intensity scores (0.5 [95% CI: -0.256, 1.256]), (0.0 [95% CI: -0.756, 0.756]) and HIT-6 (55.1 [95% CI: 42.998, 67.268]), (51.7 [95% CI: 39.532, 63.802]) in G1 and G2 haven't change significantly. The effects obtained immediately after the completion of the intervention programs were maintained until the final follow-up in all groups. Conclusion The programs conducted by G1 (therapeutic exercises) and G2 (therapeutic and aerobic exercise) had significant results at A1 and A2.
Asunto(s)
Humanos , Trastornos de la Articulación Temporomandibular , Cefalea/etiología , Cefalea/terapia , Ejercicio FísicoRESUMEN
Introducción: la cefalea constituye uno de los motivos de consulta más comunes por el cual las personas acuden a los servicios médicos, es una causa importante de discapacidad, que trae consigo consecuencias a nivel personal. Objetivo: evaluar la utilización del método clínico, en el diagnóstico de la cefalea de causa oftalmológica en la edad pediátrica. Método: se realizó un estudio observacional, descriptivo de corte transversal, a 192 pacientes que asistieron a los servicios de Urgencias de Oftalmología, en el Hospital Pediátrico Hermanos Cordové, en el período comprendido entre enero y diciembre del 2019. Se estudiaron las variables: edad y sexo, enseñanza escolar, antecedentes patológicos personales, características de la cefalea y diagnóstico presuntivo. Resultados: predominó los pacientes entre 6 y 7 años de edad del sexo femenino, cursando la enseñanza primaria, sin antecedentes patológicos personales, con una cefalea de inicio subagudo, episódica, que afecta las actividades cotidianas, que aparece en cualquier momento del día, acompañada principalmente de alteraciones visuales y náuseas y vómitos, predominando como diagnóstico presuntivo la cefalea migrañosa. Conclusiones: se demostró que el mayor por ciento de los pacientes que acudieron por cefalea a los servicios de urgencias de oftalmología, esta, no estaba relacionada a trastornos oftalmológicos(AU)
Introduction: headache is one of the most common reasons for consultation for which people go to medical services, it is an important cause of disability, which brings with it consequences on a personal level. Objective: to evaluate the use of the clinical method in the diagnosis of headache of ophthalmic cause in pediatric age. Method: an observational, descriptive, cross-sectional study was carried out of 192 patients who attended the Ophthalmology Emergency Services at the Hermanos Cordové Pediatric Hospital, in the period between January and December 2019. The variables were studied: age and sex, school education, personal pathological history, headache characteristics and presumptive diagnosis. Results: there was a predominance of female patients between 6 and 7 years of age, attending primary school, without personal pathological history, with a headache of subacute onset, episodic, which affects daily activities, which appears at any time of the day, accompanied mainly of visual disturbances and nausea and vomiting, prevailing as a presumptive diagnosis migraine headache. Conclusions: It was shown that the highest percentage of patients who attended the ophthalmology emergency department for headache, this was not related to ophthalmological disorders(EU)
Asunto(s)
Humanos , Niño , Cefalea/diagnóstico , Cefalea/terapia , Diagnóstico Clínico , Epidemiología Descriptiva , Estudios TransversalesRESUMEN
BACKGROUND: Neurological complaints are frequent in emergency department routine. Among them, headache is a common disorder, which requires a certain degree of knowledge on Neurology because of its extensive differential diagnosis. OBJECTIVE: To assess general practice physicians' level of knowledge about headaches, in addition to outlining the profile of professionals who attend in emergency departments, as well as the profile of their respective workplaces in terms of neurological approach. METHODS: We included in evaluation physicians who attend emergency care units for adult public as general practitioners. A questionnaire was applied with questions regarding participants' general knowledge on headache, neurological approach, demographic profile, and workplace profile. RESULTS: 159 physicians answered the questionnaire. The professionals' profile corresponded to recently graduated individuals (mean of 6.31 years). Knowledge about headache management was regular. Those who do not have any specialization or are not majoring a specialization were statistically significantly more confident in neurological patients care (p=0.006). Only 18.24% reported access to Magnetic Resonance Imaging and 35.85% had no access to any type of neuroimaging. CONCLUSIONS: General practice physicians often do not feel confident when performing neurological exams, demonstrating low knowledge about the topic. The profile of professionals working in these departments is predominantly of newly graduates, which may affect in some way on care quality. There was also a lack of structure for adequate care.
Asunto(s)
Competencia Clínica/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Médicos Generales/estadística & datos numéricos , Cefalea/terapia , Neurología , Adulto , Análisis de Varianza , Brasil , Estudios Transversales , Manejo de la Enfermedad , Femenino , Humanos , Masculino , Pautas de la Práctica en Medicina/estadística & datos numéricos , Encuestas y CuestionariosRESUMEN
Abstract Background: Neurological complaints are frequent in emergency department routine. Among them, headache is a common disorder, which requires a certain degree of knowledge on Neurology because of its extensive differential diagnosis. Objective: To assess general practice physicians' level of knowledge about headaches, in addition to outlining the profile of professionals who attend in emergency departments, as well as the profile of their respective workplaces in terms of neurological approach. Methods: We included in evaluation physicians who attend emergency care units for adult public as general practitioners. A questionnaire was applied with questions regarding participants' general knowledge on headache, neurological approach, demographic profile, and workplace profile. Results: 159 physicians answered the questionnaire. The professionals' profile corresponded to recently graduated individuals (mean of 6.31 years). Knowledge about headache management was regular. Those who do not have any specialization or are not majoring a specialization were statistically significantly more confident in neurological patients care (p=0.006). Only 18.24% reported access to Magnetic Resonance Imaging and 35.85% had no access to any type of neuroimaging. Conclusions: General practice physicians often do not feel confident when performing neurological exams, demonstrating low knowledge about the topic. The profile of professionals working in these departments is predominantly of newly graduates, which may affect in some way on care quality. There was also a lack of structure for adequate care.
Resumo Introdução: Queixas neurológicas são frequentes na rotina de setores de emergência. Entre elas, a cefaleia é um distúrbio comum, que por seu diagnóstico diferencial amplo, exige certo grau de conhecimento em Neurologia. Objetivo: Avaliar o nível de conhecimento em cefaleias de médicos generalistas, além de traçar o perfil dos profissionais que atendem em setores de emergência nesta função, assim como de seus respectivos locais de trabalho em termos de abordagem neurológica. Métodos: Foram incluídos na avaliação médicos que atendem em unidades de pronto-atendimento para público adulto, na função de generalista. Um questionário foi aplicado com perguntas referentes ao conhecimento geral dos participantes sobre cefaleia, abordagem neurológica, perfil demográfico e perfil do local de trabalho. Resultados: 159 médicos responderam ao questionário. O perfil dos profissionais presentes na amostra correspondeu a indivíduos graduados recentemente (média de 6,31 anos). O conhecimento a respeito da abordagem de cefaleias foi regular. Aqueles que não possuem nenhuma especialização, nem estão cursando uma residência, se mostraram, de forma estatisticamente significativa, mais seguros no atendimento de pacientes neurológicos (p=0,006). Apenas 18,24% referiram ter acesso à Ressonância Magnética e 35,85% não tiveram acesso a nenhum tipo de neuroimagem. Conclusão: Médicos generalistas frequentemente não sentem segurança ao realizar atendimento e exame neurológicos, demonstrando pouco conhecimento acerca do assunto. O perfil dos profissionais que atuam nesses setores é predominantemente de recém graduados, o que pode impactar de alguma forma na qualidade de atendimento. Verificou-se também falta de estrutura para um atendimento adequado.