RESUMEN
OBJECTIVE: Medication overuse headache (MOH) in chronic migraineurs may be a cause or consequence of the overuse of symptomatic medications for headache attacks. It is highly prevalent in tertiary centers. We compared the efficacy of 3 anti-CGRP monoclonal antibodies with traditional pharmacological agents in patients with chronic migraine (CM) and MOH. METHODS: A randomized, cross-sectional, prospective, and open trial with real-world comparison groups was carried out. The sample consisted of 100 consecutive patients having CM and MOH. RESULTS: Eighty-eight patients (65 women and 23 men) were included in the study and divided into 4 groups: those having used erenumab (19.3%), galcanezumab (29.6%), fremanezumab (25%) and conventional medications, and the control group (26.1%). Ages ranged from 18 to 78 years (mean, 44.1 ± 13.6 years). In the 6 months of follow-up, there was a significant reduction in the number of headache days in the 3 groups when compared with the control ( P < 0.0001). CONCLUSIONS: The small number of patients included in each group and the open design do not allow definitive conclusions, but the use of anti-CGRP monoclonal antibodies in patients with CM and MOH may result in lessening the number of headache days when compared with conventional treatment with drugs.
Asunto(s)
Cefaleas Secundarias , Trastornos Migrañosos , Masculino , Humanos , Femenino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Estudios Prospectivos , Estudios Transversales , Trastornos Migrañosos/tratamiento farmacológico , Anticuerpos Monoclonales/efectos adversos , Cefalea/tratamiento farmacológico , Cefaleas Secundarias/tratamiento farmacológicoRESUMEN
Cervicogenic headache can be confused with migraine headache, which conditions multiple admissions to emergency services, within the established treatments, the international headache society establishes the blockade of the greater occipital nerve (GON) with local anesthetics as necessary for the diagnosis of occipital neuralgia, with the introduction of ultrasound to perform invasive procedures, it has facilitated the performance of the technique, with excellent results, reducing stays in the emergency department and it is a technique that emergency physicians can perform.
La cefalea cervicogenica se puede confundir con cefalea migrañosa eso condiciona múltiples ingresos a los servicios de urgencias, dentro de los tratamientos establecidos, the internacional headache society establece el bloqueo del nervio occipital mayor (GON) con anestésico locales como necesario para el diagnóstico de neuralgia occipital, con la introducción del ultrasonido para realizar procedimientos invasivos ha facilitado la realización de la técnica, con excelentes resultados reduciendo las estancias en el servicio de urgencias y es una técnica que pueden realizar los médicos urgenciologos.
Asunto(s)
Humanos , Masculino , Adulto , Cefalea Postraumática/tratamiento farmacológico , Analgésicos/uso terapéutico , Bloqueo Nervioso/métodos , Nervios Periféricos , Ultrasonografía Intervencional , Urgencias Médicas , Cefalea/tratamiento farmacológicoRESUMEN
The Brazilian Headache Society (Sociedade Brasileira de Cefaleia, SBCe, in Portuguese) nominated a Committee of Authors with the aim of establishing a consensus with recommendations regarding prophylactic treatment for episodic migraine based on articles published in the worldwide literature, as well as personal experience. Migraine affects 1 billion people around the world and more than 30 million Brazilians. In addition, it is an underdiagnosed and undertreated disorder. It is well known within the medical community of neurologists, and especially among headache specialists, that there is a need to disseminate knowledge about prophylactic treatment for migraine. For this purpose, together with the need for drug updates and to expand knowledge of the disease itself (frequency, intensity, duration, impact and perhaps the progression of migraine), this Consensus was developed, following a full online methodology, by 12 groups who reviewed and wrote about the pharmacological categories of the drugs used and, at the end of the process, met to read and establish conclusions for this document. The drug classes studied were: anticonvulsants, tricyclic antidepressants, monoclonal anti-calcitonin gene-related peptide (anti-CGRP) antibodies, beta-blockers, antihypertensives, calcium channel inhibitors, other antidepressants (selective serotonin reuptake inhibitors, SSRIs, and dual-action antidepressants), other drugs, and polytherapy. Hormonal treatment and anti-inflammatories and triptans in minimum prophylaxis schemes (miniprophylaxis) will be covered in a specific chapter. The drug classes studied for part I of the Consensus were: anticonvulsants, tricyclic antidepressants, monoclonal anti-CGRP antibodies, and beta-blockers.
A Sociedade Brasileira de Cefaleia (SBCe) nomeou um Comitê de Autores com o objetivo de estabelecer um consenso com recomendações sobre o tratamento profilático da enxaqueca episódica com base em artigos da literatura mundial e da experiência pessoal. A enxaqueca é um distúrbio subdiagnosticado e subtratado que acomete um bilhão de pessoas no mundo e mais de 30 milhões de brasileiros. É conhecido na comunidade médica de neurologistas e, sobretudo, dos especialistas em cefaleia, a necessidade de se divulgar o conhecimento sobre o tratamento profilático da enxaqueca. Com esta finalidade, aliada às necessidades de atualizações de drogas e de se aumentar o conhecimento sobre a doença em si (frequência, intensidade, duração, impacto e talvez a progressão da enxaqueca), foi elaborado este Consenso, com metodologia totalmente on-line, por 12 grupos que revisaram e escreveram sobre as categorias farmacológicas das drogas e, ao final, reuniram-se para a leitura e conclusão do documento. As classes de drogas estudadas para este Consenso foram: anticonvulsivantes, antidepressivos tricíclicos, anticorpos monoclonais do antipeptídeo relacionado ao gene da calcitonina (peptídeo relacionado ao gene da calcitonina anti-CGRP), betabloqueadores, anti-hipertensivos, inibidores dos canais de cálcio, outros antidepressivos (inibidores seletivos de recaptação de serotonina, ISRSs, e antidepressivos de ação dual), outras drogas, e politerapia. O tratamento hormonal, bem como anti-inflamatórios e triptanas em esquema de profilaxia mínima (miniprofilaxia), será abordado em um capítulo próprio. As classes de drogas estudadas na parte I do Consenso foram: anticonvulsivantes, antidepressivos tricíclicos, anticorpos monoclonais anti-CGRP, e betabloqueadores.
Asunto(s)
Trastornos Migrañosos , Inhibidores Selectivos de la Recaptación de Serotonina , Humanos , Anticonvulsivantes/uso terapéutico , Antidepresivos/uso terapéutico , Antidepresivos Tricíclicos/uso terapéutico , Antihipertensivos/uso terapéutico , Brasil , Péptido Relacionado con Gen de Calcitonina/antagonistas & inhibidores , Consenso , Cefalea/tratamiento farmacológico , Trastornos Migrañosos/tratamiento farmacológico , Trastornos Migrañosos/prevención & control , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéutico , Triptaminas/uso terapéutico , Bloqueadores de los Canales de Calcio/uso terapéuticoRESUMEN
RESUMEN: La migraña es una cefalea primaria frecuente y debilitante. Los pacientes con crisis de migraña agudas y severas usualmente deben consultar por servicios de guardia, y el tratamiento convencional para el ataque de migraña incluye diversos fármacos como antiinflamatorios no esteroideos, triptanes, ergotamina, antidopaminérgicos, entre otros. Los corticoesteroides han sido ampliamente prescriptos, tanto como monoterapia o como en tratamiento coadyuvante a otros fármacos abortivos, para la crisis de migraña en los servicios de emergencia. Diferentes estudios han sido llevados a cabo con el objetivo de evaluar la efectividad de estos para abortar la crisis aguda de migraña y para evitar su recurrencia. En la presente revisión, realizamos una evaluación crítica sobre la bibliografía publicada en relación a la utilidad de los corticoesteroides en al abordaje de la crisis de migraña. En conclusión, estos podrían ser considerados como una opción razonable como tratamiento coadyuvante en las crisis de migraña resistentes, recurrentes o prolongadas (status migrañoso).
ABSTRACT Migraine is a frequent and debilitating primary headache. People with acute severe migraine attack often present to the emergency department, and standard treatment for the migraine attack generally includes the use of several drugs such as are nonsteroidal antiinflammatory drugs, triptans, ergotamine, antidopaminergic agents, among others. Steroids have been widely prescribed, either as monotherapy or as add-on treatment, to manage migraine attacks in the emergency setting. Several clinical studies have been conducted to assess the efficacy of corticosteroids in aborting acute migraine attacks and avoiding their recurrence. In this review, we make a critical appraisal of the published literature about corticosteroids treatment for the migraine attack. Overall, they could be considered as an adjunctive therapy for resistant, recurrent o prolonged (migraine status) migraine attacks.
Asunto(s)
Humanos , Corticoesteroides/uso terapéutico , Trastornos Migrañosos/tratamiento farmacológico , Cefalea/tratamiento farmacológicoRESUMEN
BACKGROUND: Migraine is a highly disabling and prevalent neurological disorder. A peptide, calcitonin gene-related peptide, was identified as involved in migraine pathophysiology and monoclonal anti-CGRP antibodies have been developed. AIM: To describe the clinical characteristics and therapeutic response of migraine patients treated with monoclonal antibodies. METHOD: An observational, prospective, uncontrolled, and descriptive study was carried out with a sample of 112 consecutive patients with episodic or chronic migraine treated with monoclonal antibodies. Eight patients did not return for the following medical consultation. They were excluded from the study. RESULTS: A total of 104 patients were described. There was a predominance of episodic migraine. Before treatment, the average frequency of headache was 15.3 ± 8.5 days per month, during the previous three months. Monoclonal antibodies were prescribed at the following frequency: erenumab (49%), galcanezumab (45.2%), and fremanezumab (5.8%). After the third month, the reduction in headache attacks was greater than 50% in 57.7% of patients. Adverse events were referred by 18.3% of patients, in this order of frequency: constipation (7.7%), insomnia (2.9%), vertigo (1.9%), erythema at the injection site (1.9%), arthralgia (1%), nasopharyngitis (1%), facial and hand edema (1%), irritation at the injection site (1%), and paresthesia at the injection site (1%). CONCLUSIONS: This described analysis of migraine patients who used monoclonal antibodies presented one of the first Brazilian experiences with real-world patients. Our results may enlighten clinicians on the outcomes and ways of prescribing anti-CGRP antibodies.
Asunto(s)
Antineoplásicos Inmunológicos , Trastornos Migrañosos , Anticuerpos Monoclonales/uso terapéutico , Brasil/epidemiología , Antagonistas del Receptor Peptídico Relacionado con el Gen de la Calcitonina/uso terapéutico , Cefalea/tratamiento farmacológico , Humanos , Trastornos Migrañosos/tratamiento farmacológico , Estudios ProspectivosRESUMEN
BACKGROUND: COVID-19, a disease caused by SARS-CoV-2, manifests with headache, both in the acute phase and as a post-infection symptom, which may be refractory to usual analgesics. OBJECTIVES: Investigate the therapeutic response of refractory COVID or post-COVID headache to indomethacin. METHODS: This was an observational, retrospective, open and uncontrolled. A sample of 37 patients diagnosed with COVID-19 presenting headache during the acute phase or after the resolution of the disease, with refractoriness to the usual symptomatic medication was treated with indomethacin. RESULTS: Of the 37 patients (24 women and 13 men), 29 were migraineurs and 8 had no previous history of headache. The average age was 40.4 ± 9.4 years, ranging from 19 to 65 years. In 26 (70.3%) patients, the onset of headache occurred within 72 h, and in 11 (29.7%), after 10 days of positivity for Sars-CoV-2. After treatment with indomethacin, 36 patients reported greater than 50% headache relief from the third day and 5 became asymptomatic on the fifth day. CONCLUSIONS: In patients with migraine or no prior history of headache who present with refractory COVID or post-COVID headache to common analgesics, anti-inflammatory drugs, and/or triptans, indomethacin should be considered a therapeutic option.
Asunto(s)
COVID-19 , Adulto , Analgésicos , COVID-19/complicaciones , Femenino , Cefalea/tratamiento farmacológico , Cefalea/etiología , Humanos , Indometacina/uso terapéutico , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , SARS-CoV-2RESUMEN
INTRODUCTION: Vestibular migraine is the most common cause of spontaneous episodic vertigo in adult patients and the second most common cause of vertigo in patients of all ages. OBJECTIVE: To assess the effectiveness of oral medication type (propranolol, flunarizine, and amitriptyline) and botulinum toxin A application on vestibular symptoms, headache severity and attack frequency for vestibular migraine patients. METHODS: Sixty patients with vestibular migraine were enrolled. Thirty patients received botulinum toxin A treatment (B+ group) in addition to the oral medication, whereas 30 patients received only oral medication (B- group). Headache severity was evaluated with Migraine Disability Assessment Scale and vertigo severity was evaluated with Dizziness Handicap Inventory scale. Vestibular migraine attack frequencies in the last three months were also evaluated. RESULTS: There was a statistically significant decrement in mean Dizziness Handicap Inventory scores, Migraine Disability Assessment Scale scores and vertigo attack frequencies after treatment for all patients, B+ and B- group patients (p<0.001 for all). The mean Migraine Disability Assessment Scale score gains (p<0.001) and vertigo attack frequency gains (p= 0.003) were significantly higher in the B+ patients than B- patients. CONCLUSIONS: Both B+ and B- group patients exhibited significant improvement in vestibular migraine attack frequencies, Dizziness Handicap Inventory score and Migraine Disability Assessment Scale score values. However, botulinum toxin A application had a more pronounced effect for Migraine Disability Assessment Scale score gain and vestibular migraine attack frequency values, but not for Dizziness Handicap Inventory score gain values. Thus, botulinum toxin A application should be considered for vestibular migraine patients whose headache severity degrees are more profound. The oral medication type (propranolol, flunarizine or amitriptyline) did not differ in influencing the vestibular migraine attack frequency, Dizziness Handicap Inventory score gain and Migraine Disability Assessment Scale score gain values.
Asunto(s)
Toxinas Botulínicas Tipo A , Trastornos Migrañosos , Adulto , Humanos , Flunarizina/uso terapéutico , Propranolol/uso terapéutico , Amitriptilina/uso terapéutico , Mareo/diagnóstico , Toxinas Botulínicas Tipo A/uso terapéutico , Vértigo/tratamiento farmacológico , Trastornos Migrañosos/tratamiento farmacológico , Cefalea/tratamiento farmacológicoRESUMEN
Introdução: O manejo da cefaleia nas salas de urgência e emergência deve ser baseada em uma anamnese detalhada para que o diagnóstico e tratamento sejam adequados, entretanto não é o que se encontra nos atendimentos. Objetivo: Avaliar o manejo do atendimento das cefaleias em uma sala de Urgência e Emergência. Métodos: Estudo de corte transversal retrospectivo, realizado através da análise de dados de 1317 prontuários eletrônicos de pacientes com queixa de cefaleia que procuraram o serviço de emergência do Hospital Regional de Barbacena durante o período de 01 de janeiro de 2017 a 30 de junho de 2019. Os diagnósticos relatados nos prontuários foram classificados de acordo com os critérios da Classificação Internacional das Cefaleias (ICHD-3). Os dados foram submetidos à análise estatísticas, pelo teste de qui-quadrado. Considerou-se diferenças estatisticamente significativas aquelas cujo valor p≤0,05. Resultados: Do total de prontuários, três foram excluídos, sendo analisados 1314. Entre os prontuários analisados, 73,21% apresentaram diagnósticos iniciais eram cefaleia, 16,67% migrânea e 10,12% cefaleia do tipo tensão. Já no diagnóstico final, cefaleia correspondeu a 59,67%, migrânea a 17,95% e cefaleia do tipo tensão a 8,52%. Em relação ao tratamento, foi receitado opioides para 43,99% dos pacientes e para o restante foram prescritos medicamentos não opioides. Conclusão: O trabalho sugeriu falha no manejo da cefaleia nas salas de urgência e emergência, provavelmente pela limitação do conhecimento dos profissionais de saúde acerca da dor de cabeça. O que acarretou no grande número de diagnósticos inespecíficos e inadequada abordagem terapêutica.
Introduction: Detailed clinical evaluation should be the basis for the proper management of headaches in emergency rooms, in order to allow adequate diagnosis and treatment. However, this is not usually observed on clinical rounds. Objective: To evaluate the management of headache consultations in an emergency rooms. Methods: This is a cross-section study was performed analyzing data from 1,317 electronic medical records of patients with headache complaints who sought treatment at the Barbacena City Regional Hospital's between January 1, 2017, and June 20, 2019. Medical records were classified according to the International Classification of Headache Disorders (ICHD-3). The data collected were statistically analyzed using chi-square tests. The study considered a p-value≤0.05 to define statistically significant differences. Results: Three medical records were excluded and 1,314 were analyzed. Among the medical records analyzed, 73.21% of initial diagnoses were classified as headache, 16.67% as migraine, and 10.12% as tension-type headache. Headache corresponded to 59.76% of final diagnoses, migraine to 17.95%, and tension-type headache to 8.52%. Regarding the treatment, 43.99% of patients were prescribed opioids for the remaining were prescribed nonopioid medications. Conclusion: The study suggests that the management of headaches is inadequate in emergency rooms, probably due to limited knowledge of health professionals about headache. This resulted in a large number of nonspecific diagnoses and inadequate therapeutic approaches.
Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Errores Diagnósticos , Servicio de Urgencia en Hospital , Cefalea/diagnóstico , Registros Médicos , Estudios Transversales , Estudios Retrospectivos , Prescripción Inadecuada , Cefalea/clasificación , Cefalea/tratamiento farmacológico , Analgésicos Opioides/uso terapéuticoRESUMEN
BACKGROUND: Headache is one of the most common causes of emergency care and migraines are the most common primary headache in this regard. OBJECTIVE: The aim of this research study was to assess the incidence of medical consultations due to headache, along with demographic characteristics and treatments pertaining to cephalalgia that were offered to patients cared for in supplemental healthcare emergency rooms. METHODS: In 2017, a total of 11,105 consultations took place, and 4,865 (43.8%) of them were complaints relating to headache. 407 records of patients with headache were randomly selected and assessed. Demographic, clinical and therapeutic data were collected using a structured form. RESULTS: The cause of headache was diagnosed as migraine in 60.0% of the patient records. Patients were mostly female (75.2%), with an average age of 33.9 ± 13.7 years. Patient management consisted of administering dipyrone in 62.4% of cases, antiemetics in 66.9%, corticosteroids in 58.9%, opioids in 24.3% and NSAIDs in 13.5%. Use of opioids was associated with a diagnosis of migraine (OR 2.4; CI 1.4-3.9; p = 0.001). Patients who received opioids were kept under observation for longer periods of time (OR 3.4; CI 2.1-5.4; p < 0.001) and exhibited a higher rate of use of antiemetics (OR 11.0; CI 4.7-25.9; p < 0.001), compared with patients who did not receive opioids. CONCLUSION: Dipyrone and antiemetics were administered to most of the patients. Opioids were used for a significant proportion of these individuals, despite the diagnosis of migraine, a condition for which their use is discouraged.
Asunto(s)
Analgésicos Opioides , Trastornos Migrañosos , Adulto , Analgésicos Opioides/uso terapéutico , Atención a la Salud , Servicio de Urgencia en Hospital , Femenino , Cefalea/tratamiento farmacológico , Cefalea/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Trastornos Migrañosos/tratamiento farmacológico , Trastornos Migrañosos/epidemiología , Adulto JovenRESUMEN
To present a young immunocompetent patient with a fourth ventricle tuberculoma without pulmonary tuberculosis. A previously healthy young male patient presented with a history of headache, nausea, and blurred vision. Neuroimaging revealed a mass present in the fourth ventricle. The lesion was successfully resected. Histological and microbiological findings suggested the presence of a tuberculoma. Tuberculomas can be found in the posterior fossa in adults. This infectious pathology should not be forsaken when considering the differential diagnosis for infratentorial masses.
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Cuarto Ventrículo/microbiología , Tuberculoma/diagnóstico , Tuberculosis del Sistema Nervioso Central/diagnóstico , Adulto , Antibióticos Antituberculosos/uso terapéutico , Diagnóstico Diferencial , Cuarto Ventrículo/patología , Cefalea/diagnóstico , Cefalea/tratamiento farmacológico , Cefalea/etiología , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Neuroimagen , Tuberculoma/complicaciones , Tuberculoma/tratamiento farmacológico , Tuberculoma/patología , Tuberculosis del Sistema Nervioso Central/tratamiento farmacológicoRESUMEN
ABSTRACT A 62-year-old woman was admitted to our clinic with the complaints of periorbital ecchymosis and subconjunctival hemorrhage that are visible, especially on the right eye. We noted that her complaints began the day after she underwent leech therapy on the glabella area for headache. On the glabella, 2 leech bites were observed close to the right side. Examination revealed ecchymosis on the bilateral eyelids and subconjunctival hemorrhage on the inferolateral and medial limbus on the right eye. No treatment was initiated, rather control measures were recommended. The follow-up after 1 month revealed that the patient's complaints had disappeared.(AU)
RESUMO Uma paciente de 62 anos procurou nosso ambulatório com queixas de equimose periorbital e hemorragia subconjuntival, visíveis principalmente no olho direito. Descobrimos que suas queixas começaram no dia seguinte a um tratamento para dor de cabeça com sanguessugas na área da glabela. Na glabela, 2 mordidas de sanguessuga foram encontradas próximas ao lado direito. Durante os exames da paciente, foram detectadas equimoses nas pálpebras bilaterais e hemorragia subconjuntival no limbo ínfero lateral e medial do olho direito. Nenhum tratamento foi iniciado, sendo recomendado apenas controle. No acompanhamento, observou-se que as queixas da paciente desapareceram em cerca de um mês.(AU)
Asunto(s)
Persona de Mediana Edad , Hemorragia del Ojo/etiología , Conjuntiva/patología , Aplicación de Sanguijuelas/efectos adversos , Cefalea/tratamiento farmacológico , Enfermedades Orbitales , HematomaAsunto(s)
Antituberculosos/uso terapéutico , Cerebro/diagnóstico por imagen , Etambutol/uso terapéutico , Mycobacterium tuberculosis/aislamiento & purificación , Pirazinamida/uso terapéutico , Rifampin/uso terapéutico , Tuberculoma/tratamiento farmacológico , Tuberculosis Meníngea/tratamiento farmacológico , Adulto , Antibacterianos/uso terapéutico , Antituberculosos/administración & dosificación , Etambutol/administración & dosificación , Cefalea/tratamiento farmacológico , Cefalea/etiología , Humanos , Isoniazida/administración & dosificación , Isoniazida/uso terapéutico , Imagen por Resonancia Magnética , Masculino , Moxifloxacino/uso terapéutico , Reacción en Cadena de la Polimerasa , Pirazinamida/administración & dosificación , Rifampin/administración & dosificación , Resultado del Tratamiento , Tuberculoma/diagnóstico por imagen , Tuberculosis Meníngea/diagnósticoRESUMEN
Migraine is a complex neurovascular disorder characterized by attacks of moderate to severe unilateral headache, accompanied by photophobia among other neurological signs. Although an arsenal of antimigraine agents is currently available in the market, not all patients respond to them. As Calcitonin Gene-Related Peptide (CGRP) plays a key role in the pathophysiology of migraine, CGRP receptor antagonists (gepants) have been developed. Unfortunately, further pharmaceutical development (for olcegepant and telcagepant) was interrupted due to pharmacokinetic issues observed during the Randomized Clinical Trials (RCT). On this basis, the use of monoclonal antibodies (mAbs; immunoglobulins) against CGRP or its receptor has recently emerged as a novel pharmacotherapy to treat migraines. RCT showed that these mAbs are effective against migraines producing fewer adverse events. Presently, the U.S. Food and Drug Administration approved four mAbs, namely: (i) erenumab; (ii) fremanezumab; (iii) galcanezumab; and (iv) eptinezumab. In general, specific antimigraine compounds exert their action in the trigeminovascular system, but the locus of action (peripheral vs. central) of the mAbs remains elusive. Since these mAbs have a molecular weight of â¼150 kDa, some studies rule out the relevance of their central actions as they seem unlikely to cross the Blood-Brain Barrier (BBB). Considering the therapeutic relevance of this new class of antimigraine compounds, the present review has attempted to summarize and discuss the current evidence on the probable sites of action of these mAbs.
Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , Antagonistas del Receptor Peptídico Relacionado con el Gen de la Calcitonina/farmacología , Péptido Relacionado con Gen de Calcitonina/efectos de los fármacos , Trastornos Migrañosos/tratamiento farmacológico , Anticuerpos Monoclonales/inmunología , Barrera Hematoencefálica/efectos de los fármacos , Barrera Hematoencefálica/inmunología , Péptido Relacionado con Gen de Calcitonina/inmunología , Cefalea/tratamiento farmacológico , HumanosRESUMEN
BACKGROUND: Cervical dystonia is the most common form of focal idiopathic dystonia and is frequently associated with pain. Headaches are not considered to be more prevalent among patients presenting with cervical dystonia, and headaches attributed to craniocervical dystonia are considered to be a rare disorder, despite the lack of studies and clinical information regarding the subject. OBJECTIVES: To investigate the prevalence, characteristics and impact of headaches attributed to craniocervical dystonia in cervical dystonia patients receiving treatment with botulinum toxin type-A (BoT-A). METHODS: Twenty-four patients presenting with cervical dystonia were assessed before receiving their scheduled BoNT-A injections and then again approximately 4 and 16 weeks after, regarding the clinical characteristics of their dystonia and headaches. Headaches were classified in accordance with the current International Classification of Headache Disorders. We used the Short Form-36 Health Survey, Hospital Anxiety and Depression Scale, Headache Impact Test-6, Toronto Western Spasmodic Torticollis Rating Scale and McGill Pain Questionnaire. RESULTS: Nineteen patients (79.1%) presented with cervical dystonia associated with pain and 18 (75.0%) with headaches. The prevalence of headaches attributed to craniocervical dystonia was 29.2%; HIT-6: 60.1 ± 9.9. Patients with headaches presented significantly poorer TWSTRS pain scores, compared to patients with no headaches. Those with headaches attributed to craniocervical dystonia presented with more disability and demonstrated a significant improvement in the impact of headaches after BoNT-A injections, together with an improvement in the dystonia. CONCLUSIONS: Headaches are highly prevalent amongst cervical dystonia patients, have an impact on their quality of life and improves after BoNT-A injections. SIGNIFICANCE: We found that headaches are more frequent among patients with cervical dystonia than previously thought, and that they contribute towards an overall increase in pain in these patients. Headaches attributed to craniocervical dystonia are associated with greater disability among patients with cervical dystonia. These headaches improve after botulinum toxin injections, in parallel with the improvement of cervical dystonia symptoms.
Asunto(s)
Toxinas Botulínicas Tipo A , Fármacos Neuromusculares , Tortícolis , Toxinas Botulínicas Tipo A/uso terapéutico , Cefalea/tratamiento farmacológico , Cefalea/epidemiología , Humanos , Fármacos Neuromusculares/uso terapéutico , Estudios Prospectivos , Calidad de Vida , Tortícolis/complicaciones , Tortícolis/tratamiento farmacológico , Tortícolis/epidemiología , Resultado del TratamientoRESUMEN
Migraine adds to the burden of patients suffering from multiple sclerosis (MS). The ID-migraine is a useful tool for screening migraine, and the Migraine Disability Assessment questionnaire can evaluate disease burden. The aim of the present study was to assess the presence and burden of migraine in patients with MS. METHODS Patients diagnosed with MS attending specialized MS units were invited to answer an online survey if they also experienced headache. RESULTS The study included 746 complete responses from patients with MS and headache. There were 625 women and 121 men, and 69% of all the patients were aged between 20 and 40 years. Migraine was identified in 404 patients (54.1%) and a moderate-to-high burden of disease was observed in 68.3% of the patients. CONCLUSION Migraine is a frequent and disabling type of primary headache reported by patients with MS.
Asunto(s)
Cefalea/epidemiología , Trastornos Migrañosos/epidemiología , Esclerosis Múltiple/epidemiología , Adulto , Brasil/epidemiología , Estudios Transversales , Evaluación de la Discapacidad , Femenino , Cefalea/tratamiento farmacológico , Humanos , Masculino , Trastornos Migrañosos/tratamiento farmacológico , Prevalencia , Distribución por Sexo , Encuestas y Cuestionarios , Resultado del Tratamiento , Adulto JovenRESUMEN
ABSTRACT Migraine adds to the burden of patients suffering from multiple sclerosis (MS). The ID-migraine is a useful tool for screening migraine, and the Migraine Disability Assessment questionnaire can evaluate disease burden. The aim of the present study was to assess the presence and burden of migraine in patients with MS. Methods: Patients diagnosed with MS attending specialized MS units were invited to answer an online survey if they also experienced headache. Results: The study included 746 complete responses from patients with MS and headache. There were 625 women and 121 men, and 69% of all the patients were aged between 20 and 40 years. Migraine was identified in 404 patients (54.1%) and a moderate-to-high burden of disease was observed in 68.3% of the patients. Conclusion: Migraine is a frequent and disabling type of primary headache reported by patients with MS.
RESUMO Enxaqueca piora o sofrimento do paciente que tem esclerose múltipla (EM). ID-migraine é uma ferramenta útil para seleção de pacientes com enxaqueca e Migraine Disability Assessment (MIDAS) é um questionário que avalia o impacto da doença. O objetivo do presente estudo foi avaliar a presença e impacto de enxaqueca em pacientes com EM. Métodos: Pacientes diagnosticados com EM e tratados em clínicas especializadas foram convidados a responder um questionário online se também apresentassem cefaleia. Resultados: O estudo incluiu 746 participantes com cefaleia e EM que preencheram completamente as respostas. Foram 625 mulheres e 121 homens, sendo 69% dos pacientes com idade entre 20 e 40 anos. Enxaqueca foi identificada em 404 pacientes (54,1%) e moderado a grave impacto da doença foi observado em 68,3% dos casos. Conclusão: Enxaqueca é uma cefaleia primária frequente e incapacitante relatada por pacientes com EM.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Adulto Joven , Cefalea/epidemiología , Trastornos Migrañosos/epidemiología , Esclerosis Múltiple/epidemiología , Brasil/epidemiología , Prevalencia , Estudios Transversales , Encuestas y Cuestionarios , Resultado del Tratamiento , Distribución por Sexo , Evaluación de la Discapacidad , Cefalea/tratamiento farmacológico , Trastornos Migrañosos/tratamiento farmacológicoRESUMEN
PURPOSE: The pineal gland plays an important role in biological rhythms, circadian and circannual variations, which are key aspects in several headache disorders. OVERVIEW: Melatonin, the main pineal secreting hormone, has been extensively studied in primary and secondary headache disorders. Altered melatonin secretion occurs in many headache syndromes. Experimental data show pineal gland and melatonin both interfere in headache animal models, decreasing trigeminal activation. Melatonin has been shown to regulate CGRP and control its release. DISCUSSION: Melatonin has been used successfully as a treatment for migraine, cluster headaches and other headaches. There is a rationale for including the pineal gland as a relevant brain structure in the mechanisms of headache pathophysiology, and melatonin as a treatment option in primary headache.
Asunto(s)
Cefalea/fisiopatología , Glándula Pineal/fisiopatología , Adulto , Animales , Péptido Relacionado con Gen de Calcitonina/fisiología , Estudios de Casos y Controles , Niño , Ritmo Circadiano/fisiología , Ensayos Clínicos como Asunto , Modelos Animales de Enfermedad , Método Doble Ciego , Cefalea/diagnóstico por imagen , Cefalea/tratamiento farmacológico , Cefalea/patología , Humanos , Melatonina/fisiología , Melatonina/uso terapéutico , Oxidación-Reducción , Núcleo Hipotalámico Paraventricular/fisiopatología , Glándula Pineal/metabolismo , Glándula Pineal/patología , Receptores de Melatonina/agonistas , Receptores de Melatonina/fisiología , Serotonina/metabolismo , Ganglio Cervical Superior/fisiopatologíaRESUMEN
OBJECTIVES: To characterize the frequency of opioid prescribing for pediatric headache in both ambulatory and emergency department (ED) settings, including prescribing rates by provider type. STUDY DESIGN: A retrospective cohort study of Washington State Medicaid beneficiaries, aged 7-17 years, with an ambulatory care or ED visit for headache between January 1, 2012, and September 30, 2015. The primary outcome was any opioid prescribed within 1 day of the visit. RESULTS: A total of 51 720 visits were included, 83% outpatient and 17% ED. There was a predominance of female (63.2%) and adolescent (59.4%) patients, and 30.5% of encounters involved a pediatrician. An opioid was prescribed in 3.9% of ED and 1.0% of ambulatory care visits (P < .001). Pediatricians were less likely to prescribe opioids in both ED (-2.70 percentage point; 95% CI, -3.53 to -1.88) and ambulatory settings (-0.31 percentage point; 95% CI, -0.54 to -0.08; P < .001). CONCLUSIONS: Opioid prescribing rates for pediatric headache were low, but significant variation was observed by setting and provider specialty. We identified opioid prescribing by nonpediatricians as a potential target for quality improvement efforts.
Asunto(s)
Analgésicos Opioides/administración & dosificación , Cefalea/tratamiento farmacológico , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adolescente , Atención Ambulatoria/estadística & datos numéricos , Niño , Estudios de Cohortes , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Masculino , Estudios Retrospectivos , WashingtónRESUMEN
STUDY OBJECTIVE: We seek to determine whether ropivacaine cervical paraspinal injections compared with normal saline solution injections provide headache relief to pediatric patients that is sufficient for emergency department (ED) discharge. METHODS: We enrolled children aged 7 to 17 years in a double-blinded, randomized, controlled trial of patients presenting to a pediatric ED with headache. Subjects were randomized into 1 of 3 groups: bilateral cervical paraspinal injections of either (1) 0.5% ropivacaine or (2) normal saline solution, or (3) a natural history group (not blinded) receiving no headache therapy for the first 30 minutes. Pain scores were assessed at enrollment and at 10-, 20-, and 30-minute intervals after the administration of the injections. After the intervention period of 30 minutes, additional therapy was provided as needed. Primary outcome was the proportion of children discharged with adequate pain relief at 30 minutes without additional therapy. Secondary outcomes included reduction in pain scores, reoccurrence of headache, and re-presentation to health care with headache. RESULTS: One hundred fifty-three children were enrolled. The proportion discharged with adequate pain relief 30 minutes after the injections did not differ between the 2 intervention groups (32% in the ropivacaine group versus 28% in the saline solution group; effect difference 4%; 95% confidence interval -14% to 21%). In contrast, only 4% percent of patients in the natural history group were discharged without additional therapy after the 30-minute assessment. Reduction of pain scores (2.0 and 2.2 in ropivacaine versus saline solution), headache reoccurrence, and return to care was similar between the 2 treatment groups. CONCLUSION: Cervical paraspinal injections of either ropivacaine or saline solution were effective for approximately one third of patients.