RESUMEN
INTRODUCTION: Primary stabbing headache (or "ice pick headache") is an alteration characterized by brief jabs (short stabs of pain, lasting ~3 seconds), which appear spontaneously, irregularly, and affecting unilaterally or bilaterally. Indomethacin has traditionally been used as the main therapeutic option. However, this drug is ineffective in a considerable percentage of patients and can generate multiple adverse effects that occur at therapeutic doses. CLINICAL CASE: A 7-year-old male patient with primary stabbing headache of mild to moderate intensity, lasting 3 to 4 seconds, without relevant history, with normal neurodevelopment, neurological examination and neuroimaging; no triggers were identified. It was started therapeutic trial with Coenzyme Q10; however, no improvement in the symptoms was identified. TREATMENT AND OUTCOMES: A therapeutic management was carried out with Melatonin, which led to complete remission of the symptoms; without adverse effects in the posterior follow-up months. CLINICAL AND SCIENTIFIC RELEVANCE: There is little information regarding effective and safe treatments for primary stabbing headache in children. The present case identifies Melatonin as an innovative, effective and safe therapeutic alternative in the treatment of primary stabbing headache in children. This is a significant advance in the understanding of primary stabbing headache in the pediatric population. CONCLUSION: Melatonin may be an effective and safe therapeutic option for the treatment of primary stabbing headache in pediatric patients. It is necessary to deepen its research, in order to establish its use in a clinical practice guide.
INTRODUCCIÓN: La cefalea punzante primaria, es una alteración que se caracteriza por punzadas breves (â¼3 segundos), que aparecen espontáneamente, de forma irregular y afectación unilateral o bilateral. Tradicionalmente se ha utilizado Indometacina como opción terapéutica principal. Sin embargo, este medicamento es inefectivo en un porcentaje considerable de pacientes y puede generar múltiples efectos adversos que se presentan a dosis terapéuticas. CASO CLÍNICO: Paciente masculino de 7 años de edad con cefalea punzante primaria de intensidad leve a moderada con una duración entre 3 y 4 segundos sin antecedentes relevantes, con neurodesarrollo, examen neurológico y de neuroimagen normales; no se identificaron desencadenantes. Se inició prueba terapéutica con Coenzima Q10, sin embargo no se identificó mejoría en los síntomas. TRATAMIENTO Y RESULTADOS: Se realizó un manejo terapéutico con Melatonina que conllevó a remisión completa de la sintomatología y sin efectos adversos en los meses posteriores de seguimiento. RELEVANCIA CLÍNICA Y CIENTÍFICA: Existe poca información respecto a tratamientos efectivos y seguros para cefalea punzante primaria en niños. El presente caso identifica la Melatonina como una alternativa terapéutica innovadora, efectiva y segura en el tratamiento de la cefalea punzante primaria en niños. Lo anterior constituye un avance significativo en la comprensión de la cefalea punzante primaria en la población pediátrica. CONCLUSIÓN: La melatonina puede ser una opción terapéutica efectiva y segura para el tratamiento de la cefalea punzante primaria en pacientes pediátricos. Se requiere ahondar en su investigación para establecer su uso en una guía de práctica clínica.
Asunto(s)
Antioxidantes/uso terapéutico , Cefaleas Primarias/prevención & control , Melatonina/uso terapéutico , Antioxidantes/efectos adversos , Niño , Estudios de Seguimiento , Cefaleas Primarias/tratamiento farmacológico , Humanos , Masculino , Melatonina/efectos adversos , Resultado del Tratamiento , Ubiquinona/análogos & derivados , Ubiquinona/uso terapéuticoRESUMEN
Abstract Introduction: Primary stabbing headache (or "ice pick headache") is an alteration characterized by brief jabs (short stabs of pain, lasting ~3 seconds), which appear spontaneously, irregularly, and affecting unilaterally or bilaterally. Indomethacin has traditionally been used as the main therapeutic option. However, this drug is ineffective in a considerable percentage of patients and can generate multiple adverse effects that occur at therapeutic doses. Clinical case: A 7-year-old male patient with primary stabbing headache of mild to moderate intensity, lasting 3 to 4 seconds, without relevant history, with normal neurodevelopment, neurological examination and neuroimaging; no triggers were identified. It was started therapeutic trial with Coenzyme Q10; however, no improvement in the symptoms was identified. Treatment and outcomes: A therapeutic management was carried out with Melatonin, which led to complete remission of the symptoms; without adverse effects in the posterior follow-up months. Clinical and scientific relevance: There is little information regarding effective and safe treatments for primary stabbing headache in children. The present case identifies Melatonin as an innovative, effective and safe therapeutic alternative in the treatment of primary stabbing headache in children. This is a significant advance in the understanding of primary stabbing headache in the pediatric population. Conclusion: Melatonin may be an effective and safe therapeutic option for the treatment of primary stabbing headache in pediatric patients. It is necessary to deepen its research, in order to establish its use in a clinical practice guide.
Resumen Introducción: La cefalea punzante primaria, es una alteración que se caracteriza por punzadas breves (∼3 segundos), que aparecen espontáneamente, de forma irregular y afectación unilateral o bilateral. Tradicionalmente se ha utilizado Indometacina como opción terapéutica principal. Sin embargo, este medicamento es inefectivo en un porcentaje considerable de pacientes y puede generar múltiples efectos adversos que se presentan a dosis terapéuticas. Caso clínico: Paciente masculino de 7 años de edad con cefalea punzante primaria de intensidad leve a moderada con una duración entre 3 y 4 segundos sin antecedentes relevantes, con neurodesarrollo, examen neurológico y de neuroimagen normales; no se identificaron desencadenantes. Se inició prueba terapéutica con Coenzima Q10, sin embargo no se identificó mejoría en los síntomas. Tratamiento y resultados: Se realizó un manejo terapéutico con Melatonina que conllevó a remisión completa de la sintomatología y sin efectos adversos en los meses posteriores de seguimiento. Relevancia clínica y científica: Existe poca información respecto a tratamientos efectivos y seguros para cefalea punzante primaria en niños. El presente caso identifica la Melatonina como una alternativa terapéutica innovadora, efectiva y segura en el tratamiento de la cefalea punzante primaria en niños. Lo anterior constituye un avance significativo en la comprensión de la cefalea punzante primaria en la población pediátrica. Conclusión: La melatonina puede ser una opción terapéutica efectiva y segura para el tratamiento de la cefalea punzante primaria en pacientes pediátricos. Se requiere ahondar en su investigación para establecer su uso en una guía de práctica clínica.
Asunto(s)
Niño , Humanos , Masculino , Cefaleas Primarias/prevención & control , Melatonina/uso terapéutico , Antioxidantes/uso terapéutico , Estudios de Seguimiento , Ubiquinona/análogos & derivados , Ubiquinona/uso terapéutico , Resultado del Tratamiento , Cefaleas Primarias/tratamiento farmacológico , Melatonina/efectos adversos , Antioxidantes/efectos adversosRESUMEN
Cefaleia é uma das queixas mais frequentes na prática médica. Dentro deste contexto, as cefaleias primárias representam o maior motivo de busca por auxílio médico. O objetivo desta revisão é abordar o diagnóstico e tratamento abortivo das cefaleias do tipo tensional, enxaqueca e em salvas.
Headache is one of the most frequent complaints in medical practice. Within the context of headache, primary represents the biggest reason for seeking medical attention. The aim of this paper is to discuss the diagnosis and treatment of tension-type headache, migraine and cluster headache.
Asunto(s)
Cefaleas Primarias/diagnóstico , Cefaleas Primarias/tratamiento farmacológico , Trastornos Migrañosos , Cefalea de Tipo TensionalRESUMEN
The efficacy and tolerability of a combination of dipyrone 600 mg, isometheptene 60 mg and caffeine 60 mg for the acute treatment of mild-to-moderate episodic primary headaches were evaluated against paracetamol 1000 mg and placebo. A total of 84 adult patients with two to six primary headache episodes (mild or moderate severity) per month were enrolled in this prospective, multicenter, randomized, two-period crossover study. Patients had a mean of 4.4 headache episodes/month (mean duration: 13 h; mean severity: 50.5 mm; assessed by visual analog scale (VAS). In patients with no improvement, rescue medications were allowed after 2 h. The primary outcome parameter was sustained pain-free rate. Secondary outcomes were evolution of pain severity (at 30, 60, 90, 120 and 240 min after treatment), presence of associated symptoms, and recurrence of episodes. Analyses included 243 headache episodes (81 patients). Sustained pain-free rates were 57.1% for combination therapy, 46.8% for paracetamol and 46.8% for placebo (not statistically significant). Pain improvement (assessed by VAS) occurred in 72.5, 54.5 and 49.2% of patients, respectively, after 120 min. The mean reduction in pain severity (assessed by VAS) was significantly lower in those receiving placebo and paracetamol compared with combination therapy (p < 0.001 at 90 and 120 min). Fewer patients required rescue medication after receiving combination therapy (18.4%), compared with paracetamol (37.7%; p = 0.008) or placebo (43.8%; p = 0.0007). Adverse events were infrequent and mild. We conclude that, despite failing to meet the primary outcome, the combination of dipyrone, isometheptene and caffeine is effective for the acute treatment of mild-to-moderate primary headache episodes, with excellent tolerability.
Asunto(s)
Analgesia/métodos , Analgésicos/uso terapéutico , Cafeína/uso terapéutico , Dipirona/uso terapéutico , Cefaleas Primarias/tratamiento farmacológico , Metilaminas/uso terapéutico , Acetaminofén/uso terapéutico , Adolescente , Adulto , Anciano , Analgésicos/administración & dosificación , Analgésicos/efectos adversos , Cafeína/administración & dosificación , Cafeína/efectos adversos , Estudios Cruzados , Dipirona/administración & dosificación , Dipirona/efectos adversos , Método Doble Ciego , Combinación de Medicamentos , Femenino , Humanos , Masculino , Metilaminas/administración & dosificación , Metilaminas/efectos adversos , Persona de Mediana Edad , Dimensión del Dolor , Estudios Prospectivos , Resultado del TratamientoRESUMEN
Primary stabbing headache is an ultra-short headache, associated with primary headaches, more prevalent in women and with a poor response to therapy. The effect of botulinum neurotoxin type-A (BoNTA) on primary stabbing headache was investigated in 24 patients. Three patients showed complete remission. Nineteen patients showed a decrease in their primary stabbing headaches that started in the second week, and that was sustained during approximately 63 days. In two patients BoNTA showed no therapeutic effect. The BoNTA seems to be an excellent therapeutic option for primary stabbing headache.
Asunto(s)
Toxinas Botulínicas Tipo A/uso terapéutico , Cefaleas Primarias/tratamiento farmacológico , Neurotoxinas/uso terapéutico , Adulto , Femenino , Cefaleas Primarias/etiología , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
Primary stabbing headache is an ultra-short headache, associated with primary headaches, more prevalent in women and with a poor response to therapy. The effect of botulinum neurotoxin type-A (BoNTA) on primary stabbing headache was investigated in 24 patients. Three patients showed complete remission. Nineteen patients showed a decrease in their primary stabbing headaches that started in the second week, and that was sustained during approximately 63 days. In two patients BoNTA showed no therapeutic effect. The BoNTA seems to be an excellent therapeutic option for primary stabbing headache.
Cefaléia primária em punhaladas (CPP) é uma cefaléia ultra-rápida, associada a cefaléias primárias, mais frequente em mulheres e com discreta resposta terapêutica. O efeito da neurotoxina botulínica do tipo A (NTBo-A) sobre a CPP foi investigado em 24 pacientes. Três pacientes apresentaram completa remissão dos sintomas. Dezenove pacientes mostraram uma redução que começou na segunda semana e que manteve-se por um período de 63 dias. Em dois pacientes a NTBo-A não apresentou nenhum efeito terapêutico. A NTBo-A parece ser uma excelente opção terapêutica no tratamento da CPP.
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Toxinas Botulínicas Tipo A/uso terapéutico , Cefaleas Primarias/tratamiento farmacológico , Neurotoxinas/uso terapéutico , Cefaleas Primarias/etiología , Dimensión del Dolor , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
AIM: To determine the prevalence and the clinical-epidemiological and therapeutic characteristics of primary headaches in a rural population in Cuba. SUBJECTS AND METHODS: A cross-sectional study was conducted in a rural population of the Policlinica Mabay in the province of Granma, Cuba. The second International Headache Society classification was used. Sample size, which was calculated by means of the program EpiInfo 2002, was 360 adult workers over 18 years of age, who were selected by simple random sampling. RESULTS: The prevalence of primary headaches was 44.72%. There was a predominance of females (71.4%). 31.1% of cases were between 50 and 59 years old. 36.6% had a family history of headaches. Onset of headaches occurred before the age of 15 years in 44.1% of patients. The most frequent location was occipital (45.3% of cases). The most frequent precipitating factors were stress (27.9%) and menstruation (27.3%). The predominant accompanying symptom was dizziness (26.1%). Tension-type headache was the most prevalent, with 92 patients (25.56%), followed by migraine, with 61 diagnoses (16.94%). 78.3% of the patients with tension-type headache and 70.5% of those with migraine tried self-medication with dipyrone and paracetamol. Patients with migraine made more frequent use of prophylactic treatment than those who suffered from tension-type headache (32.8% versus 16.3%; p = 0.01). CONCLUSIONS: The prevalence of primary headaches is high in the rural population under study; the high rate of prescription drug abuse (mainly painkillers and non-steroidal anti-inflammatory drugs) has led to a significant number of headaches becoming chronic. This health problem is also seen to have an important effect on occupational affairs.
Asunto(s)
Cefaleas Primarias/epidemiología , Población Rural/estadística & datos numéricos , Adolescente , Adulto , Amitriptilina/uso terapéutico , Analgésicos/uso terapéutico , Estudios Transversales , Cuba/epidemiología , Utilización de Medicamentos , Ergotamina/uso terapéutico , Femenino , Cefaleas Primarias/tratamiento farmacológico , Humanos , Masculino , Meprobamato/uso terapéutico , Persona de Mediana Edad , Trastornos Migrañosos/tratamiento farmacológico , Trastornos Migrañosos/epidemiología , Trastornos Migrañosos/prevención & control , Prevalencia , Propranolol/uso terapéutico , Muestreo , Cefalea de Tipo Tensional/tratamiento farmacológico , Cefalea de Tipo Tensional/epidemiología , Cefalea de Tipo Tensional/prevención & control , Verapamilo/uso terapéutico , Adulto JovenRESUMEN
In order to analyze the clinical features, approach and treatment of patients with acute primary headaches seen at the Clinics Hospital of the Federal University of Uberlândia (HC-UFU) throughout 2005, the medical charts of 109 patients were evaluated through a standardized questionnaire as to age, gender, main diagnosis, characteristics of the headache attacks, diagnostic tests and treatment. Probable migraine was the most common type of primary headache (47.7 percent), followed by probable tension-type headache (37.6 percent), unspecified headache (11.9 percent), and headache not elsewhere classified (2.8 percent). As to characteristics of the crisis, the location of the pain was described in 86.2 percent of the patients. The most commonly used drugs for treatment of acute headache attacks were dipyrone (74.5 percent), tenoxicam (31.8 percent), diazepam (20.9 percent), dimenhydrate (10.9 percent), and metochlopramide (9.9 percent). The data collected are in agreement with those reported in literature. In most cases, treatment was not what is recommended by consensus or clinical studies with appropriate methodology. Therefore, we suggest the introduction of a specific acute headache management protocol which could facilitate the diagnosis, treatment and management of these patients.
Com o objetivo de avaliar as características clínicas, abordagem e tratamento das cefaléias agudas primárias atendidas no Hospital de Clínicas da Universidade Federal de Uberlândia (HC-UFU) no ano de 2005, 109 prontuários foram analisados através de questionário padronizado, segundo idade, sexo, diagnóstico principal, características das crises, propedêutica e tratamento. A distribuição dos pacientes quanto ao tipo de cefaléia foi a seguinte: provável enxaqueca 47,7 por cento, provável cefaléia tensional 37,6 por cento, cefaléia não classificada 11,9 por cento e cefaléia não classificada em outro local 2,8 por cento. No que tange às características da crise, a localização da dor foi descrita em 86,2 por cento dos pacientes. No tratamento dos pacientes com crise aguda de cefaléia, as drogas mais utilizadas foram: dipirona (74,5 por cento), seguido de tenoxicam (31,8 por cento), diazepam (20,9 por cento), dramin® (10,9 por cento) e metoclopramida (9,9 por cento). Os dados levantados são condizentes com os relatados na literatura. O tratamento efetuado, na maioria dos casos, não foi o recomendado por consensos ou estudos clínicos com metodologia aceitável. Recomendamos, portanto, a introdução de um protocolo específico para o atendimento das cefaléias agudas, o que facilitará o diagnóstico, tratamento e manejo destes pacientes.
Asunto(s)
Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Masculino , Servicio de Urgencia en Hospital/estadística & datos numéricos , Cefaleas Primarias/diagnóstico , Enfermedad Aguda , Cefaleas Primarias/tratamiento farmacológico , Encuestas y CuestionariosRESUMEN
In order to analyze the clinical features, approach and treatment of patients with acute primary headaches seen at the Clinics Hospital of the Federal University of Uberlândia (HC-UFU) throughout 2005, the medical charts of 109 patients were evaluated through a standardized questionnaire as to age, gender, main diagnosis, characteristics of the headache attacks, diagnostic tests and treatment. Probable migraine was the most common type of primary headache (47.7%), followed by probable tension-type headache (37.6%), unspecified headache (11.9%), and headache not elsewhere classified (2.8%). As to characteristics of the crisis, the location of the pain was described in 86.2% of the patients. The most commonly used drugs for treatment of acute headache attacks were dipyrone (74.5%), tenoxicam (31.8%), diazepam (20.9%), dimenhydrate (10.9%), and metochlopramide (9.9%). The data collected are in agreement with those reported in literature. In most cases, treatment was not what is recommended by consensus or clinical studies with appropriate methodology. Therefore, we suggest the introduction of a specific acute headache management protocol which could facilitate the diagnosis, treatment and management of these patients.
Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Cefaleas Primarias/diagnóstico , Enfermedad Aguda , Adolescente , Adulto , Anciano , Niño , Femenino , Cefaleas Primarias/tratamiento farmacológico , Humanos , Masculino , Encuestas y CuestionariosRESUMEN
Nummular headache is proposed as a distinct type of headache in the Appendix of the second edition of the International Classification of Headache Disorders (ICHD-II). It is a chronic condition, with the following characteristics: pain is felt on a small circumscribed cranial area; pain is of mild to moderate intensity; there is no evidence of a structural abnormality. Herein, three cases fulfilling the ICHD-II proposed criteria (code A13.7.1) for nummular headache are reported.