RESUMO
METHOD: Neuropathic pain was induced by surgical constriction of the infraorbital nerve in rats. A control group underwent a sham procedure consisting of surgical exposure of the nerve. Subgroups of each group received either BoNT/A or isotonic saline solution. The clinical response was assessed with the -20°C test. Animals that underwent nerve constriction developed sensitization; the sham group did not. RESULTS: The sensitization was reversed by BoNT/A treatment evident 24 hours following application. Pronociceptive effect was observed in the sham group following BoNT/A. CONCLUSION: BoNT/A has an antinociceptive effect in sensitized animals and a pronociceptive effect in non-sensitized animals.
Assuntos
Analgésicos/uso terapêutico , Toxinas Botulínicas Tipo A/uso terapêutico , Neuralgia do Trigêmeo/tratamento farmacológico , Animais , Modelos Animais de Doenças , Masculino , Medição da Dor , Limiar da Dor , RatosRESUMO
ABSTRACT Purpose of the study was evaluate the possible antinociceptive effect of botulinum neurotoxin type-A (BoNT/A) in an experimental model of trigeminal neuralgia. Method Neuropathic pain was induced by surgical constriction of the infraorbital nerve in rats. A control group underwent a sham procedure consisting of surgical exposure of the nerve. Subgroups of each group received either BoNT/A or isotonic saline solution. The clinical response was assessed with the -20°C test. Animals that underwent nerve constriction developed sensitization; the sham group did not. Results The sensitization was reversed by BoNT/A treatment evident 24 hours following application. Pronociceptive effect was observed in the sham group following BoNT/A. Conclusion BoNT/A has an antinociceptive effect in sensitized animals and a pronociceptive effect in non-sensitized animals.
RESUMO A proposta do estudo foi avaliar o efeito antinociceptivo da neurotoxina botulínica do tipo A (BoNT/A) em um modelo experimental de nevralgia trigeminal. Método O grupo estudo foi obtido através da constrição do nervo infraorbital em ratos e o grupo controle pela simples exposição deste nervo. Cada um dos grupos foram subdivididos de acordo com o tratamento realizado após a intervenção cirurgica: solução salina isotônica ou BoNT/A. A resposta terapêutica foi avaliada através do teste de -20°C. Resultados Animais com constrição do nervo desenvolveram uma sensibilização nociceptiva quando comparados ao grupo controle. Ela foi revertida após 24 horas utilizando BoNT/A. O efeito pronociceptivo foi observado no grupo controle após a administração de BoNTA. Conclusão BoNT/A apresenta um efeito antinociceptivo em animais sensibilizados e pronociceptivo em animals não sensibilizados.
Assuntos
Animais , Masculino , Ratos , Neuralgia do Trigêmeo/tratamento farmacológico , Toxinas Botulínicas Tipo A , Analgésicos/uso terapêutico , Medição da Dor , Limiar da Dor , Modelos Animais de DoençasAssuntos
Hipotensão Ortostática/complicações , Transtornos de Enxaqueca/etiologia , Síndrome da Taquicardia Postural Ortostática/complicações , Síncope/complicações , Adulto , Estudos de Casos e Controles , DNA Mitocondrial/genética , Feminino , Humanos , Hipotensão Ortostática/genética , Hipotensão Ortostática/fisiopatologia , Masculino , Transtornos de Enxaqueca/genética , Transtornos de Enxaqueca/fisiopatologia , Mutação Puntual/genética , Reação em Cadeia da Polimerase , Polimorfismo de Fragmento de Restrição , Síndrome da Taquicardia Postural Ortostática/genética , Síndrome da Taquicardia Postural Ortostática/fisiopatologia , Síncope/genética , Síncope/fisiopatologia , Síndrome , Adulto JovemAssuntos
Adulto , Feminino , Humanos , Masculino , Adulto Jovem , Hipotensão Ortostática/complicações , Transtornos de Enxaqueca/etiologia , Síndrome da Taquicardia Postural Ortostática/complicações , Síncope/complicações , Estudos de Casos e Controles , DNA Mitocondrial/genética , Hipotensão Ortostática/genética , Hipotensão Ortostática/fisiopatologia , Transtornos de Enxaqueca/genética , Transtornos de Enxaqueca/fisiopatologia , Reação em Cadeia da Polimerase , Polimorfismo de Fragmento de Restrição , Mutação Puntual/genética , Síndrome da Taquicardia Postural Ortostática/genética , Síndrome da Taquicardia Postural Ortostática/fisiopatologia , Síndrome , Síncope/genética , Síncope/fisiopatologia , Adulto JovemRESUMO
OBJECTIVE: Preventive treatment is an important part of migraine therapy. When prescribing medication, physicians should understand patients' treatment preferences and select drugs that most closely meet their patients' needs. Understanding the factors that influence patients' preference increases physicians' ability to select appropriate migraine therapy. However, unlike acute migraine treatment, patients' preferences for migraine preventive treatment have never been studied. METHODS: We enrolled 250 patients who attended the Jefferson Headache Center and Sao Paulo Headache Center and had a primary headache diagnosis. Patients' age, gender, body mass index (BMI), headache diagnosis, headache frequency, duration, and intensity, headache disability (by MIDAS), and current preventive treatments were ascertained. Patients were asked to rate 7 aspects of headache prevention (efficacy, speed of onset, out-of-pocket expenses, adverse events, formulation of therapy, type of treatment, and frequency of dosing) in order of importance (1-7). Each patient also evaluated 12 different clinical scenarios, each one containing a simulation of 2 hypothetical headache preventive treatments, wherein patients could choose Product A, Product B, or neither. Patients were informed of each product's efficacy data (50%, 75%, or 100% headache elimination), adverse event profile (weight gain, concentration difficulty, and/or fatigue), and dosing frequency (once every 3 months, once per day, or twice per day). RESULTS: Most patients were Caucasian. Mean BMI was 26.55 +/- 5.34, range (17-45). Mean history of headache was 20.93 years. Fifty patients (40%) had 45 or more headache days in the past 3 months. Mean headache intensity score (0-10 scale) was 5.7 +/- 1.8. Patients were on various preventive treatments, including beta-blockers (48 [41%]), calcium-channel blockers (19 [16%]), antidepressants (52 [44%]), antiepileptics (46 [39%]), neurotoxins (16 [14%]), vitamins/herbal therapies (28 [24%]), and nonmedicinal therapy (38 [32%]). Of the 7 aspects of migraine prevention that patients were asked to rate, 72% rated effectiveness the most important aspect. Twelve percent rated speed of onset most important, 6% rated absence of adverse events most important, 3% rated formulation of therapy most important, 3% rated out-of-pocket expenses most important, and 2% rated type of treatment (prescription/vitamin) most important. None rated frequency of dosing as the most important factor. In the area of preventive treatment scenarios, patients were more likely to choose treatments with higher efficacy rates, fewer adverse events and less frequent dosing schedule. Patients indicated that they preferred the treatment options with higher efficacy rates even if side effects were present and a more frequent dosing schedule was necessary. CONCLUSION: Patients' preference regarding migraine prevention is very important in headache management. Patients rated efficacy the most important aspect in preventive therapy and preferred treatment options with higher efficacy rates. Future studies are needed for a better understanding of patients' preference for migraine prevention.
Assuntos
Inquéritos Epidemiológicos , Transtornos de Enxaqueca/prevenção & controle , Satisfação do Paciente , Medicina Preventiva/métodos , Adulto , Brasil/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/epidemiologia , Estados Unidos/epidemiologiaRESUMO
Psychiatric comorbidity, mainly anxiety and depression, are common in chronic migraine (CM). Phobias are reported by half of CM patients. Phobic avoidance associated with fear of headache or migraine attack has never been adequately described. We describe 12 migraine patients with particular phobic-avoidant behaviours related to their headache attacks, which we classified as a specific illness phobia, coined as cephalalgiaphobia. All patients were women, mean age 42, and all had a migraine diagnosis (11 CM, all overused acute medications). Patients had either a phobia of a headache attack during a pain-free state or a phobia of pain worsening during mild headache episodes. Patients overused acute medication as phobic avoidance. It is a significant problem, associated with distress and impairment, interfering with medical care. Cephalalgiaphobia is a possible specific phobia of illness, possibly linked to progression of migraine to CM and to acute medication overuse headache.