RESUMO
OBJECTIVES: This study evaluated headaches among Parkinson's disease (PD) patients and whether there was any correlation between the motor symptoms and the severity of the headaches presented. BACKGROUND: Forty to 83% of PD patients are affected by pain. Despite this high prevalence of pain, only a few studies have addressed the headaches of these patients. METHODS: This was a cross-sectional study. Consecutive patients with Parkinson disease were included. Semi-structured interview; the Epworth sleepiness scale; the Hospital Anxiety and Depression Scale; the Unified Parkinson's Disease Rating Scale (UPDRS), Part III (motor examination); and the Hoehn and Yahr scale were used. RESULTS: About 46 patients were included, 52% were men, mean age was 66 ± 11 years. Forty-three patients had headaches, 12/46 (26%), migraines, 31/46 (67%) had tension-type headaches. We found no association between the headache frequency (median: 0.5; 0.5 to 7.5 vs 0.5; 0.5 to 8 days/3 months; P = .757) or intensity (median: 5; 4 to 8 vs 5.5, 4 to 9; P = .514) and the different stages of the PD (Hoehn and Yahr scale: ≤2.5 vs >2.5). There was no correlation between UPDRS score and the intensity (r = -0.099; P = .530) or frequency of headaches (r = -0.136; P = .373). No association was found between the grade of neck stiffness (0 vs 1 and 2 vs 3 and 4) and the headache frequency (Median: 0; 0 to 3 vs 3.5; 0 to 12.5 vs 0; 0 to 6 days/3 months; P = .074) or intensity (Median: 5; 3 to 9 vs 5; 4 to 6 vs 7; 4.5 to 9; P = .434). Twelve patients said that their headaches started after PD had been diagnosed. There was no difference regarding the frequency and characteristics of headaches and PD characteristics between these patients and the other patients with previous headaches. CONCLUSIONS: In this sample of PD patients, there is no association between headache and PD.
Assuntos
Transtornos da Cefaleia/epidemiologia , Transtornos da Cefaleia/fisiopatologia , Doença de Parkinson/epidemiologia , Doença de Parkinson/fisiopatologia , Idoso , Comorbidade , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/epidemiologia , Transtornos de Enxaqueca/fisiopatologia , Índice de Gravidade de Doença , Cefaleia do Tipo Tensional/epidemiologia , Cefaleia do Tipo Tensional/fisiopatologiaRESUMO
Tension-type headaches (TTH) and irritable bowel syndrome (IBS) are comorbid diseases affecting, especially, women. One of the underlying mechanisms for both is autonomic dysfunction in the brain-gut axis. We aimed to evaluate the factors accompanying TTH and their relation to functional gastrointestinal disorders. METHODS: Women diagnosed with TTH were questioned about headache pattern and severity, and accompanying factors, as well as being screened for IBS according to the Rome III criteria. The participants were divided into two groups: constipation-dominant IBS (IBS-C) group and "others", with a total of 115 individuals included in the study. RESULTS: Of the 115 patients; 48 (41.8%) of the women had IBS-C criteria while 67 (58.2%) described mixed-type IBS or diarrhea-dominant IBS. There were no significant differences in terms of mean age (p = 0.290), body mass index (p = 0.212), visual analog scale (p = 0.965), duration of attacks (p = 0.692), and episodic/chronic type (p = 0.553). Osmophobia was seen in 43.5%; phonophobia in 68.7%, and photophobia in 47.0% of the patients, and only osmophobia was significantly associated in women in the IBS-C group (p = 0.001). CONCLUSION: In female patients with TTH, a higher level of constipation was detected. The relationship of these two diseases suggests that they may share common mechanisms. This is the first study showing the relationship of osmophobia with constipation.
Assuntos
Constipação Intestinal/complicações , Síndrome do Intestino Irritável/complicações , Cefaleia do Tipo Tensional/complicações , Adulto , Índice de Massa Corporal , Constipação Intestinal/fisiopatologia , Feminino , Humanos , Hiperacusia/fisiopatologia , Síndrome do Intestino Irritável/fisiopatologia , Pessoa de Meia-Idade , Medição da Dor , Fotofobia/fisiopatologia , Estudos Prospectivos , Índice de Gravidade de Doença , Inquéritos e Questionários , Cefaleia do Tipo Tensional/fisiopatologiaRESUMO
ABSTRACT Tension-type headaches (TTH) and irritable bowel syndrome (IBS) are comorbid diseases affecting, especially, women. One of the underlying mechanisms for both is autonomic dysfunction in the brain-gut axis. We aimed to evaluate the factors accompanying TTH and their relation to functional gastrointestinal disorders. Methods: Women diagnosed with TTH were questioned about headache pattern and severity, and accompanying factors, as well as being screened for IBS according to the Rome III criteria. The participants were divided into two groups: constipation-dominant IBS (IBS-C) group and "others", with a total of 115 individuals included in the study. Results: Of the 115 patients; 48 (41.8%) of the women had IBS-C criteria while 67 (58.2%) described mixed-type IBS or diarrhea-dominant IBS. There were no significant differences in terms of mean age (p = 0.290), body mass index (p = 0.212), visual analog scale (p = 0.965), duration of attacks (p = 0.692), and episodic/chronic type (p = 0.553). Osmophobia was seen in 43.5%; phonophobia in 68.7%, and photophobia in 47.0% of the patients, and only osmophobia was significantly associated in women in the IBS-C group (p = 0.001). Conclusion: In female patients with TTH, a higher level of constipation was detected. The relationship of these two diseases suggests that they may share common mechanisms. This is the first study showing the relationship of osmophobia with constipation.
RESUMO As cefaléias do tipo tensional (TTH) e a síndrome do intestino irritável (IBS) são comorbidades que afetam especialmente as mulheres. O mecanismo subjacente para ambas é a disfunção autonômica no eixo cérebro-intestino. Nosso objetivo foi avaliar os fatores que acompanham as TTH e sua relação com distúrbios gastrointestinais funcionais (FGID). Métodos: Mulheres com diagnóstico de TTH foram questionadas quanto ao padrão e gravidade da cefaleia, fatores acompanhantes e triadas para IBS de acordo com os critérios de Roma III e foram divididas em dois grupos: grupo com IBS com predominância de constipação (IBS-C) e as demais. Um total de 115 mulheres foram incluídas no estudo. Resultados: Do total de 115 pacientes; 48 (41,8%) das mulheres tiveram os critérios da IBS-C, enquanto 67 (58,2%) tiveram IBS do tipo misto ou IBS com predominância de diarreia. Não houve diferenças significativas em termos de idade média (p = 0,290), índice de massa corporal (IMC) (p = 0,212), escala visual analógica (VAS) (p = 0,965), duração dos ataques (p = 0,692), e tipo episódico / crônico (p = 0,553). Osmofobia foi observada em 43,5% das pacientes; fonofobia em 68,7% e fotofobia em 47,0%, e apenas osmofobia foi significativamente associada no grupo de mulheres com predominância de constipação (p = 0,001). Conclusão: Em pacientes do sexo feminino com TTH, encontra-se uma maior constipação. A relação dessas duas doenças sugere que elas podem compartilhar mecanismos comuns. Além disso, este é o primeiro estudo mostrando a relação da osmofobia com a constipação.
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Cefaleia do Tipo Tensional/complicações , Constipação Intestinal/complicações , Síndrome do Intestino Irritável/complicações , Hiperacusia/fisiopatologia , Índice de Gravidade de Doença , Medição da Dor , Índice de Massa Corporal , Estudos Prospectivos , Inquéritos e Questionários , Cefaleia do Tipo Tensional/fisiopatologia , Constipação Intestinal/fisiopatologia , Fotofobia/fisiopatologia , Síndrome do Intestino Irritável/fisiopatologiaRESUMO
BACKGROUND: Central and peripheral mechanisms may be involved in migraine and tension-type headache pathogenesis, however the role of muscle disorders in their pathophysiological mechanisms remains unclear. OBJECTIVES: To assess the association between the presence of migraine or tension-type headache and changes in longus colli muscle dimensions and sternocleidomastoid muscle activity. METHOD: An observational study with 48 women comparing the following groups: migraine (n=21), tension-type headache (n=16), and control (n=11). The cross-sectional area, lateral and anteroposterior dimensions, and shape ratio of the longus colli muscle were measured using ultrasound. The activation of the sternocleidomastoid muscle was assessed by signal amplitude and the decline in median frequency using surface electromyographic analysis. RESULTS: The dimensions of the longus colli muscle did not differ between groups (p>0.05). Post-test analysis showed lower sternocleidomastoid muscle activation on both sides, at the onset of contraction, in the group with tension-type headache when compared to the control group {right sternocleidomastoid [tension-type headache: 0.39 (0.30-0.49); control: 0.58 (0.42-0.76); p=0.026] and left sternocleidomastoid [tension-type headache: 0.39 (0.31-0.48); control: 0.60 (0.42-0.79); p=0.039], Tukey's post hoc test}. There was no difference between the three groups in sternocleidomastoid muscle activation, on both sides, at the end of contraction (p>0.05). Intergroup analysis showed no difference in the rate of decline in median frequency (p>0.05). CONCLUSION: The group with tension-type headache exhibited less activation at the onset of sternocleidomastoid muscle contraction. No association was observed between the presence of headache and alterations in longus colli muscle dimensions, median frequency, and sternocleidomastoid muscle activation at the end of contraction.
Assuntos
Transtornos de Enxaqueca/fisiopatologia , Músculos do Pescoço/fisiopatologia , Cefaleia do Tipo Tensional/fisiopatologia , Adulto , Eletromiografia , Feminino , Humanos , Músculos do Pescoço/anatomia & histologia , Músculos do Pescoço/diagnóstico por imagem , Ultrassonografia , Adulto JovemRESUMO
Neurotrophic factors (NF) are involved in pain regulation and a few studies have suggested that they may play a pathophysiological role in primary headaches. The aim of this study was to investigate NF levels in patients with tension type headache (TTH). We carried out a cross sectional study including 48 TTH patients and 48 age and gender matched controls. Beck Depression and Anxiety Inventories, and Headache Impact Test were recorded. Serum levels of NF were determined by ELISA. There were not significant differences between NF levels between TTH patients and controls. Patients with chronic and episodic TTH had not significant differences in NF levels. The presence of headache at the time of evaluation did not significantly alter the levels of NF. Depression and anxiety scores as well as headache impact did not correlate with NF levels. Our study suggest that the serum levels of NF are not altered in TTH.
Assuntos
Fatores de Crescimento Neural/sangue , Cefaleia do Tipo Tensional/sangue , Adulto , Ansiedade/sangue , Ansiedade/fisiopatologia , Estudos de Casos e Controles , Estudos Transversais , Depressão/sangue , Depressão/fisiopatologia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neurotrofina 3 , Psicometria , Receptores de Fator de Crescimento Neural/sangue , Valores de Referência , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Cefaleia do Tipo Tensional/fisiopatologia , Adulto JovemRESUMO
Neurotrophic factors (NF) are involved in pain regulation and a few studies have suggested that they may play a pathophysiological role in primary headaches. The aim of this study was to investigate NF levels in patients with tension type headache (TTH). We carried out a cross sectional study including 48 TTH patients and 48 age and gender matched controls. Beck Depression and Anxiety Inventories, and Headache Impact Test were recorded. Serum levels of NF were determined by ELISA. There were not significant differences between NF levels between TTH patients and controls. Patients with chronic and episodic TTH had not significant differences in NF levels. The presence of headache at the time of evaluation did not significantly alter the levels of NF. Depression and anxiety scores as well as headache impact did not correlate with NF levels. Our study suggest that the serum levels of NF are not altered in TTH.
Os fatores neurotróficos (FN) participam da regulação da dor e podem ter um papel na fisiopatologia das cefaleias peimárias. O objetivo do presente estudo foi avaliar os níveis séricos de FN em pacientes com cefaleia do tipo tensional (CTT). Foi realizado corte transversal com 48 pacientes com CTT e 48 controles pareados por gênero e idade. Os inventários de Beck para depressão e ansiedade, bem como o inventário de impacto da cefaleia foram aplicados. Os níveis séricos de FN foram determinados por ELISA. Não houve diferenças significativas entre níveis de FN entre pacientes com TTH e controles, bem como entre pacientes com TTH episódica e crônica. Presença de cefaleia no momento da avaliação não alterou os níveis séricos de FN. Os escores de depressão, ansiedade e impacto da cefaleia não se correlacionaram com os níveis de FN. Nosso estudo sugere que não há alteração dos níveis de FN na TTH.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Fatores de Crescimento Neural/sangue , Cefaleia do Tipo Tensional/sangue , Ansiedade/sangue , Ansiedade/fisiopatologia , Estudos de Casos e Controles , Estudos Transversais , Depressão/sangue , Depressão/fisiopatologia , Ensaio de Imunoadsorção Enzimática , Psicometria , Valores de Referência , Receptores de Fator de Crescimento Neural/sangue , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Cefaleia do Tipo Tensional/fisiopatologiaRESUMO
La fisiopatología de las cefaleas primarias es compleja e incluye un sinnúmerode interacciones que regulan el proceso nociceptivo. Dentro de los principalesresponsables de generar el dolor se encuentra el sistema trigémino vascular, que esun conjunto de estructuras que integran vías tanto centrales corticosubcorticales comoperiféricas, que desempeñan un papel activo no solo en la génesis del dolor, sino enlas manifestaciones autonómicas y visuales que acompañan la cefalea. Así mismo, estesistema es el responsable de los mecanismos de sensibilización central característicosdel dolor. En el artículo se desarrollan brevemente las principales estructuras queparticipan en la génesis de las cefaleas primarias y sus interacciones en las diferentespartes del sistema nervioso...
The pathophysiology of primary headache iscomplex and it includes several interactionsthat regulate the nociceptive process. The trigeminal-vascular system is perhaps one of theprincipal structures that generate pain due tothe integration of several pathways both centraland peripheral. In addition to this, the trigeminalvascular system also plays a central role inthe autonomic and visual symptoms that affectindividuals with headache and in the centralsensitization process. In this article we brieflydiscuss the main structures that participate in thepathophysiology of primary headaches and theirinteractions in the different levels of the centralnervous system...
Assuntos
Cefalalgias Autonômicas do Trigêmeo/classificação , Cefalalgias Autonômicas do Trigêmeo/diagnóstico , Cefalalgias Autonômicas do Trigêmeo/etnologia , Cefalalgias Autonômicas do Trigêmeo/fisiopatologia , Cefalalgias Autonômicas do Trigêmeo/terapia , Cefaleia Histamínica/fisiopatologia , Cefaleia Histamínica/história , Cefaleia do Tipo Tensional/fisiopatologia , Transtornos de EnxaquecaRESUMO
Cervicogenic headache (CEH) is a well-recognized syndrome. Proposed diagnostic criteria differentiate CEH from migraine and tension-type headache (TTH) in most of the cases. The best differentiating factors include side-locked unilateral pain irradiating from the back and evidence of neck involvement--attacks may be precipitated by digital pressure over trigger spots in the cervical/nuchal areas or sustained awkward neck positions. Migrainous traits may be present in some cases. Cervical lesions are not necessarily seen, and most common cervical lesions do not produce CEH. Whiplash may occasionally induce headaches. This is suspected when the pain onset and the whiplash trauma are close in time. Whiplash-related headaches tend to be short-lasting, admitting mostly a TTH or a CEH-like phenotype. Neuroimaging abnormalities are not necessarily expected in CEH. Whiplash patients must undergo cervical imaging mostly in connection with the trauma, as no abnormalities are pathognomonic in chronic cases.
Assuntos
Transtornos de Enxaqueca/diagnóstico , Cefaleia Pós-Traumática/diagnóstico , Cefaleia do Tipo Tensional/diagnóstico , Traumatismos em Chicotada/diagnóstico , Humanos , Transtornos de Enxaqueca/fisiopatologia , Cefaleia Pós-Traumática/fisiopatologia , Cefaleia do Tipo Tensional/fisiopatologia , Traumatismos em Chicotada/fisiopatologiaRESUMO
OBJECTIVES: A population-based cross-sectional study was conducted to estimate the prevalence of migraine, episodic tension-type headaches (ETTH), and chronic daily headaches (CDH), as well as the presence of symptoms of temporomandibular disorders (TMD) in the adult population. BACKGROUND: The potential comorbidity of headache syndromes and TMD has been established mostly based on clinic-based studies. METHODS: A representative sample of 1230 inhabitants (51.5% women) was interviewed by a validated phone survey. TMD symptoms were assessed through 5 questions, as recommended by the American Academy of Orofacial Pain, in an attempt to classify possible TMD. Primary headaches were diagnosed based on the International Classification of Headache Disorders. RESULTS: When at least 1 TMD symptom was reported, any headache happened in 56.5% vs 31.9% (P < .0001) in those with no symptoms. For 2 symptoms, figures were 65.1% vs 36.3% (P < .0001); for 3 or more symptoms, the difference was even more pronounced: 72.8% vs 37.9%. (P < .0001). Taking individuals without headache as the reference, the prevalence of at least 1 TMD symptom was increased in ETTH (prevalence ratio = 1.48, 95% confidence interval = 1.20-1.79), migraine (2.10, 1.80-2.47) and CDH (2.41, 1.84-3.17). At least 2 TMD symptoms also happened more frequently in migraine (4.4, 3.0-6.3), CDH (3.4; 1.5-7.6), and ETTH (2.1; 1.3-3.2), relative to individuals with no headaches. Finally, 3 or more TMD symptoms were also more common in migraine (6.2; 3.8-10.2) than in no headaches. Differences were significant for ETTH (2.7 1.5-4.8), and were numerically but not significant for CDH (2.3; 0.66-8.04). CONCLUSION: Temporomandibular disorder symptoms are more common in migraine, ETTH, and CDH relative to individuals without headache. Magnitude of association is higher for migraine. Future studies should clarify the nature of the relationship.
Assuntos
Transtornos da Cefaleia/epidemiologia , Transtornos da Cefaleia/fisiopatologia , Transtornos da Articulação Temporomandibular/epidemiologia , Transtornos da Articulação Temporomandibular/fisiopatologia , Adulto , Idoso , Causalidade , Doença Crônica/epidemiologia , Estudos de Coortes , Comorbidade , Estudos Transversais , Feminino , Transtornos da Cefaleia/diagnóstico , Inquéritos Epidemiológicos , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/epidemiologia , Transtornos de Enxaqueca/fisiopatologia , Medição da Dor/métodos , Prevalência , Articulação Temporomandibular/fisiopatologia , Transtornos da Articulação Temporomandibular/diagnóstico , Cefaleia do Tipo Tensional/diagnóstico , Cefaleia do Tipo Tensional/epidemiologia , Cefaleia do Tipo Tensional/fisiopatologia , Adulto JovemRESUMO
Migraine and tension-type headache (TTH) are highly prevalent primary headaches that remain underdiagnosed and undertreated in clinical practice. The similarities and differences between migraine and TTH may impose diagnostic challenges as well as management difficulties. In addition, the possibility of migraine chronification or transformation in daily or near-daily headache raises the potential level of interaction between pathophysiologic mechanisms of TTH and migraine. The continuum concept is a possible key to the understanding of this association. Future studies are necessary to clarify epidemiology, pathophysiology, and management of these two most prevalent headaches.
Assuntos
Transtornos de Enxaqueca/terapia , Cefaleia do Tipo Tensional/terapia , Doença Crônica , Progressão da Doença , Humanos , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/fisiopatologia , Cefaleia do Tipo Tensional/diagnóstico , Cefaleia do Tipo Tensional/fisiopatologiaRESUMO
Se estudiaron retrospectivamente, 78 pacientes con cefalea recurrente referidos al servicio de Neurología del HNN durante los años 2001 y 2002. 51 por ciento de los pacientes venían referidos por un pediatra, con un tiempo de espera para ser atendidos en el HNN, menor de dos meses (80 por ciento). El grupo representó el 16,5 por ciento de la consulta de pacientes nuevos. 43 varones (55.1 por ciento) y 35 mujeres (44.9 por ciento), de 2 a 13 años de edad (promedio 8), tenían menos de 1 año de evolución de cefalea (50 por ciento), de intensidad moderada (70 por ciento), pulsátil (70 por ciento) y asociada a náuses, vómitos, defectos visuales y fotofobia en 36, 30, 27 y 13 pacientes respectivamente. En 36 niños no se reportó ningún factor desencadenante pero el estrés precipitaba los síntomas en 35 casos. El 72 por ciento tenían el antecedente familiar de migraña. A 61 pacientes se les realizó una tomografía axial computarizada (TAC), que fue normal en 59, uno tenía atrofia cortical y subcortical y otro hallazgos sugestivos de neurocisticercosis. Los diagnósticos principales fueron migraña (95 por ciento) y cefalea tensional (3 por ciento), con respuesta satisfactoria (85 por ciento de los casos) a las recomendaciones, analgésicos o al tratamiento preventivo, permitiendo remitirles (75 por ciento) a sus consultas de origen. Niños con cefalea recurrente y examen neurológico normal deben recibir recomendaciones, información y seguimiento, no siendo generalmente necesario referir a Neurología, hacer exámenes paraclínicos ni hospitalizar.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Cefaleia do Tipo Tensional/etiologia , Cefaleia do Tipo Tensional/fisiopatologia , Cefaleia do Tipo Tensional/tratamento farmacológico , Cefaleia do Tipo Tensional/terapia , Costa RicaRESUMO
A case series study of 50 consecutive patients with episodic tension type headache (ETTH) was conducted. Clinical aspects, family history and impact on work activities were studied. The casuistry was made up of 40 women and 10 men. The average age was 30 (+/-12) years. Constrictive pain was present in 40 patients (80%). Sickness was the most commonly reported related phenomenon (20%). As expected, bilateral pain predominated; however, unilateral location was also present (10%). Although classically described as a mild pain, we observed that ETTH can come in intense crisis (16%). Family history of tension type headache was positive in 12 patients. The impact on work activities was substantial (14%). Our findings regarding to clinical aspects are in agreement with the literature. It is important to mention that the impact of ETTH on the individual and society should be reconsidered, and is more substantial than has been reported to date.
Assuntos
Medição da Dor , Cefaleia do Tipo Tensional , Trabalho , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Cefaleia do Tipo Tensional/complicações , Cefaleia do Tipo Tensional/genética , Cefaleia do Tipo Tensional/fisiopatologiaRESUMO
Com o objetivo de estudar os aspectos clínicos, a história familiar e o impacto da dor nas atividades laborativas, foi conduzido estudo de série de casos de 50 pacientes portadores de cefaléia do tipo tensional episódica (CTTE). Foram avaliados 40 mulheres e 10 homens, com idade média de 30 (±12) anos. Dor constrictiva esteve presente em 40 pacientes (80 por cento). O enjôo foi o principal fenômeno acompanhante (20 por cento). A dor bilateral predominou; entretanto, a localização unilateral também esteve presente (10 por cento). Embora classicamente descrita como uma dor leve, observou-se que a CTTE pode se manifestar como crises de forte intensidade (16 por cento). A história familiar foi positiva em 12 pacientes (24 por cento). O impacto nas atividades laborativas foi detectado em 14 por cento da amostra. Os achados a respeito das características da dor estão de acordo com a literatura. O impacto representado pela CTTE a nível individual e na sociedade deve, entretanto, ser reconsiderado.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Cefaleia do Tipo Tensional , Trabalho , Qualidade de Vida , Cefaleia do Tipo Tensional/complicações , Cefaleia do Tipo Tensional/genética , Cefaleia do Tipo Tensional/fisiopatologiaAssuntos
Cefaleia do Tipo Tensional/complicações , Cefaleia do Tipo Tensional/fisiopatologia , Transtornos da Visão/etiologia , Transtornos da Visão/fisiopatologia , Inibidores da Captação Adrenérgica/uso terapêutico , Amitriptilina/uso terapêutico , Ansiolíticos , Anticonvulsivantes/efeitos adversos , Ansiedade/tratamento farmacológico , Bromazepam/uso terapêutico , Cicloexanóis/uso terapêutico , Frutose/efeitos adversos , Frutose/análogos & derivados , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Cefaleia do Tipo Tensional/tratamento farmacológico , Topiramato , Cloridrato de VenlafaxinaRESUMO
UNLABELLED: This review focuses on primary headaches, its diagnosis and treatment. For the IHS specialists they are: migraine, tension-type headache (TTH), cluster and others. Migraine: the second in prevalence and the first in morbility, clinical features and differences between migraine with (Ma) and without aura (Mo). EPIDEMIOLOGY: 10% prevalence and 3:1 women to men proportion. Patophysiology: primary central nociception disorder with secondary vascular involvement. TREATMENT: specific and non-specific, acute and preventive. Psychiatric disorders and migraine: there is evidence of clinical and pharmacological links, mainly between Ma and several psychiatric disorders. Migraine in childrens: important clinical and therapeutic differences from adult, importance of family approach. Migraine and hormones: the importance of estrogen drop, as trigger factor, treatment. Migraine and epilepsy: both shares neuronal hyperexcitability pattern. Migraine and stroke: vascular and ischemic factors involved. Evidence-based medicine: improves treatment's results and studies outcome evaluation. TTH: first in prevalence, still highly subdiagnosed. Main clinical presentations: episodic and chronic. EPIDEMIOLOGY: slight female preponderance. Patophysiology and trigger factors: the role of limbic nociceptive system, sedentarism stress and muscular tension. TREATMENT: pharmacological and non-pharmacological. Cluster headache: low prevalence but high daily-living activities impact, effective treatment. Other primary headaches: variability of trigger factors and role of desensitization process. CONCLUSION: we remark the complexity of headache and the of physicians' role: to relief patients suffering, throughout a precise diagnosis and treatment.
Assuntos
Transtornos da Cefaleia Primários , Adolescente , Adulto , Criança , Pré-Escolar , Diagnóstico Diferencial , Feminino , Transtornos da Cefaleia Primários/diagnóstico , Transtornos da Cefaleia Primários/etiologia , Transtornos da Cefaleia Primários/fisiopatologia , Transtornos da Cefaleia Primários/terapia , Humanos , Masculino , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/etiologia , Transtornos de Enxaqueca/fisiopatologia , Cefaleia do Tipo Tensional/diagnóstico , Cefaleia do Tipo Tensional/etiologia , Cefaleia do Tipo Tensional/fisiopatologia , Cefaleia do Tipo Tensional/terapia , Cefalalgias Autonômicas do Trigêmeo/diagnóstico , Cefalalgias Autonômicas do Trigêmeo/etiologia , Cefalalgias Autonômicas do Trigêmeo/terapiaRESUMO
About 60% of women with migraine associate their headache attacks to the menstrual period. Regarding the non-migrainous headaches, this relationship is not so clear. The aim of this study is to present a clinical evaluation of menstrual headaches. Menstrual headache in our study was defined as the headache that begins in the interval of time from 2 days before menstruation until the last day of the menstrual period. The analyzed parameters were: intensity, character and localization of the pain, and associated symptoms. The headaches of 100 women (154 periods) whose ages ranged from 20 to 45 years were analyzed. Most headaches were classified as migraine without aura; the headaches had strong intensity in the first day of pain and reduced gradually until the last day of pain. The headaches were mostly of throbbing character and, in some moment of the menstrual period, referred as unilateral; the duration of these headaches was of longer duration than the migraine attacks reported in medical literature. Most part of the headaches began two days before the first day of the menstrual flow. Nauseas and/or vomiting were the most frequent associated symptoms. Finally, we found, among the menstrual headaches, 9 cases of tension type headache, 2 cases of cervicogenic headache and 1 case of stabbing headache.
Assuntos
Cefaleia/etiologia , Ciclo Menstrual , Adulto , Feminino , Cefaleia/classificação , Cefaleia/fisiopatologia , Humanos , Pessoa de Meia-Idade , Transtornos de Enxaqueca/etiologia , Transtornos de Enxaqueca/fisiopatologia , Medição da Dor , Estudos Prospectivos , Cefaleia do Tipo Tensional/etiologia , Cefaleia do Tipo Tensional/fisiopatologia , Fatores de TempoRESUMO
A retrospective study was performed in order to evaluate the frequency of abnormalities found by computed tomography (CT) scan of the head in 78 patients with migraine or tension-type headache. In the present study CT scan was normal in 61.5% of the patients with migraine or tension-type headache. A number of abnormalities were encountered in more than one third of the patients studied, including inflammatory sinus disease (19.2%), cysticercosis (3.9%), unruptured cerebral aneurysm (2.6%), basilar impression (2.6%), intracranial lipoma (2.6%), arachnoid cyst (2.6%), empty sella (2.6%), intracranial neoplasm (2.6%), and others (2.6%). None of these lesions were symptomatic or responsible by the headache picture, therefore, considered incidental findings. In conclusion, the fortuitous encounter of some abnormalities on CT scan of the head is often higher than what we could predict in patients suffering migraine or tension-type headache. We briefly discuss clinical, epidemiologic, and practical management of some of the abnormalities detected by CT scan as well as the indication to request a neuroimaging investigation.