RESUMO
INTRODUCTION: The efficiency of The International Classification of Headache Disorders (ICHD-3) in reflecting patients' disability has recently been questioned. This prompts consideration that clinical features beyond pain may more accurately indicate the extent of underlying brain impairment than the mere frequency of headache days. Important cognitive dysfunctions and psychological impairment have been reported in burdensome cases of migraine, and the presence of these alterations has been associated with biological changes in the nervous system. This study aimed to compare migraine-related disability within a specific patient group, classified using ICHD-3 criteria or classified based on findings from a neuropsychological evaluation using machine learning. Additionally, a complementary voxel-based morphometry (VBM) comparison was conducted to explore potential neuroanatomical differences between the resulting groups. PATIENTS AND METHODS: The study included episodic and chronic migraine patients seeking consultation at a specialized headache department. A neuropsychological evaluation protocol, encompassing validated standardized tests for cognition, anxiety, depression, perceived stress, and headache-related impact (HIT-6) and disability (MIDAS), was administered. Results from this evaluation were input into an automated K-means clustering algorithm, with a predefined K=2 for comparative purposes. A supplementary Voxel-based Morphometry (VBM) evaluation was conducted to investigate neuroanatomical contrasts between the two distinct grouping configurations. RESULTS: The study involved 111 participants, with 49 having chronic migraine and 62 having episodic migraine. Seventy-four patients were assigned to cluster one, and 37 patients were assigned to cluster two. Cluster two exhibited significantly higher levels of depression, anxiety, and perceived stress, and performed worse in alternating and focalized attention tests. Differences in HIT-6 and MIDAS scores between episodic and chronic migraine patients did not reach statistical significance (HIT-6: 64.39 (±7,31) vs 62.92 (±11,61); p= 0. 42 / MIDAS: 73.63 (±68,61) vs 84.33 (±63,62); p=0.40). In contrast, patients in cluster two exhibited significantly higher HIT-6 (62.32 (±10,11) vs 66.57 (±7,21); p=0.03) and MIDAS (68.69 (±62,58) vs 97.68 (±70,31); p=0.03) scores than patients in cluster one. Furthermore, significant differences in grey matter volume between the two clusters were noted, particularly involving the precuneus, while differences between chronic and episodic migraine patients did not withstand correction for multiple comparisons. CONCLUSIONS: The classification of migraine patients based on neuropsychological characteristics demonstrates a more effective separation of groups in terms of disability compared to categorizing them based on the chronic or episodic diagnosis of ICHD-3. These findings could reveal biological changes that might explain differences in treatment responses among apparently similar patients.
Assuntos
Pessoas com Deficiência , Transtornos da Cefaleia , Transtornos de Enxaqueca , Humanos , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/diagnóstico por imagem , Cefaleia , Transtornos da Cefaleia/diagnóstico , Coleta de DadosRESUMO
BACKGROUND: Persistent headache is a frequent symptom after coronavirus disease 2019 (COVID-19) and there is currently limited knowledge about its clinical spectrum and predisposing factors. A subset of patients may be experiencing new daily persistent headache (NDPH) after COVID-19, which is among the most treatment-refractory primary headache syndromes. METHODS: We conducted a cross-sectional study in Latin America to characterize individuals with persistent headache after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to identify factors associated with NDPH. Participants over 18 years old who tested positive for SARS-CoV-2 infection and reported persistent headache among their symptoms completed an online survey that included demographics, past medical history, persistent headache clinical characteristics, and COVID-19 vaccination status. Based on participants' responses, NDPH diagnostic criteria were used to group participants into NDPH and non-NDPH groups. Participant data was summarized by descriptive statistics. Student's t and Mann-Whitney U tests were used according to the distribution of quantitative variables. For categorical variables, Pearson's chi-square and Fisher's exact tests were used according to the size of expected frequencies. Binomial logistic regression using the backward stepwise selection method was performed to identify factors associated with NDPH. RESULTS: Four hundred and twenty-one participants from 11 Latin American countries met the inclusion criteria. One in four participants met the NDPH diagnostic criteria. The mean age was 40 years, with most participants being female (82%). Over 90% of the participants reported having had mild/moderate COVID-19. Most participants had a history of headache before developing COVID-19 (58%), mainly migraine type (32%). The most predominant clinical characteristics in the NDPH group were occipital location, severe/unbearable intensity, burning character, and radiating pain (p < 0.05). A higher proportion of anxiety symptoms, sleep problems, myalgia, mental fog, paresthesia, nausea, sweating of the face or forehead, and ageusia or hypogeusia as concomitant symptoms were reported in participants with NDPH (p < 0.05). Palpebral edema as a concomitant symptom during the acute phase of COVID-19, occipital location, and burning character of the headache were risk factors associated with NDPH. CONCLUSION: This is the first study in Latin America that explored the clinical spectrum of NDPH after SARS-CoV-2 infection and its associated factors. Clinical evaluation of COVID-19 patients presenting with persistent headache should take into consideration NDPH.
Assuntos
COVID-19 , Transtornos da Cefaleia , Humanos , Feminino , Adulto , Adolescente , Masculino , COVID-19/complicações , COVID-19/epidemiologia , Estudos Transversais , América Latina/epidemiologia , SARS-CoV-2 , Vacinas contra COVID-19 , Transtornos da Cefaleia/diagnóstico , Transtornos da Cefaleia/etiologia , Cefaleia/epidemiologia , Cefaleia/etiologiaRESUMO
The review considered points of conflict that may lead to confusion in the daily use of the International Classification of Headache Disorders (ICHD-III). Both the controversies at the time of preparing the criteria and the overlaps produced after their use in daily practice were evaluated, argued through scientific bibliography. As relevant points, the anamnesis of a patient with headache should indicate the intensity of the pain as well as the duration of the painful episode and if its location is strictly unilateral. These points may be helpful in cases of moderate pain that do not fully meet the criteria for any of the primary headaches, a frequent dilemma in daily practice.
La revisión consideró los puntos de conflicto que puedan llevar a confusión en el uso diario de la clasificación internacional de las cefaleas (ICHD-III). Se evaluaron tanto las controversias al momento de confeccionar los criterios como las superposiciones producidas tras su utilización en la práctica diaria, argumentado a través de bibliografía científica. Como puntos relevantes, la anamnesis de un paciente con cefalea debe indicar la intensidad del dolor como así también la duración del episodio doloroso y si su localización es estrictamente unilateral. Estos puntos podrán ser de ayuda en los casos de dolor moderado que no cumplan en forma absoluta los criterios para ninguna de las cefaleas primarias, dilema frecuente en la práctica diaria.
Assuntos
Transtornos da Cefaleia , Humanos , Transtornos da Cefaleia/diagnóstico , Cefaleia/diagnósticoAssuntos
Anestésicos Locais/administração & dosagem , Epistaxe/epidemiologia , Transtornos da Cefaleia/terapia , Ropivacaina/administração & dosagem , Bloqueio do Gânglio Esfenopalatino/métodos , Anestésicos Locais/efeitos adversos , Epistaxe/etiologia , Transtornos da Cefaleia/diagnóstico , Humanos , Nariz , Medição da Dor , Ropivacaina/efeitos adversos , Bloqueio do Gânglio Esfenopalatino/efeitos adversos , Resultado do TratamentoRESUMO
BACKGROUND AND PURPOSE: The relationship between unruptured intracranial aneurysms (UIAs) and chronic headache and the impact of aneurysm treatment on headache outcome are controversial. The aim of this study was to determine clinical features of a supposedly primary headache in patients with UIA. We also assessed changes in headache characteristics after UIA treatment. METHODS: We examined clinical and imaging data of patients in whom a UIA was diagnosed during diagnostic workup of a suspected primary headache. Medical records were reviewed and personal telephone follow-ups were performed after UIA treatment to assess changes in the frequency and intensity of the headache. RESULTS: Forty-two patients (76%) reported a substantial improvement in headache frequency and intensity after UIA treatment. Forty-five patients (81%) reported a decrease in headache frequency from a median of 8 days/month before treatment to 1 day/month after treatment (95% confidence interval [CI] 81-83, P < .001). The average intensity in an analog pain scale was 7.7 ± 1.6 before treatment and 5.6 ± 2.4 after treatment (P < .001). Higher headache frequency was associated with a greater odd of improvement after treatment (odds ratio 1.12, 95% CI 1.0-1.26, P = .03). No associations were found between the type of headache, type of treatment (endovascular versus surgical), number, size, or localization of the aneurysms and the response to treatment. CONCLUSIONS: The treatment of UIA had a robust beneficial effect on previous headache. Although a "placebo" effect of aneurysm treatment cannot be ruled out, these results suggest a potential association between UIA and certain chronic headaches usually considered to be primary.
Assuntos
Procedimentos Endovasculares , Transtornos da Cefaleia/prevenção & controle , Aneurisma Intracraniano/terapia , Procedimentos Cirúrgicos Vasculares , Adulto , Idoso , Distribuição de Qui-Quadrado , Feminino , Transtornos da Cefaleia/diagnóstico , Transtornos da Cefaleia/etiologia , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Medição da Dor , Indução de Remissão , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
Introducción: El Síndrome HaNDL (Headache and neurologic deficits with cerebroespinal fluid lymphocytosis) por sus siglas en inglés, es una patología que cursa con cefalea, focalización neurológica y linfocitosis en el líquido cefalorraquídeo. Objetivo: este artículo busca presentar un caso de Síndrome de HaNDL, puesto que esta condición nosológica implica un reto diagnóstico. Resultados y conclusiones: Se presenta el caso de un paciente con diagnóstico de síndrome de HaNDL los hallazgos al examen físico y del líquido cefalorraquídeo.
Introduction: The syndrome of transient Headache and Neurological Deficits with cerebrospinal fluid Lymphocytosis, is a pathology that presents cephalalgia, neurological focalization and lymphocytes in the cerebrospinal fluid. Objective: This article presents a HaNDL Syndrome case, since this nosological condition implies a diagnostic challenge. Results and conclusions: A case of a patient with HaNDL syndrome diagnosis, physical examination findings and cerebrospinal fluid are presented.
Introdução: A síndrome de HaNDL (Headache and neurologic déficits with cerebrospinal fluid lymphocytosis) por sua sigla em inglês é uma doença que causa dor de cabeça, foco neurológico e linfocitose no líquido cefalorraquidiano. Objetivo: Este artigo tem como objetivo apresentar um caso de Síndrome de HaNDL, uma vez que esta condição nosológica envolve um desafio diagnóstico. Resultados e conclusões: Apresenta-se o caso de um paciente diagnosticado com a síndrome de HaNDL, o encontrado no exame físico e o líquido cefalorraquidiano.
Assuntos
Humanos , Masculino , Adulto , Cefaleia/patologia , Doenças do Sistema Nervoso/diagnóstico , Linfocitose , Líquido Cefalorraquidiano , Transtornos da Cefaleia/diagnóstico , Cefaleia/diagnósticoRESUMO
It has been well established that primary headaches (especially migraine, chronic migraine, and tension-type headache) and temporomandibular dysfunction (TMD) are comorbid diseases, with the presence of one of them in a patient increasing the prevalence of the others. The relationship between the 2 diseases may involve the sharing of common physiopathological aspects. Studies about the treatment of this disease association have shown that a simultaneous therapeutic approach to the 2 diseases is more effective than the separate treatment of each. As a consequence, specialists in orofacial pain are now required to know the criteria for the diagnosis of headaches, and headache physicians are required to know the semiologic aspects of orofacial pain. Nevertheless, a headache may be attributed to TMD, instead be an association of 2 problems - TMD and primary headaches - in these cases a secondary headache, described in item 11.7 of the International Classification of Headache Disorders, is still a controversial topic. Attempts to determine the existence of this secondary headache with a specific or suggestive phenotype have been frustrated. The conclusion that can be reached based on the few studies published thus far is that this headache has a preferential unilateral or bilateral temporal location and migraine-like or tension-type headache-like clinical characteristics. In the present review, we will consider the main aspects of the TMD-headache relationship, that is, comorbidity of primary headaches and TMD and clinical aspects of the headaches attributed to TMD from the viewpoint of the International Headache Society and of a group of specialists in orofacial pain. This paper aims to explore our understanding of the association between TMD and headaches in general and migraine in particular.
Assuntos
Transtornos da Cefaleia/epidemiologia , Transtornos da Articulação Temporomandibular/epidemiologia , Comorbidade , Transtornos da Cefaleia/diagnóstico , Humanos , Prevalência , Transtornos da Articulação Temporomandibular/diagnósticoRESUMO
Studying the epidemiology of fibromyalgia (FM) is very important to understand the impact of this disorder on persons, families and society. The recent modified 2010 classification criteria of the American College of Rheumatology (ACR), without the need of tender points palpation, allows that larger and nationwide surveys may be done, worldwide. This article reviews the prevalence and incidence studies done in the general population, in several countries/continents, the prevalence of FM in special groups/settings, the association of FM with some sociodemographic characteristics of the population, and the comorbidity of FM with others disorders, especially with headaches.
Assuntos
Fibromialgia/epidemiologia , Saúde Global , Transtornos da Cefaleia/epidemiologia , Comorbidade , Feminino , Fibromialgia/diagnóstico , Fibromialgia/etiologia , Transtornos da Cefaleia/diagnóstico , Transtornos da Cefaleia/etiologia , Humanos , Masculino , Vigilância da População , Prevalência , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Chronic daily headaches (CDHs) are often associated with temporomandibular disorders (TMDs). However, large studies assessing the relationship were conducted in general, and not clinical, populations. Thus, clinical exams were not completed. Clinic-based studies with expert diagnosis are, in turn, often small and may not be representative. OBJECTIVE: To contrast the demographic and clinical symptoms of CDH and TMD in participants within the general population relative to patients seen in a headache clinic. METHODS: All inhabitants 10 years and older of a small city in Brazil were interviewed. Those with more than 15 days of headache per month were examined by a team consisting of a neurologist, a dentist, and a physical therapist. Headaches were classified as per the Second Edition of the International Classification of Headache Disorders and TMD as per the Research Diagnostic Criteria. The procedure was repeated (by the same team) with CDH sufferers consecutively seen in a headache center. RESULTS: Of 1605 inhabitants interviewed, 57 (3.6%) had CDH, and 43 completed all physical assessments. For specialty care group, of 289 patients, 92 had CDH, and 85 completed all assessments. No significant differences were seen for gender and age, but education level was significantly higher among those recruited at specialty care. Muscular TMD happened in 30.2% of CDH patients from the community vs 55.3% in the headache center (difference of -25.1%, 95% confidence interval of difference=-40.8% to -9.4%). No TMD happened in 41.9% of those recruited from the population relative to 20% of those in the headache center (21.9%, 95% confidence interval=6.7-37.1%). CONCLUSION: Individuals with CDH recruited from the general population are significantly less likely to have CDH relative to those selected from the headache center. Issues of generalizability are of concern when conducting clinic-based studies on the topic.
Assuntos
Instituições de Assistência Ambulatorial , Transtornos da Cefaleia/epidemiologia , Características de Residência , Transtornos da Articulação Temporomandibular/epidemiologia , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Feminino , Transtornos da Cefaleia/diagnóstico , Transtornos da Cefaleia/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Transtornos da Articulação Temporomandibular/diagnóstico , Transtornos da Articulação Temporomandibular/terapia , Adulto JovemRESUMO
OBJECTIVE: To assess the frequency of different diagnoses of headaches in the Headache Outpatient Clinic of the Hospital das Clínicas of the Universidade Federal de Minas Gerais (AmbCef-UFMG). METHODS: Cross sectional study with 289 patients consecutively attended to at AmbCef-UFMG. Headaches were diagnosed based on the criteria established by the International Classification of Headache Disorders (ICDH-2004). RESULTS: The average age of patients was 42.6 years, mostly women (86.9%) with less than nine years of education. Primary headaches were the most common type, with migraine found in 79.8% of cases, and tension-type headache (TTH) in 20.4%. Among the secondary types, the most common was headache caused by overuse of analgesics (16.6%), followed by less common types, such as idiopathic intracranial hypertension. Chronic daily headache (CDH) was found in 31.8% of cases. CONCLUSION: This study confirms literature data showing migraine as the most common headache in tertiary care centers. The expressive number of cases of CDH and headaches caused by overuse of analgesics indicates that, starting at the primary care level, patients should be advised to avoid the abuse of symptomatic drugs.
Assuntos
Transtornos da Cefaleia/diagnóstico , Adulto , Instituições de Assistência Ambulatorial , Brasil/epidemiologia , Estudos Transversais , Diagnóstico Diferencial , Feminino , Transtornos da Cefaleia/epidemiologia , Transtornos da Cefaleia Secundários/diagnóstico , Transtornos da Cefaleia Secundários/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/epidemiologia , Cefaleia do Tipo Tensional/diagnóstico , Cefaleia do Tipo Tensional/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Adulto JovemRESUMO
OBJETIVO: Avaliar a frequência dos diferentes diagnósticos de cefaleias do Ambulatório de Cefaleias do Hospital das Clínicas da Universidade Federal de Minas Gerais (AmbCef-UFMG). MÉTODOS: Estudo transversal e descritivo com 289 pacientes atendidos consecutivamente no AmbCef-UFMG. O diagnóstico da cefaleia baseou-se nos critérios da Classificação Internacional das Cefaleias (ICDH-2004). RESULTADOS: A idade média dos pacientes foi 42,6 anos, sendo a maioria do sexo feminino (86,9%) e com menos de nove anos de escolaridade. As cefaleias primárias foram as mais comuns, sendo a migrânea encontrada em 79,8% dos casos e a cefaleia do tipo tensional (CTT), em 20,4%. Entre as secundárias, o tipo mais comum foi a cefaleia por uso excessivo de analgésicos (16,6%), seguido de casos menos comuns como a hipertensão intracraniana idiopática. A cefaleia crônica diária (CCD) esteve presente em 31,8% dos casos. CONCLUSÃO: Este estudo confirma dados da literatura que mostram a migrânea como a cefaleia mais comum em centros terciários. O número expressivo de casos de CCD e de uso excessivo de analgésicos indica que, desde o nível primário de atenção, os pacientes deveriam ser orientados a evitar o uso abusivo de medicação sintomática.
OBJECTIVE: To assess the frequency of different diagnoses of headaches in the Headache Outpatient Clinic of the Hospital das Clínicas of the Universidade Federal de Minas Gerais (AmbCef-UFMG). METHODS: Cross sectional study with 289 patients consecutively attended to at AmbCef-UFMG. Headaches were diagnosed based on the criteria established by the International Classification of Headache Disorders (ICDH-2004). RESULTS: The average age of patients was 42.6 years, mostly women (86.9%) with less than nine years of education. Primary headaches were the most common type, with migraine found in 79.8% of cases, and tension-type headache (TTH) in 20.4%. Among the secondary types, the most common was headache caused by overuse of analgesics (16.6%), followed by less common types, such as idiopathic intracranial hypertension. Chronic daily headache (CDH) was found in 31.8% of cases. CONCLUSION: This study confirms literature data showing migraine as the most common headache in tertiary care centers. The expressive number of cases of CDH and headaches caused by overuse of analgesics indicates that, starting at the primary care level, patients should be advised to avoid the abuse of symptomatic drugs.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Transtornos da Cefaleia/diagnóstico , Instituições de Assistência Ambulatorial , Brasil/epidemiologia , Estudos Transversais , Diagnóstico Diferencial , Transtornos da Cefaleia Secundários/diagnóstico , Transtornos da Cefaleia Secundários/epidemiologia , Transtornos da Cefaleia/epidemiologia , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/epidemiologia , Cefaleia do Tipo Tensional/diagnóstico , Cefaleia do Tipo Tensional/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricosRESUMO
OBJECTIVE: To devise and test the reliability and validity of a brief headache diary in a series of Colombian patients with chronic daily headache. METHODS: The study was designed in five stages: selection of domains (group of patients and experts); initial devising of the items (writing group); identification of non-understandable items (n=20); assessment of internal consistency (n=100); assessment of validity and assessment of sensitivity to change during seven consecutive days (n=25, 175 observations). RESULTS: Five domains were selected: headache presence, severity and length of pain, analgesics intake, and missing workdays. The headache diary is internally consistent (≈75% of rotated variance), correlates with the medical interview (Spearman's rho and Kendall's tau over 0.8 for each domain) and it has an adequate and stable sensitivity and specificity (82 to 96%). CONCLUSIONS: This headache diary is a reliable and valid instrument and represents the most important features affecting Colombian patients with chronic daily headache.
Assuntos
Transtornos da Cefaleia/diagnóstico , Prontuários Médicos/normas , Cefaleia do Tipo Tensional/diagnóstico , Adolescente , Adulto , Analgésicos/uso terapêutico , Colômbia , Feminino , Transtornos da Cefaleia/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Inquéritos e Questionários , Cefaleia do Tipo Tensional/tratamento farmacológico , Fatores de Tempo , Adulto JovemRESUMO
OBJECTIVE: To devise and test the reliability and validity of a brief headache diary in a series of Colombian patients with chronic daily headache. METHODS: The study was designed in five stages: selection of domains (group of patients and experts); initial devising of the items (writing group); identification of non-understandable items (n=20); assessment of internal consistency (n=100); assessment of validity and assessment of sensitivity to change during seven consecutive days (n=25, 175 observations). RESULTS: Five domains were selected: headache presence, severity and length of pain, analgesics intake, and missing workdays. The headache diary is internally consistent (≈75 percent of rotated variance), correlates with the medical interview (Spearman's rho and Kendall's tau over 0.8 for each domain) and it has an adequate and stable sensitivity and specificity (82 to 96 percent). CONCLUSIONS: This headache diary is a reliable and valid instrument and represents the most important features affecting Colombian patients with chronic daily headache.
OBJETIVO: Diseñar y testar la validez y reproducibilidad de un diario de cefalea en una serie de pacientes Colombianos con cefalea crónica diaria. MÉTODOS: El estudio fue diseñado en cinco fases: selección de los dominios (grupo de pacientes y expertos); diseño inicial de los ítems (grupo redactor); identificación de ítems no comprensibles (n=20); determinación de la consistencia interna (n=100); determinación de la validez y la sensibilidad al cambio durante siete días consecutivos (n=25, 175 observaciones). RESULTADOS: Fueron seleccionados cinco dominios: presencia, severidad y duración del dolor, ingesta de analgésicos y días laborales perdidos. El diario tiene una adecuada consistencia interna (≈75 por ciento de la varianza), se correlaciona con la entrevista médica (rho de Spearman y tau de Kendall >0.8 para cada dominio) y tiene sensibilidad y especificidad estables y satisfactorias (82 a 96 por ciento). CONCLUSIONES: Este diario de cefalea es un instrumento confiable y registra las principales características de las cefaleas en pacientes con cefalea crónica diaria.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Transtornos da Cefaleia/diagnóstico , Prontuários Médicos/normas , Cefaleia do Tipo Tensional/diagnóstico , Analgésicos/uso terapêutico , Colômbia , Transtornos da Cefaleia/tratamento farmacológico , Medição da Dor , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Inquéritos e Questionários , Fatores de Tempo , Cefaleia do Tipo Tensional/tratamento farmacológicoRESUMO
We conducted a retrospective analysis of the records of 1348 patients regularly treated at the headache clinic of Department of Neurology of Santa Casa de São Paulo, Brazil. Sixty-two patients reported history of daily and persistent headache. From the 62 patients selected, only 21 (group 1) could be diagnosed with new daily-persistent headache (NDPH) according to the International Headache Society (HIS) 2004 criteria. The 41 remaining patients (group 2) could not be diagnosed with NDPH according to IHS-2004 once they presented two or more migraine attack-related symptoms, such as: nausea, photophobia, phonophobia and vomiting, in different combinations. It was not possible to classify them in groups 1 to 4 of primary headaches either. How to classify them? We suggest that the criteria are revised. And one way we can classify them, would be the subdivision: NDPH with migraine features and without migraine features that would allow the inclusion of all individuals present who has a daily and persistent headache from the beginning.
Realizamos uma análise retrospectiva do prontuário de 1348 pacientes acompanhados no ambulatório de Cefaleia do Departamento de Neurologia da Santa Casa de São Paulo, Brasil. Sessenta e dois pacientes relataram história de cefaleia persistente e diária (NDPH) desde o início. Destes, apenas 21 (grupo 1) puderam ser diagnosticados com NDPH de acordo com os critérios da Sociedade Internacional de Cefaleia 2004. Os 41 pacientes restantes (grupo 2) não puderam ser diagnosticados como NDPH, uma vez que apresentaram dois ou mais sintomas relacionados a cefaleia do tipo enxaqueca, tais como: náuseas, fotofobia, fonofobia e vômitos, em diferentes combinações. Não foi possível, também, classificá-los entre os grupos de 1 a 4 das cefaleias primárias. Como classificá-los? Sugerimos que os critérios sejam revistos. E uma maneira de podermos classificá-los seria a subdivisão da NDPH em: com características de enxaqueca e sem características de enxaqueca. Isso permitiria a inclusão de todos os indivíduos portadores de uma cefaleia diária e persistente desde o início.
Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos da Cefaleia/classificação , Transtornos da Cefaleia/diagnóstico , Doença Crônica , Transtornos de Enxaqueca/diagnóstico , Estudos RetrospectivosRESUMO
Headache is one of the most common symptoms in children and adolescents, and headache syndromes are an important reason for medical consulting. According to the second edition of the International Classification of Headache Disorders, there are 196 possible headache diagnoses, of which 113 have been described in pediatric population. Herein, we focus on unusual pediatric headache syndromes. We group them as headaches with migraine features, short-duration headaches with autonomic features, short-duration headaches without autonomic features, and potentially ominous forms of headaches. Although rare as single entities, providers focusing on pediatric headaches certainly will face some of these headaches and need to be comfortable on the diagnostic approach.
Assuntos
Transtornos da Cefaleia/epidemiologia , Adolescente , Neoplasias Encefálicas/complicações , Criança , Doença Crônica , Cefaleia Histamínica/epidemiologia , Cefaleia Histamínica/terapia , Transtornos da Cefaleia/diagnóstico , Transtornos da Cefaleia/etiologia , Humanos , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/epidemiologia , Oftalmoplegia/complicações , Neuralgia do Trigêmeo/complicaçõesRESUMO
BACKGROUND: New daily persistent headache (NDPH) is a primary chronic daily headache that is generally considered to be difficult to treat. Migraine has been linked to comorbid psychiatric conditions, mainly mood and anxiety disorders, but NDPH has never been linked to psychiatric conditions, and never studied extensively for such an association. CASE: We report nine cases (six women and three men) of patients diagnosed with NDPH and panic disorder who were treated for both conditions. Six of them (66%) had good or excellent responses. CONCLUSION: The spectrum of anxiety disorders, particularly panic disorder, should be considered in NDPH patients. Simultaneous treatment of both disorders may lead to good outcomes.