RESUMO
Fibromuscular dysplasia (FMD) is a rare non-atherosclerotic arterial disease that primarily affects middle-aged Caucasian women. Carotid web (CW) is a variant of FMD characterized by a nonatheromatous, membrane-like tissue protrusion into the carotid bulb. Reversible cerebral vasoconstriction syndrome (RCVS) is defined by severe headaches and reversible narrowing of cerebral arteries, which typically resolves within three months. While most RCVS cases have identifiable triggers, a significant portion occurs without known causes. Recent studies have reported a high prevalence of neurovascular abnormalities in RCVS patients. We present a case of a thirty-year-old woman with a sudden-onset severe headache, diagnosed with RCVS associated with carotid web. The patient had no ischemic involvement and responded well to flunarizine treatment. Follow-up imaging showed no stenosis. This case highlights a potential association between carotid web and RCVS, suggesting that FMD may contribute to vascular hyperreactivity and presents as a risk factor for RCVS. Further investigations are needed to understand the underlying mechanisms connecting these two vascular disorders. Keywords: reversible vasoconstriction syndrome; fibromuscular dysplasia; carotid web; structural abnormalities; vascular hyperreactivity.
Assuntos
Transtornos Cerebrovasculares , Displasia Fibromuscular , Transtornos da Cefaleia Primários , Vasoespasmo Intracraniano , Pessoa de Meia-Idade , Humanos , Feminino , Adulto , Vasoconstrição , Displasia Fibromuscular/complicações , Transtornos Cerebrovasculares/complicações , Fatores de Risco , Artérias Cerebrais , Vasoespasmo Intracraniano/etiologia , Vasoespasmo Intracraniano/complicações , Transtornos da Cefaleia Primários/complicaçõesRESUMO
OBJECTIVES: This cross-sectional study aimed to evaluate the influence of Primary Headache (PH) on efficacy of a Temporomandibular Disorders (TMD) conservative therapy and its association with the presence of self-reported parafunctional habits. SAMPLE AND METHODS: Sample was composed of 400 medical records, divided into four groups: I) Muscular TMD (n = 64); II) Muscular TMD+PH (n = 48); III) Muscular TMD+Articular TMD (n = 173); IV) Muscular TMD+Articular TMD+PH (n = 115). All groups had undergone a TMD therapy for three months with a stabilization appliance and counseling for habits and behavioral changes, with no specific headache management. Current pain intensity and existence or not of self-reported bruxism were assessed. Repeated measures ANOVA and Chi-Square test followed by Odds were used for statistical analysis, with a significance level of 5%. RESULTS: results of this study showed that: (1) A conservative therapy with stabilization appliance and counseling for habits and behavioral changes was effective in the TMD pain relief; (2) Groups with an additional diagnosis of PH had worsened the pain improvement significantly; and (3) no association between the presence of self-reported bruxism and PH was found. CONCLUSIONS: this study could elucidate the important effect that headache may have on the TMD management.
Assuntos
Transtornos da Cefaleia Primários/complicações , Transtornos da Cefaleia Primários/fisiopatologia , Transtornos da Articulação Temporomandibular/fisiopatologia , Transtornos da Articulação Temporomandibular/terapia , Adulto , Estudos Transversais , Métodos Epidemiológicos , Dor Facial/fisiopatologia , Dor Facial/terapia , Feminino , Humanos , Masculino , Medição da Dor , Bruxismo do Sono/fisiopatologia , Fatores de Tempo , Resultado do TratamentoRESUMO
AIMS: To investigate the association among temporomandibular disorders (TMD), sleep bruxism, and primary headaches, assessing the risk of occurrence of primary headaches in patients with or without painful TMD and sleep bruxism. METHODS: The sample consisted of 301 individuals (253 women and 48 men) with ages varying from 18 to 76 years old (average age of 37.5 years). The Research Diagnostic Criteria for Temporomandibular Disorders were used to classify TMD. Sleep bruxism was diagnosed by clinical criteria proposed by the American Academy of Sleep Medicine, and primary headaches were diagnosed according to the International Classification of Headache Disorders-II. Data were analyzed by chi-square and odds ratio tests with a 95% confidence interval, and the significance level adopted was .05. RESULTS: An association was found among painful TMD, migraine, and tension-type headache (P < .01). The magnitude of association was higher for chronic migraine (odds ratio = 95.9; 95% confidence intervals = 12.51-734.64), followed by episodic migraine (7.0; 3.45-14.22) and episodic tension-type headache (3.7; 1.59-8.75). With regard to sleep bruxism, the association was significant only for chronic migraine (3.8; 1.83-7.84). When the sample was stratified by the presence of sleep bruxism and painful TMD, only the presence of sleep bruxism did not increase the risk for any type of headache. The presence of painful TMD without sleep bruxism significantly increased the risk in particular for chronic migraine (30.1; 3.58-252.81), followed by episodic migraine (3.7; 1.46-9.16). The association between painful TMD and sleep bruxism significantly increased the risk for chronic migraine (87.1; 10.79-702.18), followed by episodic migraine (6.7; 2.79-15.98) and episodic tension-type headache (3.8; 1.38-10.69). CONCLUSION: The association of sleep bruxism and painful TMD greatly increased the risk for episodic migraine, episodic tension-type headache, and especially for chronic migraine.
Assuntos
Transtornos da Cefaleia Primários/complicações , Bruxismo do Sono/complicações , Transtornos da Articulação Temporomandibular/complicações , Adolescente , Adulto , Idoso , Doença Crônica , Escolaridade , Dor Facial/complicações , Feminino , Transtornos da Cefaleia Primários/diagnóstico , Humanos , Masculino , Estado Civil , Pessoa de Meia-Idade , Transtornos de Enxaqueca/classificação , Transtornos de Enxaqueca/complicações , Fatores de Risco , Bruxismo do Sono/diagnóstico , Inquéritos e Questionários , Transtornos da Articulação Temporomandibular/diagnóstico , Cefaleia do Tipo Tensional/complicações , População Branca , Adulto JovemRESUMO
INTRODUÇÃO: Obesidade é um problema de saúde publica relevante em todo o mundo. Pouco se sabe sobre a prevalencia e impacto das cefaléias em pacientes obesos.OBJETIVO: Avaliar a prevalência de cefaléias primárias em pacientes obesos. MÉTODO: Setenta e quatro pacientes consecutivos originários de um centro de tratamento de obesidade foram estudados e comparados com controles com índices de massa corporal menores que 25. Resultados: Cinquenta e cinco pacientes (75%) apresentaram algum diagnóstico de cefaléia primária, 49 enxaqueca (66%), 7 cefaléia do tipo tensional (9%), 36 (48%) tiveram cefaléias incapacitantes. CONCLUSÃO: Cefaléias primárias são mais comuns e incapacitantes em pacientes obesos que controles, a enxaqueca é o diagnóstico mais freqüente nesta população. Cefaléias devem ser adequadamente diagnosticadas e tratadas em pacientes obesos.
Assuntos
Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos da Cefaleia Primários/epidemiologia , Obesidade/complicações , Índice de Massa Corporal , Estudos de Casos e Controles , Transtornos da Cefaleia Primários/complicações , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/epidemiologia , Prevalência , Índice de Gravidade de DoençaRESUMO
BACKGROUND AND OBJECTIVE: Obesity is a major public health problem worldwide. Little is known about the prevalence and impact of headache disorders in obese patients. The objective of this study was to assess the prevalence of primary headaches in obese patients and controls. METHOD: Seventy-four consecutive obese patients from the obesity surgery service were studied, and compared to controls with body mass index less than 25. RESULTS: Fifty-six patients (75%) had a headache diagnosis, 49 migraine (66%), 7 tension-type headache (9%), 36 (48%) had incapacitating headaches. CONCLUSION: Primary headaches are more common and incapacitating in obese patients than controls, migraine is the most important diagnosis in this population. Headaches should be properly diagnosed and treated in obese patients.