Prevalence of migraine in patients with fibromyalgia / Prevalência de enxaqueca em pacientes com fibromialgia

Objective: To evaluate the prevalence of migraine in patients with fibromyalgia and the impacts of these comorbidities on the daily life of patients. Methods: Questionnaires were applied to fibromyalgia patients. The questionnaires were applied through a Google forms application link and in person, printed. We used FIQ, PHQ-9, and ID migraine. And for patients with a positive ID migraine, we applied the Midas subsequently. Results: Seventy fibromyalgia patients were recruited, age of 47.31 ± 14.5 years. Sixty-five (92.86%) were female and 5 (7.14%) were male. We obtained a prevalence of 60% (n = 42) of migraine associated with fibromyalgia. Among the analyzed variables, severity of depression (p = 0.007), aggregate severity of depression (p = 0.004), and impact of fibromyalgia (p = 0.008) were significantly associated. Among the migraine patients, the vast majority, 34/42 (80.95%), were classified as having severe disability. Conclusion: There is a high prevalence of migraine in patients with fibromyalgia that has an associated impact on patients' lives, which makes clinical and psychosocial management of these patients necessary.

Objetivo: Avaliar a prevalência de enxaqueca em pacientes com fibromialgia e os impactos dessas comorbidades no cotidiano dos pacientes. Métodos: Questionários foram aplicados a pacientes com fibromialgia. Os questionários foram aplicados por meio de link de aplicativo Google Forms e presencialmente, impressos. Usamos FIQ, PHQ-9 e enxaqueca ID. E para pacientes com enxaqueca ID positiva, aplicamos o Midas posteriormente. Resultados: Foram recrutados 70 pacientes com fibromialgia, idade de 47,31 ± 14,5 anos. Sessenta e cinco (92,86%) eram do sexo feminino e 5 (7,14%) do sexo masculino. Obtivemos uma prevalência de 60% (n = 42) de enxaqueca associada à fibromialgia. Entre as variáveis ​​analisadas, a gravidade da depressão (p = 0,007), a gravidade agregada da depressão (p = 0,004) e o impacto da fibromialgia (p = 0,008) foram significativamente associadas. Entre os pacientes com enxaqueca, a grande maioria, 34/42 (80,95%), foi classificada como portadora de incapacidade grave. Conclusão: Existe uma elevada prevalência de enxaqueca em pacientes com fibromialgia que tem impacto associado na vida dos pacientes, o que torna necessário o manejo clínico e psicossocial destes pacientes.

Drug use pattern and quality of life in patients with migraine at a tertiary care hospital in India: An observational study

Background: Migraine is a debilitating neurological disorder. As a leading cause of disability worldwide, it affects health-related quality of life (HRQoL). There are limited studies assessing the prescription pattern and improvement in HRQoL post-treatment. Aims and Objectives: This study aims to evaluate the drug use pattern and compare the effects of medications on HRQoL as per Migraine Disability Assessment Score (MIDAS). Materials and Methods: A prospective observational cross-sectional study was conducted on migraine patients attending neurology OPD at a tertiary care hospital. One hundred and seven patients were recruited by periodic sampling over 6 months. Prescription indicators assessed were number of antimigraine drugs per prescription, frequency of prescribed drugs, prescriptions by generic name, etc. Data were analyzed using descriptive statistics. The HRQoL was assessed after 3 months of medications by telephonic questionnaire. The change was analyzed by Wilcoxon matched pair signed-rank test. Results: Majority patients were in the third (40.2%) and fourth decade (32.7%) with a female preponderance (72.9%). Nonsteroidal anti-inflammatory drugs were commonly prescribed for aborting acute attacks with naproxen (24.1%) followed by diclofenac (2.71%). Prophylactically topiramate (27.51%), amitriptyline (18.6%), and propranolol (3.1%) were prescribed. About 36.43% of drugs were prescribed by generic names. Improvement in HRQoL was reflected by a significantly reduced MIDAS (13.95 ± 5.20 to 11.39 ± 5.07 [P < 0.05]). Conclusion: In our study, there was low generic prescribing. Naproxen was most prescribed for acute migraine and topiramate for prophylaxis. The HRQoL significantly improved after 3 months of antimigraine medications causing lesser disease burden.

Cefalea por abuso de medicamentos y sus marcadores clínicos / Medication overuse headache and its specific clinical markers

Resumen Introducción: Los marcadores clínicos de la cefalea por uso excesivo de medicación (CMA) se basan en la clasificación de las cefaleas desarrollada por la Sociedad Internacional de Cefaleas (IHS). Esta clasificación incluye sólo dos criterios: la frecuencia de los días de cefalea debe ser de 15 o más días al mes durante al menos tres o más meses; - y el número de días de uso excesivo de la medicación debe ser de 10 o 15 días al mes dependiendo del tipo de medicación. Sin embargo, los pacientes suelen tener otros marcadores clínicos asociados distintos, que la mayoría de los médicos pasan por alto durante la evaluación inicial. Metodología: Este estudio es un estudio prospectivo, longitudinal y observacional de 76 pacientes ingresados en la Unidad de Cefaleas del hospital DIPRECA. Todos ellos fueron diagnosticados de HMO según los criterios establecidos por su ICHD III beta.(1) Los pacientes recibieron un tratamiento estándar que incluía desintoxicación y medicación preventiva y fueron seguidos durante 6 meses. Se registraron los síntomas de interés en cada visita de seguimiento clínico y se administraron escalas de evaluación como Zung, MIDAS, HIT-6. Resultados: Los medicamentos sobreutilizados incluyeron antiinflamatorios no esteroideos (AINE), triptanes y cornezuelos. Los síntomas clínicos más significativos asociados fueron: despertar por la mañana con dolor de cabeza, despertar al paciente al amanecer por dolor de cabeza, dificultades de atención, depresión, dolor cervical y síndrome de dolor miofascial. Todos los síntomas mejoraron significativamente al iniciar el tratamiento, al igual que la calidad de vida medida por las escalas MIDAS y HIT-6. Discusión: Al evaluar a los pacientes con HMO, hay que tener en cuenta tanto los criterios diagnósticos de la ICHD III beta como los síntomas comunes y específicos que se observan en la mayoría de los casos de HMO.

Introduction: Clinical markers of medication overuse headache (MOH) are based on headache classification developed by the International Headache Society (IHS). This classification include only two criteria: frequency of headache days must be 15 or more days per month for at least three or more months; - and the number of days of overuse medication must be either 10 or 15 days per month depending on the type of medication. However, patients often have others distinct associated clinical markers, which are overlooked by most physicians during the initial evaluation. Methodology: This study is a prospective, longitudinal and observational study of 76 patients admitted to DIPRECA´s hospital Headache Unit. They were all diagnosed with, MOH according to the criteria established by the his ICHD III beta.(1) Patients were given standard treatment including detoxification and preventive medications and followed for 6 months. Symptoms of interest were recorded in at each clinical monitoring visit and assessment scales such as Zung, MIDAS, HIT-6 were administered. Results: Overused medications included nonsteroidal anti-inflammatory drugs (NSAIDs), triptans and ergots. The most significant clinical symptoms associated were: awaking in the morning with headache, awaking the patient at dawn by headache, attention difficulties, depression, cervical pain and myofascial pain syndrome. All symptoms significantly improved when treatment began, as did quality of life as measured by MIDAS and HIT-6 scales. Discussion: In evaluating patients with MOH consider both the ICHD III beta diagnostic criteria and the common and specific symptoms seen in most cases of MOH.

Evaluation of the effect of botulinum neurotoxin type A (BoNT/A) on daily activity performance in chronic migraine patients using VAS, MIDAS AND HIT-6 tests

@#Background & Objectives: According to ICHD-III beta 2013 criteria, chronic migraine is defined as having headaches more than 15 times a month, for a period of more than 3 months, at least 8 must have migrainous features or good response to migraine-specific treatment; there must also be a history of 5 or more migraine attacks. The aim of the present study was to evaluate the effect of Botulinum Neurotoxin A (BONT/A) on headache and daily activities in chronic migraine patients using VAS, MIDAS and HIT-6 tests. Methods: Twenty five patients admitted to Hospital Department of Neurology were reviewed retrospectively. In order to evaluate the severity of headache and effects on daily performance, MIDAS (Migraine Disability Assessment Test), VAS (Visual Analogue Scale for Pain) and HIT-6 results after the baseline assessment, first and second administration of (BONT/A) were examined retrospectively from patients’ records. Results: VAS, MIDAS and HIT-6 scores were compared after baseline assessment and the first and second administrations. Results showed that VAS, MIDAS and HIT-6 scores decreased. This difference was statistically significant (p<0.05). Correlation analysis was conducted and significant correlations between scores on these three tests were found.Conclusions: The results showed that BoNT/A is an important and effective treatment option for chronic migraine patients not responding to migraine-specific prophylactic treatment and having alterations in daily life due to frequency and severity of pain.

Comparison in the Affectivity of Riboflavin against Propranolol for Migraine Prophylaxis.

Background: The objective of this study was to assess the efficacy of Riboflavin as a prophylactic agent for migraine in comparison to the established agent, a beta blocker, Propranolol. Methods: 120 patients were grouped randomly into 3 groups after taking demographic details. One group (Group I) was given 80mg/day of Propranolol, second group (Group II) was given 100mg/day riboflavin and the third group (Group III) was given placebo. Frequency and duration of headaches, Visual Analogue scale (VAS) and Migraine disability assessment (MIDAS) score were taken at base line of treatment and at 1st month, 3rd month and 6th month of follow up. Results: The mean age of the patients in the study was 35.1 years ± 3.5 years. There was not much difference in the age of the patients and gender between the 3 groups. Neither was the incidence of family history in the three groups. The frequency of headaches reduced in one month from 3.9 to 3.1 with propranolol compared to riboflavin(3.8-3.2) but in the 3rd month and 6th month riboflavin showed a better effect than propranolol though propranolol was almost as effective (2.7 and 2.4 respectively). In the Riboflavin group, the duration of headaches reduced from 3.2 days at base line to 2.5 at the first month to 2 days in the 6th month, while in propranolol group, the reduction was from 3.1 at base line to 2.6 in the first month to 2 days in the 6th month. VAS and MIDAS were comparable in both the groups. There were more side effects like dizziness and fatigue in th Propranolol group while only orange coloured urine was the complication in the Riboflavin group. Conclusion: Riboflavin is comparable to Propranolol in the prophylaxis of migraine. Since it is cost effective as well as non toxic, it can be used instead of Propranolol which has quite a few side effects.

Functional Assessment in Greek Tension-Type Headache Sufferers: Validity, Reliability, Responsiveness and Psychometrics of the Migraine Disability Assessment Questionnaire (MIDAS).

Introduction: Functional assessment in painful musculoskeletal disorders such as tension-type headache requires valid, reliable and sensitive instruments. MIDAS (Migraine Disability Assessment questionnaire) is an internationally well-known functional index which has not been validated in Greek headache sufferers. Aims: The aim of the study was to assess headache related disability in Greek tension-type headache sufferers using MIDAS. The validity, reliability, responsiveness and psychometrics of the Greek MIDAS version were examined. Study Design: A multicenter prospective design was followed. Place and Duration of Study: The study took place in a medical rehabilitation unit and two physiotherapy private practices in Athens, from January - December 2010. Methodology: A sample of 121 patients(101 women, age: 39.4+12.7; 20men, age: 35.5 + 8.8, years) with tension-type headache was recruited. Internal consistency was computed and testretest reliability was examined for a 7-day period. Responsiveness of the GR-MIDAS was tested before and after a behaviorally oriented physical therapy protocol. Convergent and divergent validity were also examined after comparing GR-MIDAS with SF-12, VAS, Pain Catastrophising Scale (PCS), Hospital Anxiety and Depression Scale (HAD) and Short-Form McGill Pain Questionnaire (SFMPQ). Results: Cronbach’s alpha (α) was satisfactory (0.80). Test-retest reliability was both excellent for the total score (ICC=0.95) and the individual items (0.87-0.98). Measures of responsiveness such as the Standardized Effect Size (SES=1.38) and the Standardized Response Mean (SRM=1.63) were shown to be acceptable, as well as the ROC curve statistic (AUC: 0.875 +0.08). Convergent validity was evidenced (SF-12 vs MIDAS, r=-0.32, p<0.001), and also divergent validity [MIDAS vs VASaverage, r=0.31, p<0.01; MIDAS vs HAD: anxiety: r=0.17, NS, depression: r=016, NS; MIDAS vs PCS: r=0.13, NS; SFMPQ vs MIDAS: Affective: r=0.02, NS, Sensory: 0.11, NS]. Conclusion: The Greek version of MIDAS is a valid, reliable and sensitive functional measure for tension-type headache patients, comparable to the original version. The data of this study extend the psychometric properties of the instrument.

MIDAS Syndrome Presenting with Linear Skin Atrophy on the Face / 대한피부과학회지

MIDAS syndrome (microphthalmia-dermal aplasia-sclerocornea) is an X-linked dominant genetic disease. In most patients, the unbalanced translocation or deletion of the X chromosome short-arm 22.3 band is observed. This disease characteristically presents as linear atrophy of the skin limited to the face and neck, accompanied by congenital eye disease. A 9-month-old female who had linear skin atrophy on the right side of her chin visited our clinic. She also presented with microphthalmia and sclerocornea on her right eye. Results of a chromosomal study revealed a deletion of the X-chromosome short-arm 22.31 band. Here, we report on this MIDAS syndrome patient with linear skin atrophy on the face.

Topografia do cone medular do sauim (Saguinus midas) / Topography of the medullary cone in sauim (Saguinus midas)

Primata endêmico do Brasil, especificamente da floresta Amazônica, o Sauim alimentam-se de pequenos vertebrados, invertebrados, exudatos, flores, néctar, folhas e fungos, cuja morfologia é pouco conhecida. Assim, objetivou-se estabelecer parâmetros morfométricos e topográficos do cone medular dessa espécie, que sirvam de base para a prática das anestesias epidurais. Para tanto, foram avaliados quatro exemplares, provenientes da Universidade Federal Rural da Amazônia (UFRA). O Saguinus midas apresentou sete vértebras lombares e três vértebras sacrais. Após a dissecação do cone medular, registrou-se os aspectos anatômicos de interesse, enfatizando seu início (base) e seu término (ápice), que, após mensuração, revelou base em nível de L4 e ápice em S2, com comprimento médio de 5,38cm, o que leva a sugerir a região lombosacral como sendo a mais adequada para o desenvolvimento da prática de anestesias epidurais.

Primate endemic to Brazil, specifically in the Amazon rainforest, the Sauim feed on small vertebrates, invertebrates, exudates, flowers, nectar, leaves and fungi whose morphology is poorly known. Thus, the objective was to establish morphometric parameters and topographical conus of this species, as a basis for the practice of epidural anesthesia. For this purpose, four samples were evaluated, from the Universidade Federal Rural da Amazônia (UFRA). The Saguinus midas had seven lumbar vertebrae and three sacral vertebrae. After dissection of the conus, we recorded the anatomy of interest, emphasizing its beginning (base) and its end (apex), revealed that after measuring the level of base peak in L4 and S2, with an average length of 5.38cm, which leads us to suggest the lumbosacral region as the most suitable for the development of the practice of epidural anesthesia.

Differences in Clinical Features and Disability according to the Frequency of Medication Use in Patients with Chronic Migraine

BACKGROUND AND PURPOSE: Chronic migraine (CM) has a significant impact on daily activities, and analgesic overuse is a major contributing factor to migraine transformation. Limited information is available on the functional consequences of CM stemming from analgesic overuse. This study evaluated the impact of the frequency of analgesic medication use on headache-related disability and clinical features in patients with CM. METHODS: Patients with CM were enrolled consecutively and classified into two groups according to their frequency of medication use: or =15 days/month (CM-MH, n=68). All patients completed a structured questionnaire concerning the clinical features of their migraine, a validated version of the Migraine Disability Assessment questionnaire (MIDAS), and the Headache Impact Test-6 (HIT-6). RESULTS: The pain intensity, as measured by a visual analog scale, was greater in the CM-MH group than in the CM-ML group (8.5+/-0.2 vs. 7.7+/-0.3, mean+/-SD; p<0.05). In the disability domain, the MIDAS scores were significantly higher for CM-MH patients than for CM-ML patients (47.6+/-4.8 vs. 26.8+/-4.5, p<0.01). The impact from migraine, as measured by the HIT-6, was greater for CM-MH patients than for CM-ML patients (65.6+/-1.0 vs. 62.1+/-1.0, p<0.05). CONCLUSIONS: Our results indicate that the headache pain intensity and disability are greater in patients with CM who use medication frequently.

Determinación del índice MIDAS en pacientes ambulatorios de Bogotá / Determination of MIDAS index in outpatients from Bogotá

INTRODUCIÓN: la migraña es una entidad neurológica crónica. La escala MIDAS (Migraine dissability Assessment Scale) permite medir discapacidad en las personas que padecen de migraña. MATERIALES Y MÉTODOS: mediante un estudio descriptivo de corte transversal, se evaluó la discapacidad por migraña asociándola a variables demográficas, intensidad y frecuencia de las cefaleas. Se evaluaron 129 pacientes con diagnóstico de migraña, en el periodo de Septiembre de 2007 a Marzo de 2008 mediante el cuestionario MIDAS. RESULTADOS: el 86.8 por ciento de los pacientes perteneció al género femenino siendo de procedencia urbana en su mayoría (98.4 por ciento). Con respecto al estado socioeconómico perteneció a los estratos uno, dos y tres en el 98.3 por ciento del total de pacientes. La proporción de migraña sin aura/migraña con aura fue equivalente determinándose (51.9 por ciento vs 48.1 por ciento) respectivamente. La tasa de discapacidad se calculó en porcentajes semejantes (31,30.2 y 30.2) para los niveles mínimo, ligero y moderado en todos los rangos de edad estudiados. El nivel grave se encontró únicamente en el 8.5 por ciento de la población estudiada especialmente correspondiendo a población geriátrica. Del total de pacientes el 37.5 por ciento recibía tratamiento preventivo, siendo cumplido de forma adecuada en el 89.9 por ciento de los casos. CONCLUSIÓN: los hallazgos del estudio muestran pocos días de discapacidad por migraña en comparación con otros estudios. Lo anterior por la probable relación que pudiera establecerse entre el índice MIDAS y a las condiciones socio económicas actuales de la población estudiada.

INTRODUCTION: migraine is a chronic neurological entity. MIDAS (Migraine Disability Assessment Scale) scale allows to measure disability in people suffering from migraine. PATIENTS AND METHODS: by means of a cross-section study, we assessed the disability level in migraine patients in relation to demographic variables, severity and frequency of headaches. We studied 129 patients with migraine according to IHS criteria since September 2007 to march 2008 by using MIDAS questionnaire. RESULTS: 86.8 per cent of patients were female from urban area (98.4 per cent). With regard to socioeconomic origin 93.8 per cent belonged to levels one, two and three. The rate of migraine without aura/migraine with with aura was equivalent (51.9 per cent vs 48.1 per cent). Disability rate was calculated in similar percentages (31,30.2 y 30.2) for the mild, moderate and severe ranks in all the groups. The rank very severe was found only in 8.5 per cent of the population studied especially in elderly people. 37.5 per cent of all patients had preventive treatment with a good compliance in 89.9 per cent of cases.CONCLUSION: our findings show few days of disability related to migraine compared with other studies. This phenomenon could be related to the socio economical status of the population studied.

Impacto de la migraña / The impact of migraine

La migraña es quizás el motivo más frecuente de consulta al neurólogo. Su prevalencia es más alta en el sexo femenino, entre la segunda y la cuarta décadas, que es la época de mayor productividad. El dolor en la migraña por lo general es incapacitante, por lo que tiene un gran impacto en la calidad de vida; produce ausentismo laboral y escolar, disminuye el rendimiento, e interfiere con las relaciones familiares. Es necesario hacer un mayor énfasis en la migraña en los estudios de pregrado en medicina, para capacitar a los médicos generales en el diagnóstico y tratamiento de este trastorno. Existen instrumentos para medir en el consultorio el impacto de la migraña en la vida de los pacientes, de los cuales el más importante es el cuestionario MIDAS.

Migraine is perhaps the most frequent reason for consulting the neurologist. Its prevalence is higher in women between the second and fourth decades, which is the period of greatest productivity. The pain in migraine is usually disabling, and for this reason it has a big impact on the quality of life; it produces labor and school absenteeism, and it interferes with family relationships. There is a need for greater emphasis on migraine in undergraduate studies in medicine, to train the general practitioners in diagnosing and treating this disorder. There are many instruments to measure the impact of migraine in the life of the patients, such as MIDAS questionaire.

Comparisons of Life Quality between Chronic and Episodic Migraine Patients

BACKGROUND: In this study, the quality of life of patients with chronic and episodic migraine was compared using quality of life assessments tools, which included the MIDAS (migraine disability assessment) questionnaire and MSQoL (migraine-specific quality of life) questionnaire. METHODS: The investigation occurred from November 2005 to April 2006 for patients who visited the neurology department of hospital in because of headache. The patients for the question investigation consisted of 34 patients with chronic migraine (CM) and 48 patients with episodic migraine (EM). The diagnosis of migraines was obtained by the migraine criteria of the International Headache Society (IHS). RESULTS: In the comparisons of the MIDAS score in patients with CM and EM, the second question (reduced effectiveness at work/school), the fourth question (reduced effectiveness in housework), total scores (28+/-19.7 versus 12.0+/-10.1, p<.01), and the question A were higher in CM patients (51.2+/-20.1 versus 15.5+/-13.1, p<.01). MIDAS grade of CM patients were also higher than EM patients. In MSQoL score comparisons of CM and EM patients, three parts of life qualities, which are role-function restrictive, role-function preventive, and emotional function due to headache, and total score (61.9+/-11.7 versus 73.7+/-13.9, p<.01) was less in CM patients than EM patients. CONCLUSIONS: The study shows that life qualities of the patients with CM were significantly lower than of the patients with EM.