Continuous Unilateral Cephalalgia Due to Systemic Lupus Erythematosus: A Case Report / Cefaleia unilateral contínua por lúpus eritematoso sistêmico: relato de caso

BACKGROUND: Hemicrania continua is a rare form of cephalalgia featuring a chronic and persistent headache in only one side of the head. OBJECTIVES: In this report, we present a case of a patient with hemicrania continua and systemic lupus erythematosus (SLE). METHODS: We collected patient data through the electronic medical record. Afterward, we reviewed the literature regarding hemicrania continua and its pathophysiology and correlation with neurovascular alterations, inflammation, and SLE. RESULTS: A 42-year-old woman visited the emergency department due to worsening constant unilateral cephalalgia that had been present for the past 6 months. The patient reported a highly intense (10/10) headache in the entire left hemicrania that radiated to the left shoulder. During physical examination, she presented with nystagmus, vertigo, and aggravated cephalalgia associated to body movement and, despite having no optic nerve thickening. In addition, she had jaundice, tachycardia, and splenomegaly. Complimentary exams found deep anemia, depletion in complement system and anti-nuclear factors, suggesting a possible hemolytic anemia (AIHA) due to SLE. Treatment was initiated with hydrocortisone and prednisone, associated with amitriptyline, fluoxetine and diazepam, reaching full remission. CONCLUSION: These syndromes have aggravated each other, and possibly the explanation for the cephalalgia remission was the control of AIHA and SLE. It features a rare case in literature and thus warrants discussion.

INTRODUÇÃO: Hemicrania contínua é uma forma rara de cefaléia caracterizada por cefaleia crônica e persistente em apenas um lado da cabeça. OBJETIVOS: Neste relato apresentamos o caso de um paciente com hemicrania contínua e lúpus eritematoso sistêmico (LES). MÉTODOS: Coletamos dados dos pacientes por meio do prontuário eletrônico. Posteriormente, revisamos a literatura sobre a hemicrania contínua e sua fisiopatologia e correlação com alterações neurovasculares, inflamação e LES. RESULTADOS: Uma mulher de 42 anos recorreu ao serviço de urgência devido ao agravamento da cefaleia unilateral constante, presente nos últimos 6 meses. O paciente relatou cefaleia de alta intensidade (10/10) em toda a hemicrânia esquerda com irradiação para o ombro esquerdo. Ao exame físico apresentava nistagmo, vertigem e cefaléia agravada associada à movimentação corporal e, apesar de não apresentar espessamento do nervo óptico. Além disso, ela apresentava icterícia, taquicardia e esplenomegalia. Os exames complementares evidenciaram anemia profunda, depleção do sistema complemento e fatores antinucleares, sugerindo uma possível anemia hemolítica (AIHA) por LES. Iniciou-se tratamento com hidrocortisona e prednisona, associadas a amitriptilina, fluoxetina e diazepam, atingindo remissão completa. CONCLUSÃO: Essas síndromes agravaram-se mutuamente e possivelmente a explicação para a remissão da cefaléia foi o controle da AIHA e do LES. Apresenta um caso raro na literatura e, portanto, merece discussão.

Prevalência e fatores associados de cefaleia entre adolescentes: resultados de um estudo de base populacional / Prevalence of headache and associated factors among adolescents: results of a population-based study

RESUMO: Introdução: A cefaleia é uma das queixas somáticas relacionadas a problemas de saúde mais comuns entre crianças e adolescentes. Objetivo: Estimar a prevalência de cefaleia em adolescentes da cidade de São Paulo, Brasil, e fatores associados. Métodos: Trata-se de estudo transversal de base populacional, realizado em 2015, com 539 adolescentes de ambos os sexos, entre 15 e 19 anos de idade. Coletaram-se as informações por inquérito domiciliar, e selecionaram-se os participantes com base em amostragem probabilística. Utilizaram-se na análise frequências, teste χ2 e análise de regressão logística. Adotou-se nível de significância de 5%. Resultados: A prevalência estimada de cefaleia é de 38,2% (intervalo de confiança - IC95% 33,8 - 42,7), de dor de cabeça simples 32,8% (IC95% 28,8 - 37,2) e de enxaqueca 7,8% (IC95% 5,6 - 10,7). Os fatores associados encontrados com cefaleia foram: ser do sexo feminino (razão de chances/odds ratio - OR = 2,2; IC95% 1,4 - 3,4), transtorno mental comum (TMC) (OR = 2,8; IC95% 1,7 - 4,9), problema de visão (OR = 2,6; IC95% 1,6 - 4,2), dor nas costas (OR = 2,2; IC95% 1,3 - 3,5), sinusite (OR = 2,0; IC95% 1,2 - 3,4) e ter escolaridade com ensino fundamental II incompleto (OR = 3,0; IC95% 1,6 - 5,6). Conclusão: A prevalência de cefaleia em adolescentes da cidade de São Paulo em 2015 representou mais de 1/3 (um terço) dessa população. Os principais fatores associados foram sexo, baixa escolaridade e as comorbidades TMC e problema de visão.

ABSTRACT: Introduction: Cephalalgia is one of the most common somatic complaints related to health problems in childhood and adolescence. Objective: To measure the cephalalgia prevalence in adolescents from the city of São Paulo, Brazil, and associated factors. Methods: This is a cross-sectional population-based study, carried out in 2015, with 539 adolescents of both sexes, aged between 15 and 19 years. The information was collected in a household survey, and the participants were selected from probabilistic sampling. Frequencies, χ2 test and logistic regression analysis were used in the study, and significance level was 5%. Results: the estimated prevalence of cephalalgia was 38.2% (95%CI 33.8 - 42.7), and 7.8% (95%CI 5.6 - 10.7), migraine. The associated factors for cephalalgia were: female sex (OR = 2.2; 95%CI 1.4 - 3.4), Common Mental Disorder (OR = 2.8; 95%CI 1.7 - 4.9), vision impairment (OR = 2.6; 95%CI 1.6 - 4.2), besides back pain (OR = 2.2; 95%CI 1.3 - 3.5), sinusitis (OR = 2.0; 95%CI 1.2 - 3.4) and incomplete elementary education (OR = 3.0; 95%CI 1.6 - 5.6). Conclusion: The prevalence of headache among adolescents in the city of São Paulo represented more than 1/3 (one third) of this population. The main associated factors were sex, low schooling and the following comorbidities: common mental disorder and vision impairment.

Aplicación de la digitopuntura en pacientes con cefalea migrañosa. Policlínico Contreras, Matanzas, 2014 / Digitopuncture application in patients with migrainous cephalalgia. Contreras Policlinic, Matanzas, 2014

Introducción: la cefalea es toda sensación dolorosa que tiene lugar en la parte superior de la cabeza, desde el reborde orbitario hasta la nuca. Constituye la primera causa de acudir al neurólogo y uno de los motivos más frecuentes en consultas de Medicina Interna. La cefalea tipo tensión es frecuente en la práctica diaria y la más invalidante desde los puntos de vistas físico, social, económico y psicológico. Objetivo: mostrar la actuación de Enfermería en el alivio de la migraña y describir la efectividad de la digitopuntura en pacientes con cefalea migrañosa, del Policlínico Contreras, primer trimestre de 2014. Materiales y métodos: estudio observacional, descriptivo y transversal. El grupo de estudio, 120 pacientes que acudieron a la consulta de Medicina Natural y Tradicional. Resultados: la edad de mayor incidencia 25-34 años, con 47.4 %. Prevaleció el sexo femenino, en un 70 %; la duración del dolor mostró un 43.3 % de afectación. Transcurrió entre las 4 y 8 horas, y siempre tuvo relación con el estrés, en 44.2 %; en un 69.2 % existió relación del dolor con la ingestión de alimentos. Se alivió con el sueño el 61.7 %, y el 52,5 % alcanzaron estado evolutivo excelente. Conclusiones: la aplicación de la digitopuntura a pacientes con cefalea migrañosa contribuyó a que los casos estudiados evolucionaran satisfactoriamente, expresando alivio del dolor. El tratamiento demostró efectividad y contribuyó a la disminución de drogas utilizadas en esta entidad, disminución de gastos económicos que implica el consumo de las mismas; lograr reincorporar a la vida laboral y social en un menor tiempo al paciente (AU).

Introduction: cephalalgia is any painful sensation occurring in the superior part of the head, from the orbital ridge to the nape. It is the first cause of visiting a neurologist and one of the most frequent causes of Internal Medicine consultations. The tension-kind cephalalgia is frequent in daily practice and the most invaliding one from the physical, social, economic and psychological point of view. Aim: to show Nursery behavior in migraine alleviation and to describe the digitopuncture effectiveness in patients with migrainous cephalalgia from Contreras Policlinic in the first trimester of 2014. Materials and methods: observational, descriptive, cross-sectional study. The studied group was 120 patients assisting the consultation of Natural and Traditional Medicine. Outcomes: the 25-34 age group was the one that showed higher incidence, with 47.4 %. The female sex prevailed with 70 %; pain lasting had 44.3 % of affectation. It lasted between 4 and 8 hours, always related to stress in 44.2 %. There it was a relation between pain and food intake in 69.2 %. 61.7 % of the cases were lessened with sleep, and 52.5 % achieved an excellent evolving status. Conclusions: Acupuncture application to patients with migrainous cephalalgia contributed to the satisfactory evolution of the studied cases: The patients expressed pain relieve. The treatment showed effectiveness and facilitated the decrease of drug usage in this entity, also diminishing the economic expenses its use implies; the patients reincorporated to social and working life in a shorter time period (AU).

Clinical Features of Cluster Headache Patients in Korea

Cluster headache (CH) is a rare underdiagnosed primary headache disorder with very severe unilateral pain and autonomic symptoms. Clinical characteristics of Korean patients with CH have not yet been reported. We analyzed the clinical features of CH patients from 11 university hospitals in Korea. Among a total of 200 patients with CH, only 1 patient had chronic CH. The average age of CH patients was 38.1 ± 8.9 years (range 19–60 years) and the average age of onset was 30.7 ± 10.3 years (range 10–57 years). The male-to-female ratio was 7:1 (2.9:1 among teen-onset and 11.7:1 among twenties-onset). Pain was very severe at 9.3 ± 1.0 on the visual analogue scale. The average duration of each attack was 100.6 ± 55.6 minutes and a bout of CH lasted 6.5 ± 4.5 weeks. Autonomic symptoms were present in 93.5% and restlessness or agitation was present in 43.5% of patients. Patients suffered 3.0 ± 3.5 (range 1–25) bouts over 7.3 ± 6.7 (range 1–30) years. Diurnal periodicity and season propensity were present in 68.5% and 44.0% of patients, respectively. There were no sex differences in associated symptoms or diurnal and seasonal periodicity. Korean CH patients had a high male-to-female ratio, relatively short bout duration, and low proportion of chronic CH, unlike CH patients in Western countries.

Comparative study between manual therapy and TENS Burst in patients with tension-type cephalalgia / Estudo comparativo entre a terapia manual e a TENS Burst em pacientes portadores de cefaleias tensionais

Introduction Cephalgia or cephalalgia is one of the most common symptoms in the general population. Objective To compare the efficacy of physical therapy modalities, through manual therapy and the effect of Transcutaneous Nerve Stimulation (TENS) for tension-type cephalalgia. Materials and methods The study was compounded by 60 subjects, but only 40 of them completed it, due to the exclusion criteria. These were divided into control group and intervention group. The control group received treatment — manual therapy. The intervention group received TENS Burst. Patients underwent ten sessions of treatment, made at every two days on a week, lasting 30 minutes each session. Results The characteristics related to lifestyle, postural issues and range of motion are responsible for the main causes of tension-type cephalalgia. Discussion treatments showed effective results in all cases in relation to pain intensity, but the use of manual therapy techniques give the patient a better quality of life compared to the use of TENS. Final considerations The treatment of this condition deserves analysis and studies; however, there are only a few studying physical therapy techniques, especially regarding to the use of TENS. .

Introdução Cefaleia ou dor de cabeça é um dos sintomas mais comuns na população em geral. Objetivo Comparar a eficácia de modalidades de fisioterapia — terapia manual e estimulação nervosa transcutânea (TENS) — para cefaleia do tipo tensional. Materiais e métodos O estudo foi composto inicialmente por 60 indivíduos, mas apenas 40 completaram-no em virtude dos critérios de exclusão. Estes foram divididos em grupo controle e grupo de intervenção. O grupo controle recebeu terapia manual e o grupo de intervenção recebeu TENS. Os pacientes foram submetidos a 10 sessões de tratamento, sendo estas feitas dois dias por semana, com duração de 30 minutos cada. Resultados As características relacionadas ao estilo de vida, problemas posturais e amplitude de movimento são responsáveis pelas principais causas de dor de cabeça de tensão. Discussão Os tratamentos foram eficazes em todos os casos em relação à intensidade de dor, mas a utilização de técnicas de terapia manual deu aos pacientes uma melhor qualidade de vida, em comparação com a utilização de TENS. Considerações finais O tratamento dessa condição merece análise e estudos, no entanto, há poucos estudos científicos que estudam técnicas de fisioterapia, especialmente com relação ao uso da TENS. .

POST-TRAUMATIC HEADACHE:A NEUROREHABILITATION PERSPECTIVE (Part Ⅰ) / 中国康复医学杂志

Although post-traumatic headache (PTHA) is a common problem following trauma its' multidimensionality remains somewhat poorly understood.Often,clinicians and researchers try and make the problem of post-traumatic bead pain a straightforward one.One of the reasons that there is controversy of what would seem to be a simple condition on the surface is that clinicians tend to view PTHA over simplistically from both an assessment and treatment standpoint.Some have argued that PTHA is no different that non-traumatic headache in either etiology or treatment.There remain significant deficiencies in our understanding of PTHA as related to a lack of good epidemiological,treatment and prognostic literature.These limitations nust be acknowledged where applicable in the context of clinical neurorehabilitation care,as well as,in the forensic arena.This article will review the current understanding of PTHA as a complex,multidimensional post-traumatic phenomena examining incidence,etiology,assessment and management.

Cefaleas trigémino autonómicas: 3 casos de localización dentomaxilar / Trigeminal autonomic cephalalgias: 3 cases of dentomaxillar location

Las cefaleas trigemino autonómicas (CTAs: cefalea tipo cluster, hemicránea paroxística y el SUNCT) son un grupo de cefaleas primarias, caracterizadas por la presencia de dolor unilateral en la distribución somática del nervio trigémino, asociada a características autonómicas cráneofaciales ipsilaterales. A pesar de sus elementos comunes, de forma individual, difieren con respecto a su duración, frecuencia y la respuesta a indometacina. Se presentan tres casos de CTAs de localización primaria dentomaxilar, sus características comunes y particulares, y la necesidad del diagnóstico diferencial con cuadros dolorosos provenientes de estructuras estomatognáticas.

The Trigeminal Autonomic Cephalalgias (TACs: Cluster headache, paroxysmal hemicrania and SUNCT) are a primary headache grouped characterized by the presence of unilateral pain in the somatic distribution of the trigeminal nerve, associated with craniofacial ipsilateral autonomic features. Despite their common elements, individually these headaches differ with respect to attack duration, frequency, and response to indomethacin.A three cases of TACs of dentomaxilar location is presented, common and particular characteristics, and the need for differential diagnosis with pain from stomatognathic structures.

Cefalalgia cardíaca: cuando la angina es embriagadora / Cardiac cephalalgia: when angina is heady

La angina cafalalgica cardíaca es un fenómeno poco frecuente como manifestación de un evento coronario agudo. Presentamos un caso típico de ésta manifestación que se asocia a la presencia de vasospasmo coronario y flujo coronario muy lento a nivel epicárdico y miocárdico. La presencia de palpitaciones durante la cefalea advirtió a la paciente del probable origen cardíaca de sus síntomas.

Headache angina or heart headache is a rare phenomenon as a manifestation of an acute coronary event. We report a typical case of this event that is associated with the presence of coronary vasospasm and slow coronary flow on myocardial and epicardial levels. The presence of palpitations during the headache warned the patient of probable cardiac origin of their symptoms.

A Case of Cardiac Cephalalgia Showing Reversible Coronary Vasospasm on Coronary Angiogram

BACKGROUND: Under certain conditions, exertional headaches may reflect coronary ischemia. CASE REPORT: A 44-year-old woman developed intermittent exercise-induced headaches with chest tightness over a period of 10 months. Cardiac catheterization followed by acetylcholine provocation demonstrated a right coronary artery spasm with chest tightness, headache, and ischemic effect of continuous electrocardiography changes. The patient's headache disappeared following intra-arterial nitroglycerine injection. CONCLUSIONS: A coronary angiogram with provocation study revealed variant angina and cardiac cephalalgia, as per the International Classification of Headache Disorders (code 10.6). We report herein a patient with cardiac cephalalgia that manifested as reversible coronary vasospasm following an acetylcholine provocation test.

Caracterización clínica y de conglomerados de clases latentes de la migraña familiar en el aislado genético de Antioquia / Clinical and latent class cluster characteristics of familiar migraine in the antioquian genetic isolate

INTRODUCCIÓN: la migraña es una entidad de alta prevalencia cuya etiología parece tener un gran componente genético. OBJETIVOS: determinar las características clínicas y la de conglomerados de clases latentes (CCL) en las familias colombianas de la región de Antioquia con un caso índice con cefalea crónica. MATERIAL Y MÉTODOS: se estudiaron 550 individuos (374 mujeres y 176 hombres) de 121 familias colombianas de la región de Antioquia. A todos se les hizo una pregunta de rastreo para seleccionar a los miembros con posible migraña. A los sospechosos se les hizo una entrevista con los criterios de la International Headache Society (IHS) y un examen neurológico para establecer el diagnóstico y su clasificación en migraña con aura (MCA) y migraña sin aura (MSA). Los criterios de la IHS fueron usados para hacer un análisis de CCL, calculando índices de máxima verosimilitud y controlando el cumplimiento del supuesto de la independencia local. RESULTADOS: el 61,6 % de los miembros de las familias tuvieron migraña. El 40 % tuvo MSA y el 21,6 % MCA. La intensidad fue de moderada a severa en 96,4 % de los casos. Aproximadamente el 70 % presentaron síntomas de náuseas, vómitos, sonofobia, fotofobia e incremento con el ejercicio. Se derivaron 4 CCL: uno con MSA+MCA, con alta probabilidad de ser mujeres y con crisis de inicio temprano; otro grupo de personas sanas de ambos sexos; un tercero con MSA de aparición a edad intermedia, con crisis moderadas a severas de larga duración y predominante de mujeres; y un cuarto grupo de mujeres con MSA de aparición temprana y crisis de corta duración. CONCLUSIONES: las características clínicas de los pacientes con migraña de estas familias son similares a lo informado en otros estudios. La distribución de los CCL hace pensar en una probable transmisión de una predisposición genética que, en interacción con factores ambientales, determinaría la edad de inicio de las crisis y si esas son de tipo MSA o MSA+MCA.

INTRODUCTION: migraine is a disorder with high prevalence and with probable genetic etiology. OBJECTIVE: to determine the clinical and latent class cluster (LCC) characteristics of Antioquian families with one probands with chronic headache. MATERIALS AND METHODS: 550 individuals (374 females and 176 males) were studied. All participants were asked with one screening question in order to select suspicious of migraine. An interview with the International Headache Society (IHS) criteria and a neurological examination were administered to all probably migraine affected patients. Migraine diagnosis and classification into migraine with aura (MA) and migraine without aura (M0) was done. The IHS were used to develop a LCC analysis, calculating maximum likelihood index and controlling the local independence assumption. RESULTS: 61,6 per cent of the family members were affected with migraine, 40 per cent had M0 and 21,6 per cent had MA. Intensity was estimated between moderate to severe by 96,4 per cent of the cases. Approximately 70 per cent had nausea, vomiting, sonophobia, photophobia and worsening with exercise. 4 LCC were derived: one with M0 + MA, with high probability to be females, and early onset crisis; other group was constituted by healthy people of both genders; the third cluster had M0 of intermediate age onset, with moderate to severe attack, with long duration and predominantly females; finally a 4th cluster of females with M0 of early onset and short duration. CONCLUSIONS: clinical characteristics of migraine patients in these Antioquian families were similar to those informed by others studies. The distribution of LCC suggests a genetic transmission of vulnerability, which interacting with several environmental factors, would determine the age of onset and the types of attacks as M0, or M0+MA.

A Case of Brain Stem Neuro-Behcet's Disease Presenting as Paroxysmal Headache With Autonomic Features

Migraine without aura was significantly frequent in Beh et's disease patients. While, the relationship of TAC(trigeminal autonomic cephalalgia) and Beh et's disease was not known. And, it is thought that pathogenesis of proxysmal headache with autonomic features in neuroBehcet's disease as our case may be different from those of clust headache and TAC. A 45-year-old male admitted with left sided periobital poxysmal headache accompained by ipsilateral conjunctival injection and lacrimination with autonomic features. T2WMR image showed about 1.5x2.6x2.6 cm sized mass with high signal intensity surrounded by a rim of low signal intensity in pons. Enhanced MR image showed enhancing mass-like lesion inside the T2 high signal intensity. CSF study revealed neutrophilic pleocytosis with normal pressure, protein and glucose concentration. No malignant cell were seen. Antiphospholipid antibody and cryoglobuline was significantly increased. 3 days after hospitalvisit, oral ulcerations appeared in the patient. He was treated with high-dose steroid for a week and his headache and abnormal findings of CSF study became fully recovered. Two weeks later, the mass was nearly reduced in the pons on follow-up MR image. We suggest to include a careful interviewfor 2ndary TAC as the first neurologic symptom in the diagnostic work-up of Behet's disease.