ABSTRACT
Objetivos: Conocer prevalencia global de cefalea y subtipos en Enfermedades Autoinmunes Sistémicas (EAS) y compararla con la población general. Establecer en pacientes con Lupus Eritematoso Sistémico (LES) la relación entre cefalea y anticuerpos antifosfolípidos (aPL), actividad, otras manifestaciones neurológicas. Comparar la eficacia entre la segunda clasificación de la International Headache Society (ICHD-II), 2004, y la del American College of Rheumatology (ACR), 1999, para clasificar cefaleas en LES. Métodos: Noventa pacientes fueron evaluados con un cuestionario basado en criterios de la ICHD-II. En pacientes con LES también se aplicó la clasificación de cefaleas del ACR. Prevalencia anual de cefalea y migraña se comparó con la de Uruguay. Resultados: La prevalencia anual de cefalea en EAS fue similar a la población general (50,6 por ciento vs 58,4 por ciento). Fueron primarias 47 (52 por ciento): Tipo tensional 31 (34,4 por ciento), migraña 16 (17,8 por ciento), sin aura 13. Se halló asociación significativa entre EAS y migraña, teniendo 2,87 más posibilidades de presentarla estos individuos que la población general (17,8 por ciento vs 6,2 por ciento, P = 0,0001). De 19 lúpicos con cefalea, relación con actividad: 1, aPL positivos: 13, otras manifestaciones neurológicas: 5. Aplicando la ICHD-II se diagnosticó el 100 por ciento de cefaleas en LES; con la clasificación del ACR se diagnosticó el 86 por ciento. Conclusión: La prevalencia de cefalea fue similar ala población general. Predominaron las primarias, tipo tensional y migraña. La migraña fue más prevalente en las EAS. En LES no se demostró asociación entre cefalea y actividad, aPL, otros síndromes neuropsiquiátricos. La ICHD-II debería utilizarse en LES, y la clasificación del ACR debería revisarse.
Objectives: Learn the global prevalence of headache and its subtypes in Systemic Autoimmune Diseases (SADs); compare it with the general population. In Systemic lupus erythematosus (SLE), to establish the relationship between headache and: antiphospholipid antibodies (APA), activity, other neurological manifestations. To compare the efficacy between the second classification of the International Headache Society (ICHD-II), 2004 and the classification of the American College of Rheumatology (ACR) 1999 to classify headaches in SLE. Methods: Ninety patients were evaluated with a questionnaire based on criteria of the ICHD-II. In patients with SLE the criteria of the ACR were also used. The annual prevalence of headache and migraine was compared with Uruguays. Results. The annual prevalence of headache in SADs was similar to the general population (50.6 percent vs. 58.4 percent). There were 47 primary headaches (52 percent): 31 tension type (34,4 percent), 16 migraines (17,8 percent), 13 without aura. A significant association was found between SADs and migraine; these patients had a 2.86 times greater chance of presenting migraines than the general population (17.8 percent vs. 6.2 percent, P = 0,0001). In the case of the 19 patients with SLE and headache, there was a relationship with activity in 1 case, 13 were APA positive, 5 had other neurologic manifestations. Applying the ICHD-II criteria 100 percent of headaches were diagnosed in SLE, applying those of the ACR, 86 percent. Conclusion: The primary headaches predominated, with the same prevalence and subtypes (tension type and migraine) than in the general population. Individuals with SADs have a higher possibility of suffering from migraine. In SLE, no relationship was demonstrated between headache and activity, APA or other neuropsychiatric syndromes. The ICHD-II should be the one to be used in SLE patients, the ACR classification should be revised.
Subject(s)
Humans , Male , Adolescent , Adult , Female , Middle Aged , Aged, 80 and over , Headache/epidemiology , Headache/etiology , Autoimmune Diseases/complications , Autoimmune Diseases/epidemiology , Headache/classification , Headache Disorders, Primary/epidemiology , Headache Disorders, Primary/etiology , Headache Disorders, Secondary/epidemiology , Headache Disorders, Secondary/etiology , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/epidemiology , Prevalence , Surveys and Questionnaires , Migraine Disorders/epidemiology , Migraine Disorders/etiologyABSTRACT
The authors reported a 54 year-old Italian woman with headache attributed to spontaneous low cerebrospinal pressure and normal brain magnetic resonance imaging. Lumbar puncture was done and opening pressure was not measurable. 99mTc radionuclide cysternography was used in diagnosis and demonstrated 3 lumbar leakages and early appearance of bladder activity. Epidural blood patch was performed. This option was safe and successful to treat this kind of headache without relapse of symptoms after 3 years follow-up.