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1.
Medicina (B.Aires) ; 81(3): 427-431, jun. 2021. graf
Article in Spanish | LILACS | ID: biblio-1346480

ABSTRACT

Resumen La migraña es un trastorno muy prevalente que afecta a alrededor del 15% de los sujetos adultos. Es clasificada por la Organización Mundial de la Saludentre los primeros puestos como causa de discapacidad. Los tratamientos preventivos habituales hasta ahora derivan de otras indicaciones y por serendipia se utilizan en prevención de migraña: betabloqueantes, drogas antiepilépticas, antidepresivos tricíclicos, bloquean tes de canales de calcio, toxina botulínica. Todas ellas han mostrado eficacia similar al 50% en reducir el número de episodios migrañosos pese a efectos secundarios indeseados. Durante los últimos años, se ha evaluado la eficacia y seguridad de los anticuerpos monoclonales (AM) que actúan sobre la vía del péptido relacionado con el gen de la calcitonina (CGRP) en migraña. Dicho péptido es relevante en la activación del dolor en territorio meníngeoy es mediado por terminales nerviosas trigeminales una vez activado el proceso migrañoso. Su dosaje en crisis migrañosas ha sido elevado en diversos estudios y su neutralización/bloqueo, redunda en alivio del dolor. Los anticuerpos monoclonales erenumab, galcanezumab, fremanezumab, eptinezumab aprobados en el mercado EE.UU./Europa desde 2018 y tras varios trabajos de Fase III y abiertos de extensión, mostraron clara seguridad yeficacia y están presentes en nuestro medio desde mediados de 2019. Desarrollamos la racionalidad e indicaciones de uso de los mismos.


Abstract Migraine is a very prevalent disorder that is estimated to affect about 10-15% of adult subjects. Ac cording to the World Health Organization migraine is one of the first causes of disability. Traditional preventive treatments discovered by serendipity include Beta blockers, antinconvulsants drugs, calcium channel blockers, tricyclic antidepressants and onabotulinum A and offer about 50% efficacy after controlled placebo trials and real life use. Because of lack of adherence and adverse events, there is a loss of beneficial sustain on these treat ments. Recently, the efficacy and safety of monoclonal antibodies (MA) that act on the peptide pathway related to the calcitonin gene (CGRP) has been evaluated in migraine, being the first specific tailored treatment on one of the multiple targets on migraine. This family of drugs: erenumab, galcanezumab, fremanezumab, eptinezumab, finished Fase III, extensions trials and many of them are in the market approved since 2018.Since 2019 are available in Argentina. We will describe the rationale for the prescription of this family of new drugs for migraine.


Subject(s)
Humans , Adult , Antineoplastic Agents, Immunological/therapeutic use , Migraine Disorders/prevention & control , Migraine Disorders/drug therapy , Argentina , Calcitonin Gene-Related Peptide Receptor Antagonists/therapeutic use , Antibodies, Monoclonal/therapeutic use
2.
Artemisa; I Jornada Científica de Farmacología y Salud. Fármaco Salud Artemisa 2021; 2021. [1-13] p. tab.
Non-conventional in Spanish | LILACS, MTYCI | ID: biblio-1284607

ABSTRACT

Introducción: La cefalea migrañosa ocupa la séptima causa de incapacidad a nivel mundial, constituyendo un problema de salud que requiere un adecuado diagnóstico y tratamiento. Objetivo: valorar la efectividad de la acupuntura en pacientes con cefalea migrañosa atendidos en la consulta de neurología en el policlínico Aracelio Rodríguez Castellón del municipio Cumanayagua. Material y método: se realizó una investigación experimental, de tipo cuasiexperimental. El universo estuvo constituido por 40 pacientes atendidos en consulta de neurología en el policlínico Aracelio Rodríguez Castellón de Cumanayagua. La muestra la conformaron 16 pacientes, por muestreo probabilístico aleatorio simple. Las variables utilizadas fueron: edad, sexo, intensidad, frecuencia, trastornos del sueño, efectos adversos del tratamiento con acupuntura, efectividad del tratamiento. Procedimientos. Aplicación de acupuntura en intervalos de 1,5-2 meses, 10 sesiones dos veces por semana. Resultados: el 75% de los pacientes con cefalea migrañosa son mujeres, el 62.5% presento dolor de moderada intensidad, el 50% de los casos estudiados respondieron de forma excelente al tratamiento acupuntural. Conclusiones: la terapia acupuntural evidencia efectividad, seguridad en el tratamiento complementario de la cefalea migrañosa. Su empleo racional es una opción terapéutica que refuerza el arsenal terapéutico en las comunidades.


Subject(s)
Acupuncture Therapy , Migraine Disorders/therapy , Patients , Sleep Wake Disorders , Complementary Therapies , Cuba
4.
Article in Chinese | WPRIM | ID: wpr-877668

ABSTRACT

OBJECTIVE@#To observe the effect of five-element acupuncture on the cognitive function repair of migraine patients with depression/anxiety disorder.@*METHODS@#The migraine patients with depression/anxiety disorder (19 cases, 5 cases dropped off) were taken as the observation group, and received five-element acupuncture twice a week for 8 weeks. Healthy subjects (19 cases) were selected by demographic data matching as the control group. The cognitive function was evaluated with the event related potential (ERP) technique, and the latency and amplitude of visual evoked potential P300 were adopted as the observation indexes. The headache days (every 4 weeks), headache intensity [visual analogue scale(VAS) score], and headache impact test-6 (HIT-6) score, Hamilton depression scale (HAMD) score and Hamilton anxiety scale (HAMA) score were used as the observation indexes for curative effect.@*RESULTS@#Before the treatment, latency of target stimulus at Fz [ (417.5±34.3) ms] in the observation group was extended compared with the healthy subjects of the control group [(388.6±42.1) ms, @*CONCLUSION@#There are some cognitive impairments in migraine patients with depression/anxiety disorder. Five-element acupuncture not only relieves headache, anxiety and depression effectively, but also improves the activation level of the frontal lobe. It significantly repairs the impaired cognitive function.


Subject(s)
Acupuncture Points , Acupuncture Therapy , Anxiety Disorders , Cognition , Depression/therapy , Evoked Potentials, Visual , Humans , Migraine Disorders/therapy , Treatment Outcome
5.
Article in Chinese | WPRIM | ID: wpr-877558

ABSTRACT

OBJECTIVE@#To observe the therapeutic effect between acupuncture combined with medication and simple medication on migraine and cerebral hemodynamics.@*METHODS@#A total of 120 patients with migraine were randomized into an acupuncture plus medication group (60 cases, 3 cases dropped off) and a medication group (60 cases, 6 cases dropped off). In the medication group, flunarizine hydrochloride capsule was given orally before sleep, 10 mg a day. On the basis of the treatment in the medication group, acupuncture was applied at Sizhukong (TE 23), Shuaigu (GB 8), Taiyang (EX-HN 5), Fengchi (GB 20) and etc. in the acupuncture plus medication group, 30 min each time, once a day. Treatment for 4 weeks was required in both groups. Before and after treatment, the visual analogue scale (VAS) score, indexes of cerebral hemodynamic [blood flow velocity of anterior cerebral artery (ACA), middle cerebral artery (MCA), posterior cerebral artery (PCA), vertebral artery (VA) and basilar artery (BA)] and total TCM syndrome score were observed, and the clinical therapeutic effect and the incidence of the adverse events were evaluated in both groups.@*RESULTS@#Compared before treatment, the VAS scores, the blood flow velocity of ACA, MCA, PCA, VA, BA and the total TCM syndrome scores were decreased in both groups (@*CONCLUSION@#Acupuncture combined with flunarizine hydrochloride capsule can effectively relieve the pain in patients with migraine, reduce the cerebral blood flow velocity, the efficacy is superior to simple flunarizine hydrochloride capsule.


Subject(s)
Acupuncture Points , Acupuncture Therapy , Hemodynamics , Humans , Migraine Disorders/therapy , Pain , Treatment Outcome
6.
Arq. neuropsiquiatr ; 78(12): 778-782, Dec. 2020. tab
Article in English | LILACS | ID: biblio-1142370

ABSTRACT

ABSTRACT Background: Migraine is one of the most common disorders in neurological clinical practice and is part of the group of primary headaches. It often affects individuals in the age group of 25-55 years, when people are at their peak of economic productivity. Many patients ultimately overuse analgesics. Overuse is defined by the use of analgesics for at least 15 times a month - within a minimal three-month period. Impulsivity and migraine cause losses in the lives of individuals suffering from them, as they can compromise these individuals' social, emotional, and professional spheres. Regarding the professional sphere, it results in economic losses compared with the overall population. Objective: To investigate the presence of impulsive behavior in patients with migraine and with medication-overuse migraine. Methods: Cross-sectional study on 210 female and male patients; 140 were diagnosed with migraine according to criteria of the International Classification of Headache Disorders and were subdivided into two groups (70 patients each). One of these groups was composed of medication-overuse patients; the control group was composed of non-migraine patients (70 patients). All patients were evaluated with the Barratt Impulsivity Scale (BIS-11). Results: The group of migraine patients accounted for the highest impulsivity level, followed by the control group and, finally, by the medication-overuse group. However, these differences did not attain statistical significance. Conclusions: It was not possible to establish a clear connection between migraine and impulsive behavior. Association was higher among migraineurs without medication overuse.


RESUMO Introdução: A enxaqueca é uma das condições mais comuns na prática clínica neurológica, enquadrando-se no grupo das cefaleias primárias. Sua prevalência é maior na faixa etária de 25 a 55 anos, coincidindo com o pico da produtividade econômica. Muitos pacientes recorrem ao uso abusivo de analgésicos. O uso excessivo desses medicamentos é definido pela sua utilização por pelo menos 15 vezes ao mês, por um período de no mínimo três meses. A impulsividade e a enxaqueca causam prejuízos na vida dos indivíduos afetados, podendo comprometer os âmbitos social, emocional e profissional, resultando em um prejuízo monetário a esse grupo, em relação à população em geral. Objetivo: Investigar a presença de comportamento impulsivo em pacientes com enxaqueca com abuso de analgésico. Métodos: Estudo de corte transversal com 210 pacientes, homens e mulheres, sendo 140 com diagnóstico de enxaqueca segundo os critérios da Classificação Internacional das Cefaleias (IHCD-3), subdivididos em dois grupos de 70 pacientes cada, um composto por pacientes em uso excessivo de medicamentos, e um grupo controle composto por indivíduos sem enxaqueca. Todos os pacientes foram avaliados com a Escala de Impulsividade de Barratt - BIS 11. Resultados: O grupo com enxaqueca apresentou maior impulsividade, seguido do grupo controle e, por fim, o grupo com enxaqueca com abuso de medicamentos. No entanto, essas diferenças não atingiram significância estatística. Conclusão: Não foi possível encontrar relação direta entre a enxaqueca e comportamentos impulsivos. No entanto, esta relação foi maior entre os pacientes com enxaqueca sem abuso de analgésico.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Headache Disorders, Secondary/epidemiology , Migraine Disorders/drug therapy , Migraine Disorders/epidemiology , Prevalence , Cross-Sectional Studies , Prescription Drug Overuse , Analgesics/adverse effects , Impulsive Behavior
8.
Arq. neuropsiquiatr ; 78(9): 541-548, Sept. 2020. tab
Article in English | LILACS | ID: biblio-1131754

ABSTRACT

ABSTRACT Background: Few studies have explored the coexistence of migraine and disordered eating attitudes. Furthermore, the underlying pathophysiological mechanisms of migraine and disordered eating attitude comorbidity are not clearly understood. Objective: This study aimed to investigate the association between migraine and disordered eating attitudes in relation to personality traits, obesity, quality of life, migraine severity, depression, and anxiety. Methods: This study included 91 patients with episodic migraine and 84 healthy control subjects. Self-report questionnaires were used to evaluate anxiety, depression, migraine-related disability, personality traits, quality of life, and eating disorders. Results: The Eating Attitude Test (EAT) showed disordered eating attitudes in 21 patients (23.1%) in the migraine group and eight patients (9.5%) in the control group. Migraine-related disability, anxiety, depression, neuroticism, and quality of life scores were significantly worse in migraine patients with disordered eating attitudes compared to migraine patients without disordered eating attitudes. In migraine patients, eating attitude test scores were positively correlated with migraine-related disability, anxiety, depression, and neuroticism scores, and negatively correlated with quality of life scores. Conclusion: The association of migraine and disordered eating attitudes was shown to be related to depression, anxiety, quality of life and personality traits and may also indicate a more clinically severe migraine. To the best of our knowledge, there is no literature study that deals with all these relevant data together. However, neuropsychiatry-based biological studies are required to better understand this multifaceted association.


RESUMO Introdução: Poucos estudos exploraram a coexistência de migrânea e hábitos alimentares inadequados. Além disso, os mecanismos fisiopatológicos subjacentes da migrânea e da comorbidade da atitude alimentar inadequada não são claramente entendidos. Objetivo: Este estudo teve como objetivo investigar a associação entre migrânea e atitudes alimentares inadequadas em relação aos traços de personalidade, obesidade, qualidade de vida, gravidade da migrânea, depressão e ansiedade. Métodos: Este estudo incluiu 91 pacientes com migrânea episódica e 84 indivíduos saudáveis. Questionários de autorrelato foram utilizados para avaliar ansiedade, depressão, incapacidade relacionada à enxaqueca, traços de personalidade, qualidade de vida e distúrbios alimentares. Resultados: O Teste de Hábito Alimentar (THA) mostrou hábitos alimentares inadequados em 21 pacientes (23,1%) no grupo com migrânea e 8 pacientes (9,5%) no grupo controle. Os índices de incapacidade, ansiedade, depressão, neuroticismo e qualidade de vida relacionados à migrânea foram significativamente piores em pacientes com migrânea com hábitos alimentares inadequados em comparação com pacientes com migrânea sem hábitos alimentares inadequados. Em pacientes com migrânea, os escores dos testes de hábito alimentar foram correlacionados positivamente com os escores de incapacidade, ansiedade, depressão e neuroticismo relacionados à migrânea e negativamente com os escores de qualidade de vida. Conclusão: A associação de migrânea e atitudes alimentares inadequadas mostrou-se relacionada à depressão, ansiedade, qualidade de vida e traços de personalidade, podendo também indicar uma migrânea mais clinicamente grave. Até onde sabemos, não há estudo de literatura que lide com todos esses dados relevantes juntos. No entanto, são necessários estudos biológicos baseados em neuropsiquiatria para entender melhor essa associação multifacetada.


Subject(s)
Humans , Feeding and Eating Disorders , Migraine Disorders , Anxiety , Personality , Quality of Life , Attitude , Depression/epidemiology , Obesity/complications , Obesity/epidemiology
9.
Arq. neuropsiquiatr ; 78(8): 468-472, Aug. 2020. tab, graf
Article in English | LILACS | ID: biblio-1131745

ABSTRACT

ABSTRACT Background: Migraine is a major cause of disability, which affects many areas of life, including productivity at work. Measuring absenteeism and presenteeism resulting from migraine with the use of appropriate tools is essential for better understanding the impact of this disease. Objective: The aim of the present study was to assess the work impact of migraine using the Brazilian Portuguese version of Work Productivity and Activity Impairment (WPAI) questionnaire. Methods: This survey was carried out with the aid of a smartphone app (Dr Cefaleia for Doctors) containing the questionnaires: ID-Migraine, Headache Impact Test (HIT-6), and WPAI. The data were collected during a headache awareness event. Correlations were assessed between migraine impact (HIT-6) with WPAI parameters: a) work time missed (absenteeism), b) impairment at work (presenteeism), c) overall work productivity loss (absenteeism+presenteeism), and d) activity impairment outside work. Results: Overall, 305 subjects with headache were interviewed and 167 were classified as having migraine. No significant differences in migraine impact according to sex (p=0.8) and modality of work were registered (p=0.8). Females had significantly higher absenteeism score (p<0.001), but presenteeism score was not significantly different between genders (p=0.3). WPAI absenteeism and presenteeism scores significantly correlated with migraine impact (HIT-6). Conclusions: The results suggest WPAI Brazilian Portuguese version was efficient in assessing migraine related work impact. The use of an app with validated questionnaires facilitates the conduction of migraine impact research in different populations, allowing a better understanding of the burden of this disease.


RESUMO Introdução: A enxaqueca é uma causa importante de incapacidade, afetando diversos domínios, incluindo a produtividade no trabalho. Avaliar o absenteísmo e o presenteísmo decorrentes da enxaqueca, por meio de ferramentas adequadas, é essencial para melhor conhecer o impacto desta doença. Objetivo: O objetivo deste estudo foi avaliar o impacto da enxaqueca sobre a produtividade no trabalho utilizando a versão em português do questionário Work Productivity and Activity Impairment (WPAI). Métodos: Para a realização desta pesquisa utilizou-se o aplicativo Dr. Cefaleia para Médicos com os seguintes questionários: "ID-Migraine", "Headache Impact Test - HIT-6" e o WPAI. Os dados foram coletados durante um mutirão de conscientização sobre cefaleias. Foram avaliadas as correlações entre o impacto da enxaqueca (HIT-6) com os parâmetros do WPAI: a) tempo de trabalho perdido (absenteísmo), b) comprometimento do trabalho (presenteísmo), c) perda geral de produtividade (absenteísmo+presenteísmo), e d) comprometimento das atividades fora do trabalho. Resultados: Foram entrevistados 305 indivíduos com cefaleia, sendo que 167 dos casos foram classificados como enxaqueca. Não foram encontradas diferenças significativas no impacto da enxaqueca de acordo com o sexo (p=0,8) nem a modalidade de trabalho (p=0,8). As mulheres tiveram maior absenteísmo (p<0,001) mas não houve diferenças significativas entre os sexos quanto ao presenteísmo (p=0,3). Tanto os escores de absenteísmo quanto de presenteísmo do WPAI correlacionaram-se significativamente com o impacto da enxaqueca (HIT-6). Conclusões: Os resultados descritos sugerem que a versão em português do WPAI foi eficiente em avaliar o impacto no trabalho relacionado à enxaqueca. O uso de um aplicativo contendo questionários validados facilita pesquisas sobre o impacto da enxaqueca em diferentes populações, permitindo uma melhor compreensão do ônus resultante desta doença.


Subject(s)
Humans , Male , Female , Smartphone , Migraine Disorders , Brazil , Surveys and Questionnaires , Efficiency
10.
Arq. neuropsiquiatr ; 78(7): 397-402, July 2020. tab, graf
Article in English | LILACS | ID: biblio-1131726

ABSTRACT

ABSTRACT Background: The relationship of bidirectional comorbidity between chronic migraine and pain in the cephalic segment led us to evaluate the improvement in reducing the pain in patients diagnosed with chronic migraine headache and awake bruxism, when undergoing treatment with a partial posterior interocclusal device designed for the management and control of awake bruxism through biofeedback. Methods: Seventy-four patients were evaluated during the following periods: pretreatment, seven, thirty, ninety, one hundred and eighty days, and one year. The evaluation was carried out by measuring the pain in the pretreatment period and pain reduction after awake bruxism treatment, using clinical evaluation and numerical scales for pain. Results: Most of the patients who complained of headache migraine pain, masticatory myofascial pain, temporomandibular joint and neck pain experienced a significant reduction in overall pain, including headaches, between t0 and t30 (p<0.0001). After 30 days of using the device, it was observed that the improvement remained at the same level without any recurrence of pain up to t90. At t180 and t360, it was observed that even with the device withdrawal (at t90) the improvement remained at the same level. Conclusion: The utilization of a posterior interocclusal device designed for the management and control of awake bruxism through biofeedback seems to contribute to the reduction of pain (including migraine headache) in the majority of patients, and, even with the device withdrawal (at t90), the improvement remained at the same level, suggesting the patients succeeded in controlling their awake bruxism and consequently the pains.


RESUMO Introdução: A relação de comorbidade bidirecional entre enxaqueca crônica e dor no segmento cefálico nos levou a avaliar a melhora na redução da dor em pacientes diagnosticados com cefaleia crônica de enxaqueca e bruxismo de vigília, quando submetidos a tratamento com dispositivo interoclusal posterior parcial projetado para o manejo e o controle do bruxismo acordado através de biorretroalimentação (biofeedback). Métodos: Setenta e quatro pacientes foram avaliados durante os seguintes períodos: pré-tratamento, sete, trinta, noventa e cento e oitenta dias, e um ano. A avaliação foi realizada por meio da avaliação da dor no período pré-tratamento e redução da dor após o tratamento do bruxismo de vigília, através de avaliação clínica e escalas numéricas de dor. Resultados: A maioria dos pacientes que se queixou de dor de cabeça com enxaqueca, dor miofascial mastigatória, articulação temporomandibular e dor no pescoço sofreu uma redução significativa na dor geral, incluindo dores de cabeça, entre t0 e t30 (p<0,0001). Após 30 dias de uso do dispositivo, observou-se que a melhora permaneceu no mesmo nível, sem recorrência da dor até t90. Em t180 e t360, observou-se que, mesmo com a retirada do dispositivo (em t90), a melhoria permaneceu no mesmo nível. Conclusão: A utilização de um dispositivo interoclusal posterior projetado para o controle do bruxismo de vigília através de biofeedback parece contribuir para a redução da dor (incluindo enxaqueca) na maioria dos pacientes, e, mesmo com a retirada do dispositivo (t90), a melhora manteve-se no mesmo nível, sugerindo que os pacientes conseguiram controlar o seu bruxismo de vigília e a dor associada a esse hábito.


Subject(s)
Humans , Wakefulness/physiology , Facial Pain/complications , Bruxism/complications , Temporomandibular Joint Disorders/complications , Migraine Disorders/complications , Biofeedback, Psychology , Bruxism/diagnosis , Temporomandibular Joint Disorders/diagnosis
11.
Rev. chil. neuro-psiquiatr ; 58(2): 127-139, jun. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1115478

ABSTRACT

Resumen Objetivo: Determinar la relación del abuso de medicamentos y síntomas de ansiedad en pacientes adultos ambulatorios con migraña crónica en la Clínica SANNA /Sánchez Ferrer, Trujillo-Perú. Material Y Método: Estudio transversal, con una muestra de 104 pacientes con migraña crónica con y sin abuso de medicamentos. Se reportan frecuencias absolutas, relativas, promedio y DE según el tipo de variable. En el análisis bivariado por medio del Chi2 de Homogeneidad y nivel del análisis multivariado, utilizando regresión de Modelos Lineales Generalizados, familia Poisson y Poisson con varianza robusta. Resultados: Encontramos 96 (92.3%) pacientes de sexo femenino, con una edad media y DE 37.1 ± 9.6. A nivel general, 1 de cada 3 pacientes tenían síntomas de ansiedad y 1 de cada 2 pacientes reportaron abuso de medicamentos. La proporción de pacientes con síntomas de ansiedad fue tres veces mayor en el grupo con abuso de medicamentos que aquellos sin abuso de medicamentos. Los pacientes ambulatorios con migraña crónica que abusan de medicamentos tienen 2.28 veces mayor riesgo de padecer síntomas de ansiedad, que aquellos que no abusan de medicamentos. Conclusiones: Los pacientes ambulatorios con migraña crónica que abusan de medicamentos tienen mayor riesgo de padecer síntomas de ansiedad. Por lo tanto, es necesario incorporar soporte psicológico a todos los pacientes con abuso de medicamentos y prevenir efectos secundarios de ese abuso.


Objective: To determine the relationship of medication abuse and anxiety symptoms in adult outpatients with chronic migraine in the SANNA / Sánchez Ferrer Clinic, Trujillo-Peru. Material And Method: Cross-sectional study, with a sample of 104 patients with chronic migraine with and without medication abuse. Absolute, relative, average and SD frequencies are reported according to the type of variable. In the bivariate analysis through the Chi2 of Homogeneity and level of the multivariate analysis, using regression of Generalized Linear Models, Poisson and Poisson family with robust variance. Results: We found 96 (92.3%) female patients, with a mean age and SD 37.1 ± 9.6. Overall, 1 in 3 patients had anxiety symptoms and 1 in 2 patients reported medication abuse. The proportion of patients with anxiety symptoms was three times higher in the group with medication abuse than those without medication abuse. Outpatients with chronic migraine who abuse medications are 2.28 times more at risk of anxiety symptoms than those who do not abuse medications. Conclusions: Outpatients with chronic migraine who abuse medications have a higher risk of anxiety symptoms. Therefore, it is necessary to incorporate psychological support to all patients with medication abuse and prevent side effects of that abuse.


Subject(s)
Humans , Male , Female , Anxiety , Outpatients , Drug Misuse , Migraine Disorders , Peru , Cross-Sectional Studies
12.
Arq. neuropsiquiatr ; 78(6): 337-341, June 2020. tab
Article in English | LILACS | ID: biblio-1131717

ABSTRACT

ABSTRACT Background: Migraine is a multifactorial neurovascular syndrome and closely associated to inflammation. Cystatin C (Cys C) is a neuroendocrine polypeptide which also plays a role in inflammation. Objective: To investigate the levels of Cys C in migraine patients without aura. Methods: A total of 80 participants were included in the study; 40 patients and 40 healthy controls. Serum Cys C levels were investigated by using enzyme-linked immunosorbent assay (ELISA). Statistical analysis were performed using Statistical Package for the Social Sciences (SPSS) version 22.0 (SPSS Inc, IL, USA). Results: Serum Cys C levels were found as 73.88 ng/mL in the patient group and 24.92 ng/mL in the healthy control group, being significantly higher among patients (p=0.000). Serum Cys C levels were significacntly different across age subgroups among patients (p=0.049), but not among controls. However, visual analog scale (VAS) (p=0.707), disease duration time (p=0.725) and body mass index (p=0.136) were not significantly different between the two groups. Conclusion: Our findings demonstrate that high serum Cys C levels are independently associated to migraine without aura. To the best of our knowledge, this is the first study to determine the serum levels of Cys C in patients with migraine. Thus, serum Cys C may be a potential biomarker of migraine.


RESUMO Introdução: A enxaqueca é uma síndrome neurovascular multifatorial e está intimamente associada à inflamação. A cistatina C (Cys C) é um polipeptídeo neuroendócrino que também desempenha papel importante na inflamação. Objetivo: Investigar os níveis de Cys C em pacientes com enxaqueca sem aura. Métodos: Foram incluídos no estudo 80 participantes; 40 pacientes e 40 controles saudáveis. Os níveis séricos de Cys C foram investigados usando o ensaio de imunoabsorção ligado à enzima (enzyme-linked immunosorbent assay - ELISA). A análise estatística foi realizada utilizando o Statistical Package for the Social Sciences (SPSS), versão 22.0 (SPSS Inc, IL, EUA). Resultados: Em nosso estudo, os níveis séricos de Cys C foram encontrados em 73,88 ng/mL no grupo de pacientes e 24,92 no grupo de controle saudável, sendo os níveis significativamente maiores nos pacientes (p=0,000). Os níveis séricos de Cys C foram significativamente diferentes entre faixas etárias no grupo de pacientes (p=0,049). No entanto, a escala visual analógica (EVA) (p=0,707), o tempo de duração da doença (p=0,725) e o índice de massa corporal (p=0,136) não foram significativamente diferentes entre os dois grupos. Conclusão: Nossos achados demonstram que altos níveis séricos de Cys C estão independentemente associados à enxaqueca sem aura. Até onde sabemos, este é o primeiro estudo a determinar os níveis séricos de Cys C em pacientes com enxaqueca e os resultados sugerem que o Cys C sérico pode ser um potencial biomarcador nessa condição clínica.


Subject(s)
Humans , Cystatin C , Migraine Disorders/metabolism , Enzyme-Linked Immunosorbent Assay , Biomarkers
13.
Arq. neuropsiquiatr ; 78(6): 370-379, June 2020. tab, graf
Article in English | LILACS | ID: biblio-1131710

ABSTRACT

ABSTRACT Background: Individuals with migraine usually complain about lower memory performance. Diagnostic methods such as neuroimaging may help in the understanding of possible morphologic and functional changes related to the memory of those individuals. Therefore, the aim of this review is to analyze the available literature on neuroimaging changes related to memory processing in migraine. Methods: We searched the following databases: Pubmed/Medline, Psycinfo, Science Direct, Cochrane and Web of Science. We used articles without restriction of year of publication. The combination of descriptors used for this systematic review of literature were Neuroimaging OR Imaging OR Brain AND Migraine OR Chronic Migraine AND Memory. Results: Of the 306 articles found, nine were selected and all used magnetic resonance imaging (MRI). The studies used structural and functional MRI techniques with a predominance of 3 Tesla equipment and T1-weighted images. According to the results obtained reported by these studies, migraine would alter the activity of memory-related structures, such as the hippocampus, insula and frontal, parietal and temporal cortices, thereby suggesting a possible mechanism by which migraine would influence memory, especially in relation to the memory of pain. Conclusions: Migraine is associated to global dysfunction of multisensory integration and memory processing. This condition changes the activity of structures in various regions related to memory of pain, prospective memory, as well as in short- and long-term verbal and visuospatial memories. However, it is necessary to perform studies with larger samples in association with cognitive tests, and without the interference of medications to verify possible alterations and to draw more concrete conclusions.


RESUMO Introdução: Indivíduos com enxaqueca geralmente se queixam de menor desempenho de memória. Métodos de diagnóstico como a neuroimagem podem auxiliar no entendimento de possíveis alterações morfológicas e funcionais relacionadas à memória desses indivíduos. Portanto, o objetivo desta revisão é analisar a literatura disponível sobre alterações de neuroimagem relacionadas a alterações de memória na enxaqueca. Métodos: Pesquisou-se nas seguintes bases de dados: PubMed/MEDLINE, Psycinfo, Science Direct, Cochrane e Web of Science. Foram utilizados artigos sem restrição de ano de publicação. A combinação dos descritores utilizados para esta revisão sistemática da literatura foram Neuroimaging OR Imaging OR Brain AND Migraine OR Chronic Migraine AND Memory. Resultados: Dos 306 artigos encontrados, nove foram selecionados e todos utilizaram ressonância magnética (RM). Os estudos utilizaram as técnicas de RM estrutural e funcional com predomínio de equipamentos de 3 Tesla e imagens ponderadas em T1. De acordo com os resultados obtidos nos estudos, a enxaqueca alteraria a atividade de estruturas relacionadas à memória, como o hipocampo, a ínsula e os córtices frontal, parietal e temporal, sugerindo um possível mecanismo pelo qual a enxaqueca influenciaria a memória, especialmente em relação à memória da dor. Conclusões: A enxaqueca está associada à disfunção global da integração multissensorial e processamento de memória. Essa condição altera a atividade de estruturas em várias regiões relacionadas à memória da dor, à memória prospectiva, bem como às memórias verbais e visuais-espaciais de curto e longo prazo. No entanto, é necessário realizar estudos com amostras maiores em associação com testes cognitivos, e sem a interferência de medicamentos para verificar possíveis alterações e tecer conclusões mais concretas.


Subject(s)
Humans , Neuroimaging , Migraine Disorders/diagnostic imaging , Brain/diagnostic imaging , Magnetic Resonance Imaging , Memory
14.
Arq. neuropsiquiatr ; 78(3): 133-138, Mar. 2020. tab
Article in English | LILACS | ID: biblio-1098078

ABSTRACT

Abstract Cognitive impairment has been described in all phases of a migraine attack and interictally. However, the prevalence and phenotype of such impairment in chronic migraine (CM) have not yet been studied. Objectives: The aim of this study was to evaluate both the prevalence of the objective cognitive deficit in patients with CM and the factors underlying its etiology. Methods: 144 patients with CM and 44 age-matched patients with low-frequency episodic migraine (EM) (a maximum of 4 headache days per month) participated in this study. Neuropsychiatric characteristics were measured with the HADS Hospital Anxiety and Depression Scale. Cognitive function was assessed with the Montreal Cognitive Assessment (MoCA), Digit Symbol Substitution Test (DSST), Rey Auditory Verbal Learning Test (RAVLT), and the Perceived Deficits Questionnaire (PDQ-20). Results: Compared to EM, CM subjects demonstrated higher subjective and objective cognitive impairment across all tests. CM patients had 4 times higher odds of achieving a RAVLT score in the lower quartile range compared to EM (Odds Ratio [OR] 3.8; 95% confidence interval [95%CI] 1.5‒9.6; р=0.005). In the MoCA, CM patients demonstrated the most striking impairment in memory/delayed recall (65.3%), attention (46.5%), abstraction (30.6%), and language (27.1%). Chronic headache and level of education, but not gender, depression or anxiety, were independent predictors of cognitive impairment. Conclusions: Cognitive impairment is prevalent in the CM population during their mildest possible pain and may be caused by a central sensitization. Timely preventive treatment of EM is warranted.


Resumo O comprometimento cognitivo foi descrito em todas as fases de um ataque de enxaqueca, de maneira intermitente. Entretanto, a prevalência e o fenótipo desse comprometimento na enxaqueca crônica (EC) não foram estudados. Objetivos: O objetivo deste estudo foi avaliar a prevalência do déficit cognitivo objetivo em pacientes com EC e fatores subjacentes à sua etiologia. Métodos: 144 pacientes com CM e 44 pacientes pareados por idade com enxaqueca episódica (EE) de baixa frequência (máximo de 4 dias de dor de cabeça por mês) foram incluídos. As características neuropsiquiátricas foram medidas pela Hospital Anxiety and Depression Scale (HADS). A função cognitiva foi avaliada por meio da Montreal Cognitive Assessment (MoCA), o Digit Symbol Substitution Test (DSST), o Rey Auditory Verbal Learning Test (RAVLT) e o Perceived Deficits Questionnaire (PDQ-20). Resultados: Em comparação com a EE, os indivíduos com EC demonstraram um comprometimento cognitivo subjetivo e objetivo maior em todos os testes. Os pacientes com CM tiveram 4 vezes mais chances de alcançar um escore RAVLT na faixa quartil inferior, em comparação com EE (Odds Ratio [OR] 3,8; intervalo de confiança de 95% [IC95%] 1,5‒9,6; p=0,005). No MoCA, os pacientes com EC demonstraram o maior prejuízo na memória/atraso na recordação (65,3%), atenção (46,5%), abstração (30,6%) e linguagem (27,1%). Dor de cabeça crônica e nível de escolaridade, mas não o sexo, depressão ou ansiedade, foram preditores independentes de comprometimento cognitivo. Conclusões: O comprometimento cognitivo é prevalente na população com enxaqueca crônica mesmo durante uma dor muito leve e pode ser causado pela sensibilização central. O tratamento preventivo oportuno da enxaqueca episódica se faz necessário.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Cognitive Dysfunction/etiology , Headache/epidemiology , Migraine Disorders/epidemiology , Anxiety/epidemiology , Severity of Illness Index , Prevalence , Cross-Sectional Studies , Depression/physiopathology , Depression/epidemiology , Cognitive Dysfunction/psychology , Cognitive Dysfunction/epidemiology , Migraine Disorders/classification , Migraine Disorders/psychology
16.
Rev. chil. pediatr ; 91(1): 46-50, feb. 2020. tab
Article in Spanish | LILACS | ID: biblio-1092786

ABSTRACT

Resumen: Introducción: La migraña abdominal (MA) es infrecuente y poco estudiada. Nuestro objetivo fue investigar el diagnóstico y tratamiento de niños y adolescentes con MA y compararlos entre gastroen terólogos y neurólogos pediatras. Pacientes y Método: Todos los cuadros de MA (1-18 años) de un hospital de EE. UU, con diagnóstico de MA o sus variantes (ICD-9 346.2 o IC-10 G43.D, G43.D0, G43.D1) entre 2011-2017 fueron revisados. La información sobre diagnóstico, intervalo desde inicio de síntomas, criterios diagnósticos, pruebas diagnósticas, tratamiento y resultado se analizaron. Re sultados: Sesenta y nueve historias médicas fueron identificadas. La edad media al diagnóstico fue 9,7 años. El 48% de los pacientes fueron del sexo femenino. Cincuenta (72,4%) pacientes fueron tratados solo por gastroenterólogos pediatras, y 10/69 (14,5%) por neurológos pediatras exclusivamente. 6/69 (8,7%) fueron inicialmente evaluados por gastroenterología y posteriormente referidos a neurología, y 2/69 (2,9%) fueron inicialmente evaluados por neurología y luego referidos a gastroenterología. 3/10 (30%) de las MA diagnosticadas por neurólogos no mencionaban que el paciente tuviera dolor abdominal, sin embargo, todos los diagnósticos realizados por gastroenterólogos presentaron dicho síntoma (p=0,0035). 5/50 (10%) de las historias médicas de gastroenterología y ninguna de las histo rias de neurología mencionaban los criterios de Roma. Conclusiones: La mayoría de los niños fueron diagnosticados por pediatras gastroenterólogos. Los gastroenterólogos rara vez utilizaron los criterios de Roma. Pacientes evaluados por neurología son frecuentemente diagnosticados con MA, incluso sin presentar dolor abdominal (criterio necesario para el diagnóstico). Se recomienda educación para el correcto y oportuno diagnóstico de la migraña abdominal.


Abstract: Introduction: Abdominal migraine (AM) is uncommon and understudied. Our objective was to investigate the diagnosis and treatment of children and adolescents with AM and compare with that of pediatric gastroenterologists and neurologists. Patients and Method: All AM cases (1-18 years) from a USA hospital with diagnosis of abdominal migraine or its variants (ICD-9 346.2 or IC-10 G43.D, G43.D0, G43.D1) between 2011 and 2017 were reviewed. Information on diagnosis, interval from onset of symptoms, diagnostic criteria, diagnostic tests, treatment, and outcome were analyzed. Results: 69 medical records were identified. The mean age at diagnosis was 9.7 years, and 48% of patients were female. 50/69 (72.4%) patients were exclusively treated by a pediatric gastroenterologist and 10/69 (14.5%) exclusively by a pediatric neurologist. 6/69 (8.7%) were initially evaluated by gas troenterology and referred to neurology, and 2/69 (2.9%) were initially evaluated by neurology and then referred to gastroenterology. 3/10 (30%) of the AM diagnosed by neurologists did no report ab dominal pain (AP), however, all diagnoses made by gastroenterologists did (p = 0.0035). 5/50 (10%) of the gastroenterology medical records and no neurology medical records mentioned Rome criteria. Conclusions: Most of the children were diagnosed by pediatric gastroenterologists. Gastroenterolo gists rarely use the Rome criteria. Patients evaluated by neurologists are frequently diagnosed with AM even without AP (a criterion that is required for its diagnosis). Education is recommended for the correct and timely diagnosis of AM.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Pediatrics , Practice Patterns, Physicians'/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Gastroenterology , Migraine Disorders/diagnosis , Migraine Disorders/therapy , Neurology , Referral and Consultation , United States , Abdominal Pain/etiology , Follow-Up Studies , Practice Guidelines as Topic , Guideline Adherence/statistics & numerical data , Diagnosis, Differential , Diagnostic Errors , Migraine Disorders/complications
17.
Braz. j. otorhinolaryngol. (Impr.) ; 86(1): 83-90, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1089374

ABSTRACT

Abstract Introduction Subjective benign paroxysmal positional vertigo is a form of benign paroxysmal positional vertigo in which during the diagnostic positional maneuvers patients only present vertigo symptoms with no nystagmus. Objective To study the characteristics of subjects with subjective benign paroxysmal positional vertigo. Methods Prospective multicenter case-control study. All patients presenting with vertigo in the Dix-Hallpike test that presented to the participating hospitals were included. The patients were separated into two groups depending on whether nystagmus was present or not. An Epley Maneuver of the affected side was performed. In the follow-up visit, patients were checked to see if nystagmus and vertigo were present. Both groups of patients were compared to assess the success rate of the Epley maneuver and also to compare the presence of 19 variables. Results 259 patients were recruited, of which 64 belonged to the subjective group. Nystagmus was eliminated in 67.2% of the patients with benign paroxysmal positional vertigo. 89.1% of the patients with subjective benign paroxysmal positional vertigo remained unaffected by nystagmus, thus showing a significant difference (p = 0.001). Osteoporosis and migraine were the variables which reached the closest to the significance level. In those patients who were taking vestibular suppressors, the percentage of subjective benign paroxysmal positional vertigo was not significantly higher. Conclusions Subjective benign paroxysmal positional vertigo should be treated using the Epley maneuver. More studies are needed to establish a relationship between osteoporosis, migraine and subjective benign paroxysmal positional vertigo. The use of vestibular suppressants does not affect the detection of nystagmus.


Resumo Introdução A vertigem posicional paroxística benigna subjetiva é um tipo de vertigem posicional paroxística benigna na qual, durante as manobras posicionais diagnósticas, os pacientes apresentam apenas sintomas vertiginosos sem nistagmo. Objetivo Estudar as características de indivíduos com vertigem posicional paroxística benigna subjetiva. Método Estudo prospectivo multicêntrico de caso-controle. Foram incluídos todos os pacientes com vertigem no teste de Dix-Hallpike, que se apresentaram nos hospitais participantes. Os pacientes foram separados em dois grupos, dependeu da presença ou não do nistagmo. Uma manobra de Epley foi realizada no lado afetado. Na consulta de seguimento, os pacientes foram avaliados para verificar a presença ou não do nistagmo e da vertigem. Ambos os grupos de pacientes foram comparados para avaliar a taxa de sucesso da manobra de Epley e também para comparar a presença de 19 variáveis. Resultados Foram recrutados 259 pacientes, dos quais 64 pertenciam ao grupo subjetivo. O nistagmo foi eliminado em 67,2% dos pacientes com vertigem posicional paroxística benigna. Em 89,1% dos casos, os pacientes com vertigem posicional paroxística benigna subjetiva mantiveram-se não afetados pelo nistagmo, mostraram uma diferença significativa (p = 0,001). Osteoporose e enxaqueca foram as variáveis que atingiram o nível mais próximo ao de significância. Nos pacientes que tomavam supressores vestibulares, a porcentagem de vertigem posicional paroxística benigna subjetiva não foi significativamente maior. Conclusões A vertigem posicional paroxística benigna subjetiva deve ser tratada com a manobra de Epley. Mais estudos são necessários para estabelecer uma relação entre osteoporose, enxaqueca e vertigem posicional paroxística benigna subjetiva. O uso de supressores vestibulares não afeta a detecção do nistagmo.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Young Adult , Osteoporosis/physiopathology , Benign Paroxysmal Positional Vertigo/physiopathology , Migraine Disorders/physiopathology , Osteoporosis/complications , Posture/physiology , Sulpiride/therapeutic use , Betahistine/therapeutic use , Nystagmus, Physiologic/physiology , Case-Control Studies , Prospective Studies , Physical Therapy Modalities , Benign Paroxysmal Positional Vertigo/complications , Benign Paroxysmal Positional Vertigo/drug therapy , Migraine Disorders/complications
18.
Article in Chinese | WPRIM | ID: wpr-781773

ABSTRACT

OBJECTIVE@#To compare the analgesic effect of bloodletting acupuncture at -well points along three- meridians of foot combined with routine acupuncture and simple routine acupuncture on migraine.@*METHODS@#A total of 60 patients with migraine were randomized into an observation group and a control group, 30 cases in each one, of which, 4 cases were dropped out in the observation group, 1 case was dropped out in the control group. In the observation group, bloodletting acupuncture at -well points combined with routine acupuncture were applied. The bloodletting acupuncture was applied at corresponding -well points of three- meridians of foot [Lidui (ST 45), Zhiyin (BL 67), Zuqiaoyin (GB 44)] according to pain location. And routine acupuncture was adopted at Sizhukong (TE 23), Shuaigu (GB 8), Taiyang (EX-HN 5), Fengchi (GB 20), Hegu (LI 4), Taichong (LR 3), Zulinqi (GB 41), Yanglingquan (GB 34) and Waiguan (TE 5). In the control group, routine acupuncture was applied, acupoint selection and operation were the same as the observation group. The treatment was given once a day, 30 min a time, 5 days as one course with 2 days interval, and 2 courses were required. Before treatment, immediately after needle withdrawal, 4 h after needle withdrawal and after 2 courses of treatment, the visual analogue scale (VAS) score was compared in the two groups. Before and after treatment, the migraine comprehensive score was observed in the two groups, and the therapeutic effect was evaluated.@*RESULTS@#Immediately after needle withdrawal, 4 h after needle withdrawal and after 2 courses of treatment, the VAS scores in the two groups were decreased (0.05).@*CONCLUSION@#Bloodletting acupuncture at -well points along three- meridians of foot combined with routine acupuncture and simple routine acupuncture have analgesic effect, and the combined therapy is superior to simple routine acupuncture.


Subject(s)
Acupuncture Points , Bloodletting , Humans , Meridians , Migraine Disorders , Therapeutics , Treatment Outcome
19.
Article in Chinese | WPRIM | ID: wpr-781762

ABSTRACT

The problems of the syndrome differentiation of migraine in acupuncture treatment were collected, e.g. inconsistency of syndrome differentiation, unclear staging of syndrome differentiation, lack of standardization in comparison between syndrome differentiation and non-differentiation, insufficient research on the factors of syndrome differentiation. In view of the exiting problems, focusing on two aspects of migraine, namely syndrome differentiation and acupuncture effect, the clinical treatment and research are conducted in migraine treated with acupuncture based on syndrome differentiation. It is believed that the comprehensive observation of the relationship between syndrome differentiation and acupuncture effect, as well as the analysis of the relevant factors of syndrome differentiation of migraine should be the focus in future research.


Subject(s)
Acupuncture Therapy , Humans , Migraine Disorders , Therapeutics , Treatment Outcome
20.
Article in Chinese | WPRIM | ID: wpr-826676

ABSTRACT

OBJECTIVE@#To systematically review the effect of acupuncture on emotional disorder in the patients with migraine and knee osteoarthritis and its effect time limit.@*METHODS@#The randomized controlled trials of acupuncture for migraine or knee osteoarthritis were retrieved from the databases, starting from the time of establishment through to December, 2018, i.e. the Cochrane Library, PubMed, EMbase, CNKI, SinoMed, VIP and Wanfang. The bias risk assessment tool of Cochrane Review Manual 5.1.0 was adopted to evaluate the quality of trials in methodology. RevMan 5.3 software was used for the Meta-analysis.@*RESULTS@#A total of 12 articles were included, with 2450 cases. Regarding the immediate effect, the score of the emotional function subscale of migraine-specific quality-of-life questionnaire (MSQ) in the acupuncture group was higher than the control group (6.38[2.78,9.98], =25%). In view of the emotional function subscale of the short-form of health survey (SF-36/SF-12), and the scores of the mental function and negative mode scale in Spain's index of quality of life (PQLC), there were no significant differences in the scores between the acupuncture group and the control group. In 3 months of treatment, the score of the emotional function subscale of MSQ in the acupuncture group was higher than the control group (9.66 [3.06,16.25], =44%). The difference in the score of the mental health subscale of SF-36 and SF-12 was not significant between the acupuncture group and the control group. In 3 to 6 months of treatment, as well as in over 6 months of treatment, the score of every scale was not different statistically between the acupuncture group and the control group.@*CONCLUSION@#Acupuncture effectively maintains the healthy emotion in the patients with migraine and the effect is sustainable for 3 months after treatment. But the improvement of acupuncture is not remarkable in emotional disorder induced by knee osteoarthritis.


Subject(s)
Acupuncture Therapy , Chronic Pain , Psychology , Therapeutics , Emotions , Humans , Migraine Disorders , Psychology , Therapeutics , Osteoarthritis, Knee , Psychology , Therapeutics , Quality of Life , Treatment Outcome
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