RESUMO
Migraine is a common, highly prevalent genetic neurological disorder. Its most burdensome form is the chronic migraine, which is clinically defined by the presence of headache on ≥15 days/month for longer than three months, with eight or more typical migraine days. Medication-overuse headache (MOH) is a secondary headache disorder associated with the overuse of symptomatic headache medications on ≥10 days/month for longer than 3 months. Chronic migraine and medication-overuse headache often coexist and most chronic migraineurs have medication overuse headache. Despite that, general practitioners and health professionals do not know about MOH. This review aims at presenting insights, recent knowledge, and guidance regarding the approach and treatments for patients with a dual diagnosis of chronic migraine and medication-overuse headache.
A enxaqueca é um distúrbio neurológico genético comum e altamente prevalente. Sua forma mais grave é a enxaqueca crônica, que é clinicamente definida pela presença de cefaleia ≥15 dias/mês por mais de três meses, com oito ou mais dias típicos de enxaqueca. A cefaleia por uso excessivo de medicamentos (MOH) é uma cefaleia secundária associada ao uso excessivo de medicamentos sintomáticos para cefaleia em ≥10 dias/mês por mais de 3 meses. A enxaqueca crônica e a cefaleia por uso excessivo de medicamentos geralmente coexistem e a maioria dos pacientes com enxaqueca crônica apresenta cefaleia por uso excessivo de medicamentos. Apesar disso, os clínicos gerais e os profissionais de saúde não conhecem o MS. Esta revisão tem como objetivo apresentar insights, conhecimentos recentes e orientações sobre a abordagem e tratamentos para pacientes com diagnóstico duplo de enxaqueca crônica e cefaleia por uso excessivo de medicamentos.
RESUMO
ABSTRACT Objective: Binge eating disorder (BED) is the most prevalent eating disorder in individuals with obesity. Its association with factors that control hunger and satiety has not yet been elucidated. We evaluated whether levels of inflammatory markers, frequency of psychiatric comorbidities, and appetite-related hormones levels differ between individuals with obesity with and without BED. Materials and methods: The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-5 - Clinician Version (SCID-5-CV), Binge Eating Scale, and Hospital Anxiety and Depression Scale were evaluated in 39 individuals with obesity. Plasma levels of C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), leptin, ghrelin, and glucagon-like peptide-1 (GLP-1) were measured. Results: Individuals of the BED group exhibited significantly higher percentages of altered eating patterns (hyperphagia, bingeing, post-dinner eating, feeling "stuffed", and emotional eating), higher depressive symptom scores and levels of leptin, CRP, and TNF-α, compared to those from the non-BED group. Logistic regression showed that BED was independently associated with depressive symptoms and CRP levels. Conclusions: Individuals with obesity and BED showed greater psychiatric comorbidity, worse eating patterns and worse inflammatory profile than those without BED. BED should be assessed as an indicator of clinical severity in patients with obesity.