Sinais clínicos da migrânea vestibular em adolescentes / Clinical signs of vestibular migraine in adolescents / Signos clínicos de la migraña vestibular em adolescentes

Introdução: A migrânea é um tipo de cefaleia primária incapacitante que, quando associada a crises de vertigem, configura-se migrânea vestibular. Objetivo: Verificar quais as principais manifestações clínicas da migrânea vestibular em adolescentes. Métodos: Trata-se de uma revisão integrativa da literatura, cujas buscas foram executadas nas bases de dados eletrônicas PubMed/Medline, Scientific Electronic Library Online (SciELO), e Portal da Biblioteca Virtual em Saúde (BVS), em junho de 2022. Foram incluídas publicações entre o ano 2012 e o mês de junho de 2022; estudos observacionais e ensaios clínicos envolvendo seres humanos, nos quais o objetivo fosse avaliar indivíduos com idades entre 12 e 19 anos com diagnóstico de migrânea vestibular e verificar suas principais manifestações clínicas nessa população. Resultados: Todos os estudos mencionaram um maior percentual de meninas nas amostras, porém a diferença entre os sexos para os diferentes diagnósticos não foi avaliada em todas as pesquisas. Conclusão: Verificou-se, com a presente revisão, que as manifestações clínicas da migrânea na adolescência são semelhantes às da população adulta. (AU)

Introduction: Migraine is a disabling type of primary headache that, when associated with vertigo attacks, constitutes vestibular migraine. Objective: To investigate the main clinical findings of vestibular migraine in adolescents. Methods: This is an integrative literature review, with searches conducted in the electronic databases PubMed/Medline, Scientific Electronic Library Online (SciELO), and the Virtual Health Library Portal (BVS) in June 2022. Publications from the year 2012 to June 2022 were included; observational studies and clinical trials involving human subjects, in which the objective was to assess individuals aged 12 to 19 years diagnosed with vestibular migraine and investigate their main clinical findings in this population. Results: All studies mentioned a higher percentage of girls in the samples; however, the difference between sexes for different diagnoses was not assessed in all studies. Conclusion: With this review, it was found that the clinical findings of migraine in adolescence are similar to those in the adult population. (AU)

Introducción: La migraña es em tipo de dolor de cabeza adolescente incapacitante que, cuando se dolesc em ataques de vértigo, constituye la migraña vestibular. Objetivo: Investigar las principales manifestaciones clínicas de la migraña vestibular em adolescentes. Métodos: Se trata de em revisión integradora de la literatura, em búsquedas realizadas em las bases de datos electrónicas PubMed/Medline, Scientific Electronic Library Online (SciELO) y el Portal de la Biblioteca Virtual em Salud (BVS) em junio de 2022. Se incluyeron publicaciones desde el año 2012 hasta junio de 2022; dolescê observacionales y ensayos clínicos que involucraran a sujetos humanos, en los cuales el objetivo fuera evaluar adolescentes de 12 a 19 años en diagnóstico de migraña vestibular e investigar sus principales manifestaciones clínicas em esta población. Resultados: Todos los adolescentes mencionaron en mayor porcentaje de niñas en las muestras; sin embargo, la diferencia entre los sexos para diferentes diagnósticos no fue evaluada en todos los adolescentes. Conclusión: En esta revisión, se descobrió que las manifestaciones clínicas de la migraña en la dolescência son similares a las de la población adulta. (AU)

Analysis of risk factors associated with cerebral angiography headache / Análise de fatores de risco associados a cefaleia da angiografia cerebral

Abstract Background Despite previous studies indicating a moderate/high incidence of angiography headache (AH), there is still limited data about the risk factors associated with its occurrence. Objective The present study aimed to assess the associations among demographic, clinical, and technical characteristics of cerebral digital subtraction angiography (DSA) and the occurrence of AH. Methods Cross-sectional analytical observational study with a sample comprised of individuals with a recommendation for elective DSA. Clinical interviews were conducted to assess the occurrence of AH, using a standardized questionnaire. Results Among 114 subjects, the mean age was 52.8 (±13.8) years old, 75.4% (86/114) were women, 29.8% (34/114) had a history of migraines, and 10.5% (12/114) had chronic headaches. The overall frequency of AH was 45.6% (52/114). Of those, 88.4% (46/52) underwent 3D angiography, 7.7% (4/52) underwent aortography, and 1.9% (1/52) underwent both procedures. There was a statistically significant association between AH and previous history of migraine (odds ratio [OR]: 4.9; 95% confidence interval [CI] 1.62-14.7; p = 0.005) and 3D angiography (OR 6.62; 95%CI: 2.04-21.5; p = 0.002). Conclusions 3D angiography is strongly associated with the occurrence of AH, which has never been reported before. The association between a previous history of migraine and AH confirms the results of previous studies.

Resumo Antecedentes Apesar de estudos prévios indicarem uma incidência moderada/alta de cefaleia da angiografia (CA), os dados sobre os fatores de risco associados à sua ocorrência ainda são relativamente escassos. Objetivo O presente estudo teve como objetivo avaliar as associações entre as características demográficas, clínicas e técnicas da angiografia cerebral por subtração digital (ACSD) e a ocorrência de CA. Métodos Estudo observacional analítico transversal com uma amostra composta por indivíduos com indicação de ACSD em caráter eletivo. Entrevistas clínicas foram realizadas utilizando um questionário padronizado para acessar a ocorrência de CA. Resultados Entre os 114 indivíduos, a idade média foi de 52,8 (±13,8) anos, 75,4% (86/114) eram mulheres, 29,8% (34/114) tinham histórico de enxaqueca e 10,5% (12/114) tinham cefaleia crônica. A frequência geral de CA foi de 45,6% (52/114). Desses, 88,4% (46/52) foram submetidos à angiografia 3D, 7,7% (4/52), à aortografia e 1,9% (1/52), aos dois procedimentos. Houve associação estatisticamente significativa entre CA e histórico prévio de enxaqueca (odds ratio [OR] 4,9; intervalo de confiança [IC] 95%: 1,62-14,7; p = 0,005) e angiografia 3D (OR 6,62; IC95%: 2,04-21,5; p = 0,002). Conclusões A angiografia 3D está fortemente associada à ocorrência de CA, o que é inédito na literatura. A associação entre um histórico de enxaqueca e a CA confirma os resultados de estudos anteriores.

Acute headache attributed to ischemic stroke: assessment of its characteristics and associated factors / Cefaleia aguda atribuída ao acidente vascular cerebral isquêmico: avaliação das características e fatores associados

Abstract Background It is estimated that headache attributed to ischemic stroke occurs in 7.4% to 34% of the cases. Despite its frequency, this headache has been little studied in terms of its risk factors and characteristics. Objective To assess the frequency and clinical characteristics of headache attributed to ischemic stroke and the factors associated with its occurrence. Methods The present was a cross-sectional study which included patients consecutively admitted within 72 hours of the onset of ischemic stroke. A semi-structured questionnaire was used. The patients underwent magnetic resonance imaging. Results A total of 221 patients were included, 68.2% of whom were male, and the mean age was of 68.2 ± 13.8 years. The frequency of headache attributed to ischemic stroke was of 24.9% (95% confidence interval [95%CI]: 19.6-31.1%). The headache had a median duration of 21 hours and most frequently began at the same time as the focal deficit (45.3%), with a gradual onset (83%). It was of moderate intensity, pulsatile (45.3%), bilateral (54.6%), and presented a similar pattern to that of tension-type headache (53.6%). Headache attributed to stroke was significantly associated with previous tension-type headache, and previous migraine with and without aura (logistic regression). Conclusion Headache attributed to stroke is common, with a pattern similar to that of tension-type headache, and it is associated with a history of tension-type and migraine headaches.

Resumo Antecedentes A cefaleia atribuída ao acidente vascular cerebral isquêmico (AVCi) tem uma frequência de 7,4% a 34% dos casos. Apesar de ser considerada frequente, esta cefaleia ainda é pouco estudada em termos de seus fatores de risco e características. Objetivo Avaliar a frequência e as características clínicas da cefaleia atribuída ao AVCi e os fatores associados com a sua ocorrência. Métodos Este foi um estudo transversal que incluiu pacientes admitidos consecutivamente com até 72 horas do início do AVCi. Foi utilizado um questionário semiestruturado. Os pacientes realizaram ressonância magnética. Resultados Foram incluídos 221 pacientes, 68,2% dos quais eram do sexo masculino, e com idade média de 68,2 ± 13,8 anos. A frequência da cefaleia atribuída ao AVCi foi de 24,9% (intervalo de confiança de 95% [IC95%]: 19,6-31,1%). A duração mediana da cefaleia foi de 21 horas, e ela se iniciou com mais frequência ao mesmo tempo em que o déficit focal (45,3%), teve instalação gradual (83%), foi de moderada intensidade, pulsátil (45,3%), bilateral (54,6%) e teve um padrão semelhante ao da cefaleia de tipo tensional (53,6%). A cefaleia atribuída ao AVCi esteve significativamente associada à cefaleia de tipo tensional prévia, e à migrânea com e sem aura prévias (regressão logística). Conclusão A cefaleia atribuída ao AVCi é frequente, tem padrão mais habitual semelhante ao da cefaleia de tipo tensional, e está associada aos antecedentes de cefaleia de tipo tensional e migrânea.

Malformación de Arnold-Chiari tipo I con siringomielia

Introducción: Las malformaciones de Arnold-Chiari, son un grupo heterogéneo de desórdenes neurológicos caracterizados por alteraciones dentro de las regiones del cerebelo, tallo cerebral y unión cráneo-cervical; todas resultan en un desplazamiento inferior del cerebelo hacia el canal espinal por el foramen magno, sea en conjunto con la médula inferior o no. Objetivo: Describir los hallazgos clínicos, estudios complementarios, criterios diagnósticos, conducta terapéutica y evolución, en un caso con malformación de Chiari tipo I con siringomielia. Presentación de caso: Se presenta a una paciente con cefalea de curso insidioso a la que se le diagnostica malformación de Chiari tipo I con siringomielia, que requirió tratamiento neuroquirúrgico. La evolución posoperatoria fue favorable. Conclusiones: La malformación de Arnold-Chiari es una entidad rara; la aparición de la resonancia magnética nuclear ha permitido que su diagnóstico aumente y por tanto, su incidencia. El caso presentado tuvo un curso clínico clásico.

Introduction: Arnold-Chiari malformations are a heterogeneous group of neurological disorders characterized by alterations within the regions of the cerebellum, brain stem and craniocervical junction; all result in inferior displacement of the cerebellum into the spinal canal through the foramen magnum, whether in conjunction with the inferior cord or not. Objective: To describe the clinical findings, complementary studies, diagnostic criteria, therapeutic approach and evolution, in a case with type I Chiari malformation with syringomyelia. Case report: A patient with an insidious course of headache is reported. She was diagnosed with type I Chiari malformation with syringomyelia, which required neurosurgical treatment. The postoperative evolution was favorable. Conclusions: Conclusions: Arnold-Chiari malformation is a rare entity. the appearance of nuclear magnetic resonance has allowed it to be diagnosed and therefore its incidence has increased. The reported case had a classic clinical course.

Comparison between Simple Planas Indirect Tracks and occlusal splints for treatment of temporomandibular disorder-related headache: a randomized controlled clinical trial / Comparação entre Pistas Indiretas Planas Simples e placas miorrelaxantes para tratamento de dor de cabeça relacionada à disfunção temporomandibular: ensaio clínico randomizado

ABSTRACT BACKGROUND AND OBJECTIVES: Temporomandibular disorder-related headache (TMDH) is a very common clinical condition which manifests as pain around the temples. The treatment recommended in dentistry is occlusal splint. However, there is a device generally used in functional jaw orthopedics, called simple Planas indirect tracks (SPIT), which has been shown to be efficient in managing these headaches. This clinical trial aimed to compare SPIT and occlusal splints in the treatment of TMDH patients. METHODS: This randomized clinical trial included thirty-seven women who had TMDH for more than one year into three groups: GPIT treated with SPIT, GSPLINT treated with a Michigan splint, and a control group (CG) submitted to no treatment. The randomization was paired, that is, each new individual was assigned to a group sequentially. The number of headache days per month, average pain intensity, pain response to masseter and temporalis palpation, and days of pain drug use were collected and analyzed. The follow-up lasted for 3 months. RESULTS: Thirty-seven patients were included but 4 dropped out during treatment and 33 underwent intervention. Patients in GPIT exhibited superior results compared to GSPLINT and CG, with significant differences between groups for almost all variables. In GPIT, the number of headache days was reduced by 87.43%, pain intensity by 66.67%, and days of drug use by 88.42%, with significant improvement in all parameters compared to CG. In GSPLINT, the number of headache days decreased by 44.46% and days of drug use by 36.63%, while pain intensity increased by 46.67%; however, there was no significant difference in any of the parameters compared to CG. CONCLUSION: SPIT may be a good treatment option for patients with TMDH since these appliances have shown much more consistent results than occlusal splints. Further studies and with more individuals will be needed to confirm these findings.

RESUMO JUSTIFICATIVA E OBJETIVOS: A cefaleia secundária à disfunção temporomandibular (CDTM), é uma condição clínica muito comum, com dores nas têmporas. O tratamento padrão na odontologia são as placas miorrelaxantes, entretanto um aparelho da ortopedia funcional dos maxilares, chamado de Pistas Indiretas Planas Simples (PIPS), tem se demonstrado eficiente no controle dessas cefaleias. Este estudo clínico visou comparar as PIPS com as placas miorrelaxantes, no quadro álgico de CDTM. MÉTODOS: Este ensaio clínico randomizado incluiu 37 mulheres portadoras de CDTM há mais de um ano, que foram distribuídas aleatoriamente em três grupos: o GPIPS, no qual as pacientes foram tratadas com PIPS, o GPLACA, com uso de placas miorrelaxantes de Michigan e o grupo controle (GC), sem qualquer tratamento. A aleatorização foi pareada, sendo que cada participante era consecutivamente alocada em um grupo diferente. Foram coletados e analisados dias de cefaleia por mês, intensidade de dores, resposta álgica à palpação de masseter e temporal, bem como os dias de uso de fármacos. O acompanhamento foi de três meses. RESULTADOS: Das 37 pacientes iniciais, 4 desistiram do tratamento e apenas 33 foram submetidos a alguma intervenção. As pacientes do GPIPS apresentaram resultados muito superiores às do GPLACA e do GC, com diferenças significativas entre os grupos em quase todas as variáveis. No GPIPS, os dias de dor diminuíram 87,43%, a intensidade 66,67% e os dias de uso de fármacos analgésicos 88,42%, sendo estatisticamente significante a melhora em todos os parâmetros em relação ao GC. Já no GPLACA, os dias de dor diminuíram 44,46% e os dias de uso de fármacos 36,63%, mas a intensidade da dor aumentou 46,67%, porém sem diferença estatisticamente significante em nenhum parâmetro quando comparado ao GC. CONCLUSÃO: O uso do PIPS pode ser uma boa escolha de tratamento da CDTM, tendo apresentado resultados mais consistentes do que as placas miorrelaxantes. Mais estudos e com mais participantes são necessários para confirmar estes achados.

Aspirin and poetry: Did João Cabral de Melo Neto suffer from acetylsalicylic acid-overuse headache? / Aspirina e poesia: João Cabral de Melo Neto sofria de cefaleia por uso excessivo de ácido acetilsalicílico?

Introduction: João Cabral de Melo Neto is considered one of the most important Brazilian poets of all time. He suffered from severe headaches for the longest part of his life, being diagnosed with migraine. He took a significant amount of acetylsalicylic acid pills every day for many years. Objective: The objective of this narrative review includes identifying how headache and its treatment influenced João Cabral de Melo Neto's poetry as well as analyzing the correlation between Melo Neto's migraine diagnosis and his documented overuse of aspirin and investigating the possibility of an acetylsalicylic acid-overuse headache diagnosis. Methods: The authors thoroughly read biographical books and interviews about the life of João Cabral de Melo Neto. They systematically documented all references to headaches and aspirin. Melo Neto's clinical case documented in his biography and interviews were juxtaposed with The International Classification of Headache Disorders (ICHD-3) diagnostic criteria for acetylsalicylic acid-overuse headache diagnosis. Results: The word "aspirin" appears 8 times in 6 of Melo Neto's poems. He compares it to the sun, attributing to it the capacity to refocus a "blurred body" (his state during a headache). The poet reported that took one aspirin pill every hour every day, for several years. Conclusions: Headache and the use of acetylsalicylic acid influenced João Cabral de Melo Neto's poetry and life. He presented a risk behavior for developing medication overuse headache, specifically its subform: acetylsalicylic acid-overuse headache.

Introdução: João Cabral de Melo Neto é considerado um dos mais importantes poetas brasileiros de todos os tempos. Ele sofreu fortes dores de cabeça durante a maior parte de sua vida, sendo diagnosticado com enxaqueca. Ele tomou uma quantidade significativa de comprimidos de ácido acetilsalicílico todos os dias durante muitos anos. Objetivo: O objetivo desta revisão narrativa inclui identificar como a cefaleia e o seu tratamento influenciaram a poesia de João Cabral de Melo Neto, bem como analisar a correlação entre o diagnóstico de enxaqueca de Melo Neto e o seu documentado uso excessivo de aspirina e investigar a possibilidade de um diagnóstico de cefaleia por uso excessivo de ácido acetilsalicílico. Métodos: Os autores fazem leitura minuciosa de livros biográficos e entrevistas sobre a vida de João Cabral de Melo Neto. Eles documentaram sistematicamente todas as referências a dores de cabeça e aspirina. O caso clínico de Melo Neto documentado em sua biografia e entrevistas foi justaposto aos critérios diagnósticos da Classificação Internacional de Cefaleias (ICHD-3) para diagnóstico de cefaleia por uso excessivo de ácido acetilsalicílico. Resultados: A palavra "aspirina" aparece 8 vezes em 6 poemas de Melo Neto. Ele o compara ao sol, atribuindo-lhe a capacidade de reorientar um "corpo turvo" (seu estado durante uma dor de cabeça). O poeta relatou que tomou um comprimido de aspirina a cada hora, todos os dias, durante vários anos. Conclusões: A dor de cabeça e o uso de ácido acetilsalicílico influenciaram a poesia e a vida de João Cabral de Melo Neto. Apresentou comportamento de risco para desenvolver cefaleia por uso excessivo de medicamentos, especificamente sua subforma: cefaléia por uso excessivo de ácido acetilsalicílico.

Characterization of persistent headache attributed to past stroke / Caracterização da cefaleia persistente atribuída a acidente vascular cerebral prévio

Abstract Background Persistent headache attributed to past stroke (PHAPS) is a controversial entity, recently included in the third edition of the International Classification of Headache Disorders (ICHD-3) despite being described only in retrospective studies. Objective To determine the frequency and characteristics of PHAPS in patients admitted with acute stroke. Methods We selected all patients with headache associated with acute stroke (HAAS) from a prospective, single-center registry of patients with acute stroke admitted to a Neurology ward between November 2018 and December 2019. We analyzed demographic, clinical, and neuroimaging data. We assessed the follow-up with a phone call questionnaire at 6 to 12 months. Results Among 121 patients with acute stroke, only 29 (24.0%) had HAAS. From these, 6 (5.0%) were lost to follow-up. In total, 23 (20.0%) patients answered the 6- to 12-month follow-up questionnaire and were included in this study. The median age of the sample was 53 years (interquartile range [IQR]: 38-78 years), and there was no sex predominance. Of the 10 patients (8,3%) that had persistent headache, 8 (6.6%) suffered from previous chronic headaches; however, they all mentioned a different kind of headache, and 1 (0,8%) probably had headache secondary to medication. Conclusions In the present study, only 10 out of 121 stroke patients (8.3%) referred persistent headache at the 6- to 12-month follow-up, but the majority already suffered from previous chronic headache, which raises the question that the actual prevalence of PHAPS may be lower than previously reported.

Resumo Antecedentes A cefaleia persistente atribuída a acidente vascular cerebral (AVC) prévio é uma entidade controversa, recentemente incluída na terceira edição da Classificação Internacional de Transtornos da Cefaleia (International Classification of Headache Disorders, ICHD-3), apesar de descrita apenas em estudos restrospectivos. Objetivo Determinar a frequência e as características do acidente vascular cerebral prèvio em doentes admitidos com AVC agudo. Métodos Selecionamos todos os doentes com cefaleia associada a AVC agudo de um registro unicêntrico e prospectivo de doentes admitidos no serviço de Neurologia entre novembro de 2018 e dezembro de 2019. Analisamos dados demográficos, clínicos e imagiológicos. Reavaliamos aos 6 a 12 meses por questionário telefónico. Resultados Entre os 121 doentes admitidos com AVC agudo, apenas 29 (24,0%) tinham cefaleia associada a AVC agudo. Destes, 6 (5,0%) perderam-se no seguimento. Ao todo, 23 (20,0%) responderam ao questionário e foram incluídos. A idade mediana foi de 53 anos (intervalo interquartílico [IIQ]: 38-78 anos), e não houve predominância de gênero. Dos 10 doentes (8,3%) que apresentam cefaleia persistente, 8 (6,6%) tinham histórico de cefaleia; no entanto todos mencionaram um tipo diferente de cefaleia, e 1 (0,8%) provavelmente tinha cefaleia secundária a medicação. Conclusões Neste estudo, apenas 10 em 121 doentes (8,3%) mencionaram cefaleia persistente aos 6 a 12 meses de seguimento, mas a maioria sofria de cefaleia prévia, pelo que a real prevalência de acidente vascular cerebral prèvio pode ser inferior à descrita nos estudos realizados até a data.

Primary headache and myofascial pain: a data based study / Cefaleia primária e dor miofascial: um estudo baseado em dados

Aim: This study aimed to evaluate the relationship be-tween the presence of primary headaches and myofascial pain in orofacial patients. Materials and methods: Six hundred and ninety-nine records of patients seeking treatment in a specialized orofacial pain clinic were assessed. The primary diagnostic categories of heada-che and myofascial pain were recorded. Data analyses were carried out by Pearson Chi-square and Logistic Regression, with a p-value of 0.05. Results: Average age of patients was 34.6 years. Females constituted 82.8% of the sample. A relationship between the presence of tension-type headache and myofascial pain was found (p=0.00); however, this relationship was not found for the presence of migraine and myofascial pain (p>0.05). Discussion: Tension-type headaches may be triggered or perpetuated by trigger points in orofacial structures. Conclusion: It can be concluded that trigger points in myofascial pain patients can play an important role in the genesis of tension-type headache.

Objetivo: Este estudo avaliou a relação entre a presença de cefaleia primária e dor miofascial em pacientes orofaciais. Materiais e métodos: Foram avaliados 699 prontuários de pacientes que buscavam atendimento em clínica especiali-zada em dor orofacial. As categorias diagnósticas primárias de cefaleia e dor miofascial foram registradas. A análise dos dados foi realizada pelo Qui-quadrado de Pearson e Regressão Logística, com valor de p=0,05. Resultados: A idade média dos pacientes foi de 34,6 anos. O sexo feminino constituiu 82,8% da amostra. Foi encontrada relação entre a presença de cefaleia do tipo tensional e dor miofascial (p = 0,00); en-tretanto, essa relação não foi encontrada para a presença de enxaqueca e dor miofascial (p> 0,05). Discussão: As cefaleias primárias do tipo tensionais podem ser desencadeadas ou perpetuadas por pontos-gatilhos nas estruturas orofaciais. Conclusão: Pode-se concluir que os pontos-gatilhos em pacientes com dor miofascial podem desempenhar um papel importante na gênese da cefaleia do tipo tensional.

Reversible cerebral vasoconstriction syndrome characterized by postpartum headache: a case report / 中华围产医学杂志

We report the diagnosis and treatment of a case of reversible cerebral vasoconstriction syndrome characterized by postpartum thunderclap headache. The patient experienced a thunderclap headache on the second day after delivery, which gradually worsened. On postpartum day 4, she presented with sudden convulsion and hypertension on admission on May 19, 2020, and was initially diagnosed with postpartum eclampsia. We confirmed the diagnosis of reversible cerebral vasoconstriction syndrome based on the results of cranial magnetic resonance angiography (MRA) and other examinations and the consultation with neurologists. After antihypertensive and spasmolytic treatment, the patient's blood pressure returned to normal, and she was discharged on postpartum day 8. Reexamination with cranial MRA at 50 + days after delivery indicated that the cerebral vasospasm was relieved. No severe headaches or convulsions were observed during follow-up till June 2021.

Medication overuse headache and awareness / Cefaleia por abuso de medicação e conscientização

ABSTRACT Background: Medication overuse headache (MOH) is the worsening of an underlying headache due to the overuse of its acute treatment. Unintentionally, healthcare professionals may contribute to this condition. Health professionals play an important role in preventing this increasingly frequent and difficult-to-treat condition. Objective: To investigate MOH awareness among physicians with headache through a survey conducted among medical doctors on our university campus. Methods: This was an observational cross-sectional study about MOH awareness. The total number of medical doctors working in the Dokuz Eylül University Health Campus was provided by the administrative unit. A total of 18 questions were prepared and administered on a voluntary basis to obtain information about MOH awareness. Results: A total of 312 medical doctors were surveyed, including 198 (63.5%) from internal medical sciences, 81 (26%) from surgical medical sciences, and 33 (10.5%) from basic medical sciences. Half of the physicians in our sample were unaware of MOH. Our results showed that awareness of MOH, was quite low even among medical doctors. Conclusions: MOH causes both labor and financial losses to countries and impairs the quality of life of patients. Preventing excessive use of medications by raising awareness among doctors is an important step to prevent the development of MOH.

RESUMO Antecedentes: A cefaleia por uso excessivo de medicamentos (CEM) é o agravamento de uma cefaleia subjacente devido ao uso excessivo do seu tratamento agudo. Involuntariamente, os profissionais de saúde podem contribuir para essa condição. Os profissionais de saúde desempenham um papel importante na prevenção dessa condição cada vez mais frequente e de difícil tratamento. Objetivo: Investigar a conscientização da CEM entre médicos com dor de cabeça por meio de uma pesquisa realizada entre médicos em nosso campus universitário. Métodos: Este foi um estudo transversal observacional sobre a consciência da CEM. O número total de médicos que trabalham no Campus de Saúde da Universidade Dokuz Eylül foi fornecido pela unidade administrativa. Um total de 18 questões foram preparadas e aplicadas de forma voluntária para obter informações sobre a conscientização da CEM. Resultados: Um total de 312 médicos foram pesquisados, incluindo 198 (63,5%) das ciências médicas internas, 81 (26%) das ciências médicas cirúrgicas e 33 (10,5%) das ciências médicas básicas. Metade dos médicos de nossa amostra desconhecia a CEM. Nossos resultados mostraram que o conhecimento sobre a CEM era bastante baixo, mesmo entre os médicos. Conclusões: A CEM causa perdas laborais e financeiras aos países e prejudica a qualidade de vida dos pacientes. Prevenir o uso excessivo de medicamentos por meio da conscientização dos médicos é um passo importante para prevenir o desenvolvimento da CEM.

Zeus' pain: did he experience a thunderclap headache? / A dor de Zeus: fora ele acometido por uma cefaleia em trovoada?

Zeus is known as the king of the gods and god of the sky. His attributes are lightning and thunder and he is often depicted about to hurl them. According to Greek mythology, Zeus molested the titan Metis and decided to swallow her when she was pregnant, which resulted in an excruciating headache, only relieved after a craniotomy performed using Hephaestus' axe. The result of this procedure was the birth of Athena, Zeus' daughter. We conducted a combined analysis of some writings such as the classical mythological poem Theogony by Hesiod, and some other books that examine and retell myths and legends of ancient Greece, with medical papers on this topic, trying to characterize Zeus' headache. Would it be possible to fit Zeus' headache into the group of thunderclap headaches?

Zeus é conhecido como rei dos deuses e deus dos céus. Tem como atributos os raios e os trovões e é frequentemente representado prestes a lançá-los. De acordo com a mitologia grega, Zeus molestou a titã Métis e resolveu engoli-la grávida, o que resultou em uma cefaleia excruciante, apenas aliviada após uma craniotomia realizada por meio do machado de Hefesto. O fruto deste procedimento foi Atena, filha de Zeus. Realizamos uma análise combinada utilizando escritos mitológicos clássicos como o poema Teogonia de Hesíodo, além de outros livros sobre mitologia e artigos médicos que tratam deste tema, para tentar caracterizar a cefaleia de Zeus. Seria possível enquadrar a cefaleia de Zeus no grupo das cefaleias em trovoada?

Prevalence of obesity in patients suffering from migraine

Background: Migraine is one of the most common primary headaches, accounting for significant morbidity in patients suffering from it. An association between obesity and migraine has been documented in the past, despite some studies pointing to the contrary. Author’s purpose is to calculate the prevalence of obesity in migraine patients in order to contribute to the existing concepts. A positive correlation could lead to the employment of weight loss interventions in the management of obese patients with migraine.Methods: In this cross-sectional study, 400 patients, recently diagnosed with migraine, attending the Neurology Outpatient Department at the Dr. Ruth KM Pfau Civil Hospital Karachi were enrolled after taking informed consent.  Migraine was diagnosed using International Classification of Headache Disorders III (ICHD III) criteria. Height (meters) and weight (kilograms) were measured and body mass index calculated. This data was kept confidential. The results were tabulated and analyzed using SPSS version 19.  Continuous quantitative data were analyzed using chi square test. A p Value of less than or equal to 0.05 was considered significant.Results: The mean age of enrolled participants was 30.69±6.96 years, 204(51%) were >30 years of age, 159(39.8%) were male and 241(60.3%) were female, mean height was 1.55±0.1 meters, mean weight was 56.26±12.98 kg, and mean duration of migraine was 5.04±2.02 weeks. The prevalence of obesity in patients with migraine was 108 (27%).Conclusions: It was concluded that the prevalence of obesity in patients with migraine was 27%.

Profilaxis y educación en migraña y cefalea tensional: una percepción de la eficacia de las prácticas de los médicos de atención primaria / Prophylaxis and education for migraine and tension type headache: a perception of the effectiveness of the practices of primary health physicians

RESUMEN INTRODUCCIÓN: La migraña y la cefalea tipo tensional son los dolores de cabeza primarios más frecuentes en la consulta médica; la mejoría clínica de los pacientes se relaciona con la educación brindada y la prescripción de tratamientos profilácticos por parte de sus médicos tratantes. OBJETIVO: Determinar la frecuencia de prescripción del tratamiento profiláctico y de la realización de explicaciones educativas al paciente con cefalea primaria por parte de los médicos de atención primaria, además de los factores asociados a ellas. MATERIALES Y MÉTODOS: Estudio de corte transversal con 152 pacientes con criterios para migraña o cefalea tensional de la ICHD y con indicación para tratamiento profiláctico según las guías canadienses, que fueron atendidos por médicos de atención primaria. Se aplicó un cuestionario para establecer el tipo de prácticas realizadas por los profesionales y se realizó un análisis univariado y bivariado. RESULTADOS: Solo al 23 % de los pacientes le formularon tratamiento profiláctico, el 56 % nunca recibió explicación educativa sobre su enfermedad y el 70 °% nunca había sido remitido a consulta de neurología. El 44 °% respondió no saber sobre el origen de la cefalea y se encontró una asociación significativa entre el nivel educativo del paciente y el hecho que le ofrecieran explicación educativa. CONCLUSION: La frecuencia en la formulación de profilaxis farmacológica y realización de explicaciones educativas al paciente por parte del médico de atención primaria fue baja. Esto puede relacionarse con un desconocimiento de los protocolos de manejo en cefalea primaria y fallas en las habilidades clínicas recibidas en el pregrado.

SUMMARY INTRODUCTION: Migraine and tension type headache are the most frequent primary headaches in the medical practice; the clinical improvement of the patients is related to the education carry out by his physician and the prescription of prophylactic treatments. Migraine and tension-type headache are the most frequent primary headaches in the medical office; the clinical improvement of the patients is related to the education provided and the prescription of prophylactic treatments by their treating doctors. OBJECTIVE: To determine the frequency of prescription of prophylactic treatment and of educational explanations to the patient with primary headache by primary care physicians, and the possible factors associated with them. MATERIALS AND METHODS: Cross-sectional study with 152 patients that have Migraine or Tensional Headache according to the ICHD criteria and that had an indication for prophylactic treatment according to the Canadian guidelines for the prophylaxis management of patients with migraine, which were attended by primary care physicians. Application of a questionnaire to establish the type of practices carried out by professionals; an univariate and bivariate analysis was performed. RESULTS: 56 °% of the patients never received an educational explanation about their disease, 70 °% had never been referred to a neurology consultation previously, and 23 % had been prescribed prophylactic treatment. 44 °% answered not knowing about the origin of the headache and found a significant association between the educational level of the patient and the fact that they offered educational explanation. CONCLUSION: The frequency of formulation of pharmacological prophylaxis and the performance of educational explanations to the patient by the Primary Care Physician was very low; This may be related to a lack of knowledge of management protocols in primary headache and to flaws in the clinical skills previously obtained in undergraduate training.

Síndrome De Vasoconstricción Cerebral Reversible Secundario A Fármacos: Reporte De Caso / Reversible Cerebral Vasoconstriction Syndrome Secondary To Drugs: Case Report

Resumen Introducción: El síndrome de vasoconstricción cerebral reversible es una entidad clínica y radiológica caracterizada por cefalea en estallido recurrente y vasoconstricción segmental multifocal de las arterias cerebrales, acompañado o no de otros déficits neurológicos, el cual resuelve espontáneamente en uno a tres meses. Métodos: Se reporta el caso clínico de una paciente que fue diagnosticada de síndrome de vasoconstricción cerebral reversible secundario a fármacos vasoactivos. Se plantea una búsqueda bibliográfica y una puesta al día de las últimas actualizaciones en relación a esta patología. Conclusión: Al menos la mitad de los casos de este síndrome son secundarios, sobre todo postparto y/o por la exposición a sustancias vasoactivas tales como drogas ilícitas, simpaticomiméticos y serotoninérgicos. Es trascendental identificar este cuadro a fin de retirar los posibles agentes causales, o evitar las complicaciones potenciales

Introduction: Reversible cerebral vasoconstriction syndrome is a clinical-radiologic syndrome characterized by recurrent thunderclap headache, with or without other acute neurological symptoms, and diffuse segmental constriction of cerebral arteries that resolves spontaneously within 3 months. Methods: It is described a clinic case of a woman, who was diagnosed with reversible cerebral vasoconstriction syndrome. A literature search and an update of the latest updates regarding this disease was done. Conclusion: At least half of the cases of this syndrome are secondary, especially postpartum and/or exposure to vasoactive substances such as illicit drugs, sympathomimetics and serotonergic drugs. It is crucial to identify this disorder in order to remove possible causative agents, or avoid potential complications.

Consensus of the Brazilian Headache Society on the treatment of chronic migraine / Consenso da Sociedade Brasileira de Cefaleia sobre o tratamento da migrânea crônica

ABSTRACT Chronic migraine poses a significant personal, social and economic burden and is characterized by headache present on 15 or more days per month for at least three months, with at least eight days of migrainous headache per month. It is frequently associated with analgesic or acute migraine medication overuse and this should not be overlooked. The present consensus was elaborated upon by a group of members of the Brazilian Headache Society in order to describe current evidence and to provide recommendations related to chronic migraine pharmacological and nonpharmacological treatment. Withdrawal strategies in medication overuse headache are also described, as well as treatment risks during pregnancy and breastfeeding. Oral topiramate and onabotulinum toxin A injections are the only treatments granted Class A recommendation, while valproate, gabapentin, and tizanidine received Class B recommendation, along with acupuncture, biofeedback, and mindfulness. The anti-CGRP or anti-CGRPr monoclonal antibodies, still unavailable in Brazil, are promising new drugs already approved elsewhere for migraine prophylactic treatment, the efficacy of which in chronic migraine is still to be definitively proven.

RESUMO A migrânea (enxaqueca) crônica determina uma carga pessoal, social e econômica significativa e é caracterizada por dor de cabeça presente em quinze ou mais dias por mês por ao menos três meses, com no mínimo oito dias de cefaleia migranosa a cada mês. É frequentemente associada ao uso excessivo de medicação analgésica ou antimigranosa aguda e isso não deve ser negligenciado. Este consenso foi elaborado por um grupo de membros da Sociedade Brasileira de Cefaleia, para descrever as evidências atualmente disponíveis e fornecer recomendações relacionadas ao tratamento farmacológico e não farmacológico da migrânea crônica. Estratégias de retirada na cefaleia por uso excessivo de medicamentos também são descritas, assim como os riscos dos tratamentos durante a gravidez e a amamentação. O topiramato oral e as injeções de toxina onabotulínica A são os únicos tratamentos que receberam a recomendação classe A, enquanto que o valproato, a gabapentina e a tizanidina receberam recomendação classe B, juntamente com acupuntura, biofeedback e mindfulness. Os anticorpos monoclonais anti-CGRP ou anti-CGRPr, ainda não disponíveis no Brasil, são novos fármacos promissores, já aprovados em outros países para o tratamento profilático da migrânea, cuja eficácia na migrânea crônica ainda está por ser definitivamente comprovada.

Prevalence of Primary Headache Disorders in Pregnant Women (A Hospital Based Study from Kashmir -North- West India)

Objective: A hospital based observational study of Primary headache disorders among pregnant women attending tertiary care hospitals in Srinagar. Methods: The study sample comprised of pregnant women who reported to ante-natal clinics or medical outpatients department of associated hospitals of Govt. medical College, Srinagar, with the chief complaint of headache. A pretested questionnaire was presented to the participants and the diagnosis of various primary headache disorders was established by adopting the ICHD-2 criteria. Results: Among 2000 women screened, 34.25% of cases complained of headaches during pregnancy. Primary headache disorders (migraine, tension-type headache) was observed in 70.51% patients. Conclusion: Among primary headache disorders, migraine and tension type headache were observed in (59.48%) and (39.65%) cases respectively.

A review of 50 cases of bath-related headache: clinical features and possible diagnostic criteria / Uma revisão de 50 casos de cefaleia relacionada ao banho: características clínicas e possíveis critérios diagnósticos

ABSTRACT Objective: To describe clinical features and possible diagnostic criteria of the 50 bath-related headache (BRH) cases that have been published in the literature to date. Methods: Based on a literature search in the major medical databases, we analyzed all case reports or case series on BRH that were published between 2000 and 2017. Results: We describe 48 women and two men diagnosed with BRH. Of these 50 patients, 90% were from Asian countries. The average age was 49.3 years. There was an association of BRH with migraine (28%), tension-type headache (12%) and cold stimulus headache (4%). Headache was bilaterally localized, had an explosive or pulsating quality and a severe intensity. The pain lasted from five minutes to four days. Associated manifestations were nausea, vomiting, photophobia or phonophobia. There was a good therapeutic response with nimodipine and when avoiding a hot bath. Conclusions: Bath-related headache is a benign headache that is not associated with a structural lesion.

RESUMO Objetivo: Descrever as características clínicas e possíveis critérios diagnósticos dos 50 casos de cefaleia relacionada ao banho (CRB) que foram publicados na literatura até agora. Métodos: Com base em uma pesquisa de literatura nas principais bases de dados médicos, analisamos todos os relatos de casos ou séries de casos sobre BRH que foram publicados entre 2000 e 2017. Resultados: Descrevemos 48 mulheres e 2 homens diagnosticados com CRB. Destes 50 pacientes, 90,0% eram asiáticos. A média de idade foi 49,3 anos. Houve associação com migrânea (28,0%), cefaleia do tipo tensional (12,0%) e cefaleia por estímulo frio (4,0%). A cefaleia foi localizada bilateralmente, explosiva ou pulsátil e de forte intensidade. A dor durou de 5 minutos a 4 dias.As manifestações associadas foram náuseas, vômitos, fotofobia ou fonofobia. Houve uma boa resposta terapêutica com nimodipina e evitando-se banho quente. Conclusões: CRB é uma cefaleia benigna não associada com lesão estrutural.

Neuroimaging Findings of First-Visit Headache Patients

BACKGROUND: Neuroimaging can play a crucial role in discovering potential abnormalities to cause secondary headache. There has been a progress in the fields of headache diagnosis and neuroimaging in the past two decades. We sought to investigate neuroimaging findings according to headache disorders, age, sex, and imaging modalities in first-visit headache patients. METHODS: We used data of consecutive first-visit headache patients from 9 university and 2 general referral hospitals. The International Classification of Headache Disorders, third edition, beta version was used in headache diagnosis. We finally enrolled 1,080 patients undertook neuroimaging in this study. RESULTS: Among 1,080 patients (mean age: 47.7±14.3, female: 60.8%), proportions of headache diagnosis were as follows: primary headaches, n=926 (85.7%); secondary headaches, n=110 (10.2%); and cranial neuropathies and other headaches, n=43 (4.1%). Of them, 591 patients (54.7%) received magnetic resonance imaging (MRI). Neuroimaging abnormalities were found in 232 patients (21.5%), and their proportions were higher in older age groups and male sex. Chronic cerebral ischemia was the most common finding (n=88, 8.1%), whereas 76 patients (7.0%) were found to have clinically significant abnormalities such as primary brain tumor, cancer metastasis, and headache-relevant cerebrovascular disease. Patients underwent MRI were four times more likely to have neuroimaging abnormalities than those underwent computed tomography (33.3% vs. 7.2%, p <0.001). CONCLUSIONS: In this study, the findings of neuroimaging differed according to headache disorders, age, sex, and imaging modalities. MRI can be a preferable neuroimaging modality to identify potential causes of headache.

Comprehensive review and update on chronic migraine

Chronic migraine (CM) is a common and disabling neurologic disorder. CM is defined as more than 15 days a month over a 3-month period, including at least 8 days per month on which their headaches and associated symptoms meet diagnostic criteria for migraine. Quality of life is highly compromised in patients with this condition, and comorbidities are more frequent than with episodic migraine. The diagnosis requires a carefully-conducted patient interview and neurologic examination, sometimes combined with additional diagnostic tests, to differentiate CM from secondary headache disorders and other primary chronic headaches. CM typically develops from episodic migraine over months to years. Several factors are associated with an increased risk of episodic migraine developing into CM, including the frequent use of abortive migraine drugs. Through identification of risk factors for progression to CM, clinicians can educate patients about modifiable risk factors and can begin appropriate individualized preventive therapy. There is a high frequency of medication overuse in CM. The first step in the management of CM complicated by medication overuse is withdrawal of the overused drugs and detoxification treatment. This article provides an overview of CM, including its epidemiology, risk factors for its development, and information on its pathophysiology, diagnosis, and management.

Prognostic factors in 26 patients with spontaneous intracranial hypotension / 第二军医大学学报

Objective To explore the clinical characteristics and prognostic factors of spontaneous intracranial hypotension (SIH) patients. Methods The clinical data of patients with SIH, who admitted to Changhai Hospital of Navy Medical University (Second Military Medical University) from 2010 to 2017 and met the SIH diagnostic criteria of international classification of headache disorders, 3rd edition (ICHD-3), were collected. The effects of the general clinical features, such as gender, age and course of disease, and cerebrospinal fluid pressure and imaging features on prognosis of the SIH patients were analyzed. Results Of 26 SIH patients, 19 patients (73.08%) were cured and 7 patients (26.92%) were relieved. The gender, age, course of disease, severity of headache, headache types and cerebrospinal fluid pressure had no significant effect on the prognosis of the SIH patients. Among the 13 SIH patients with abnormal cranial magnetic resonance imaging findings, such as strenthening signals in cerebral dura, subdural fluid accumulation and brain sagging, 12 patients (63.16%) were cured and 1 (14.28%) was relieved, and the difference was significant (P=0.027). Conclusion SIH patients with headache have a good prognosis; imaging examination contributes to the diagnosis of SIH and may indicate the prognosis.