Tratamiento con bloqueo esfenopalatino de la cefalea refractaria por trombosis del seno cavernoso / Treatment with sphenopalatine blockade against refractory headache due to thrombosis of the cavernous sinus

Introducción: Entre las cefaleas secundarias se encuentra la atribuida a flebotrombosis cerebral producida por trombosis séptica del seno cavernoso. El ganglio esfenopalatino interviene en la génesis y mantenimiento de cefaleas unilaterales; pues envía conexiones a la cavidad nasofaríngea y meninges, así desempeña una función importante en la modulación neuronal; el bloqueo de dicho ganglio es un método fácil, seguro, económico y efectivo de tratamiento del dolor irruptivo de algunos tipos de cefalea. Objetivo: Presentar los resultados del bloqueo GEFP en el tratamiento de la cefalea grave refractaria secundaria a trombosis séptica del seno cavernoso. Presentación de caso: Paciente de 71 años de edad, al que se realizó de forma exitosa bloqueo transnasal del ganglio esfenopalatino, para tratamiento de cefalea grave refractaria secundaria a trombosis séptica del seno cavernoso, consiguiéndose analgesia efectiva con disminución progresiva de la cefalea y control total de la misma a las 72 h de tratamiento. Conclusiones: El bloqueo podría constituir una opción en la terapéutica de este tipo de cefalea(AU)

Introduction: Among secondary headaches, one is attributed to cerebral phlebothrombosis produced by septic thrombosis of the cavernous sinus. The sphenopalatine ganglion (SPG) is involved in the genesis and maintenance of unilateral headaches, since it sends connections to the nasopharyngeal cavity and meninges, playing thus an important role in neuronal modulation; therefore; the blockade of this ganglion is an easy, safe, economic and effective method for treating breakthrough pain in some types of headache. Objective: To present the results of SPG blockade in the treatment of refractory severe headache produced by septic thrombosis of the cavernous sinus. Case presentation: A 71-year-old male patient is presented, who was successfully performed a transnasal SPG blockade, as a treatment for refractory severe headache caused by septic thrombosis of the cavernous sinus. Effective analgesia is achieved, together with progressive decrease of headache until it was totally controlled at 72 hours. Conclusions: Blockade was an option in the therapy of this type of headache(AU)

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.

Evaluation of structural changes in orbitofrontal cortex in relation to medication overuse in migraine patients: a diffusion tensor imaging study / Avaliação das mudanças estruturais no córtex orbitofrontal em relação ao uso excessivo de medicamentos em pacientes com migrânea: um estudo de imagem por tensor de difusão

Abstract Background: Migraine is a prevalent neurological disease that leads to severe headaches. Moreover, it is the commonest among the primary headaches that cause medication overuse headache (MOH). The orbitofrontal cortex (OFC) is one of the structures most associated with medication overuse. Objective: To determine microstructural changes in the OFC among migraine patients who developed MOH, through the diffusion tensor imaging (DTI) technique. Methods: Fifty-eight patients who had been diagnosed with migraine based on the Classification of Headache Disorders (ICHD-III-B) were included in the study. Patients were sub-classified into two groups, with and without MOH, based on the MOH criteria of ICHD-III-B. DTI was applied to each patient. The OFC fractional anisotropy (FA), and apparent diffusion coefficient (ADC) values of the two groups were compared. Results: The mean age of all the patients was 35.98±7.92 years (range: 18-65), and 84.5% (n=49) of them were female. The two groups, with MOH (n=25) and without (n=33), were alike in terms of age, gender, family history, migraine with or without aura and duration of illness. It was found that there was a significant difference in FA values of the left OFC between the two groups (0.32±0.01 versus 0.29±0.01; p=0.04). Conclusions: An association was found between MOH and changes to OFC microstructure. Determination of neuropathology and factors associated with medication overuse among migraine patients is crucial in terms of identifying the at-risk patient population and improving proper treatment strategies specific to these patients.

RESUMO Introdução: A migrânea é uma doença neurológica prevalente que causa fortes dores de cabeça. Além disso, é a mais comum entre as cefaleias primárias que causam cefaleia por uso excessivo de medicamentos (CUEM). O córtex orbitofrontal (OF) é uma das estruturas mais associadas ao uso excessivo de medicamentos. Objetivo: Determinar alterações microestruturais no córtex OF em pacientes com migrânea que desenvolveram CUEM, por meio da técnica de imagem por tensor de difusão (ITD). Métodos: Cinquenta e oito pacientes com diagnóstico de migrânea, com base na Classificação das Cefaleias (ICHD-III-B), foram incluídos no estudo. Os pacientes foram subclassificados em dois grupos, com e sem CUEM, com base nos critérios de CUEM da ICHD-III-B. A ITD foi aplicada a cada paciente. Os valores de anisotropia fracionada OFC (AF) e coeficiente de difusão aparente (CDA) dos dois grupos foram comparados. Resultados: A média de idade de todos os pacientes foi de 35,98±7,92 anos (variação: 18‒65), sendo 84,5% (n=49) do sexo feminino. Os dois grupos, com CUEM (n=25) e sem (n=33), são semelhantes em termos de idade, sexo, história familiar, migrânea com ou sem aura e duração da doença. Verificou-se que houve diferença significativa nos valores de AF do córtex OF esquerdo entre os dois grupos (0,32±0,01 versus 0,29±0,01; p=0,04). Conclusões: Foi encontrada associação entre o CUEM e as alterações na microestrutura do córtex OF. A determinação da neuropatologia e dos fatores associados ao uso excessivo de medicamentos entre pacientes com migrânea é crucial para identificar a população de pacientes em risco e melhorar as estratégias de tratamento adequadas específicas para esses pacientes.

Impulsivity prevalence in migraine patients without and with medication overuse / Prevalência de impulsividade em pacientes com enxaqueca sem e com abuso de medicação

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.

Medication-overuse headache. Retrospective comparison of preventive treatments / Cefaleia por uso excessivo de medicamentos. Comparação retrospectiva de tratamentos preventivos

ABSTRACT Objectives: Medication-overuse headache is commonly seen in tertiary centers. Limited evidence is available regarding treatment. We compared the use of one or two drugs, three drugs, or four pharmacological agents for the prevention of headache. Methods: This was a retrospective analysis of 149 consecutive patients. Sudden withdrawal and pharmacological prevention with one or more drugs were carried out. Adherence and the decrease of headache frequency of more than 50% were compared after four months between the one or two, three, and four drug groups. Results: There was no difference in adherence (p > 0.6). Headache frequency reduction was shown in 23 (54.8%, one or two drugs), 33 (70%, three drugs) and 11 (55%, four drugs); p = 0.13 and p = 0.98, not significant. There was a tendency towards significance between the one or two drug takers versus the three drug and four drug takers together (p = 0.09). Conclusions: The use of more drugs was not better at improving headache. However, there is the possibility that acting simultaneously on different sites may promote broader modulation and better outcome.

RESUMO Objetivos: Cefaleia por uso excessivo de medicamentos (CEM) é comum em centros terciários. Existe evidência limitada quanto a estratégias de tratamento e se combinar drogas é melhor do que abordagens com monoterapia. Objetivamos comparar o uso de até dois, três ou quatro agentes farmacológicos para a prevenção. Métodos: Estudo retrospectivo de 149 pacientes consecutivos. A suspensão súbita das drogas usadas em excesso e o início de prevenção foram realizados. A adesão e a redução superior a 50% na frequência da cefaleia foram comparadas após quatro meses entre até duas drogas, três drogas e quatro drogas. Resultados: A adesão não foi diferente (p > 0.6). A redução da frequência de cefaleia foi de 23 (54.8%, até duas drogas, 33 (70%, três drogas) e 11 (55%, quatro drogas; p = 0.13 e p = 0.98, não significativo). Houve uma tendência à significância quando comparamos até duas drogas com três e quatro drogas (p = 0.09). Conclusões: Não demonstramos superioridade de mais drogas, comparando-se a um ou dois medicamentos. Acreditamos na possibilidade de atuação em sítios de diferentes de forma simultânea e a modulação mais abrangente com melhores parâmetros evolutivos.

Series de Pediatría Garrahan. El niño con problemas neurológicos / Garrahan Pediatrics Series. The child with neurological problems

Las afecciones neurológicas son uno de los motivos de consulta más frecuentes en la práctica pediátrica ambulatoria y ocupan un alto índice de las camas en la internación. El papel del pediatra en este contexto es muy complejo, ya que es quien recibe a un paciente en la emergencia o en el consultorio y debe estar atento a si un determinado síntoma o signo neurológico puede ser transitorio o el indicio de una enfermedad grave. Así, son fundamentales tanto el conocimiento de las distintas entidades neurológicas y de sus aspectos epidemiológicos y patogénicos como también el examen semiológico y los primeros estudios por realizar para la orientación diagnóstica, el tratamiento inicial, las indicaciones de derivación, la prevención de riesgos y el asesoramiento a los padres. Este nuevo volumen aborda esta temática especial con énfasis en el trabajo interdisciplinario y entre sus características se destacan: El estudio de importantes temas clínicos, como las convulsiones febriles, que se presentan en el 2% al 5% de los niños; la epilepsia infantil, con una prevalencia del 1%; la cefalea, cuya incidencia ha aumentado en los últimos veinte años y es hoy el motivo de consulta más frecuente en los servicios de neurología; las crisis paroxísticas no epilépticas, que aparecen entre el 5% y el 20% de la población infantil; el desafío diagnóstico del lactante hipotónico; las encefalopatías agudas, y los trastornos de la marcha y del movimiento. La inclusión, en todos los capítulos, de casos clínicos con su evolución y desenlace, textos destacados con los principales conceptos, puntos claves para recordar, además de material complementario, como bibliografía adicional, videos y enlaces a sitios web de interés. Una obra sólida y práctica, que transmite las experiencias de los profesionales de una institución del prestigio internacional del Hospital de Pediatría Prof. Dr. Juan P. Garrahan ­a treinta años de su creación- dedicada a todos los pediatras, donde quiera que trabajen al servicio de la salud de los niños.

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.

Volume Gain of Brainstem on Medication-Overuse Headache Using Voxel-Based Morphometry / 中华医学杂志(英文版)

<p><b>Background</b>Histopathology identified the anatomical and molecular abnormalities of brainstem nuclei in migraine patients. However, the exact whole brainstem structural changes in vivo have not yet been identified in medication-overuse headache (MOH) transformed from migraine. The aim of this study was to investigate the regional volume changes over the whole brainstem in the MOH patients using voxel-based morphometry (VBM) in vivo.</p><p><b>Methods</b>High-resolution three-dimensional structural images were obtained using a 3.0-Tesla magnetic resonance system from 36 MOH patients and 32 normal controls (NCs) who were consecutively recruited from the International Headache Center, Chinese People's Liberation Army General Hospital, from March 2013 to June 2016. VBM was used to assess the brainstem structural alteration in the MOH patients, and voxel-wise correlation was performed to evaluate the relationship with the clinical characteristics.</p><p><b>Results</b>The brainstem region with increased volume located in the left ventrolateral periaqueductal gray (MNI coordinate: -1, -33, -8), ventral tegmental area (MNI coordinate: 0, -22, -12), bilateral substantia nigra (MNI coordinate: -8, -16, -12, 9, -16, -12), and trigeminal root entry zone (MNI coordinate: -19, -29, -31; 19, -32, -29) in MOH patients compared with NCs. The headache visual analog scale score was positively related with the left rostral ventromedial medulla (RVM) (MNI coordinate: -1, -37, -56; cluster size: 20; r = 0.602) in the MOH patients.</p><p><b>Conclusions</b>The regional volume gain of brainstem could underlie the neuromechanism of impaired ascending and descending pathway in the MOH patients, and the left RVM volume alteration could imply the impaired tolerance of nociceptive pain input and could be used to assess the headache disability in the MOH patients.</p>

Cefalea... ¿y algo más?: Neuroimágenes en el estudio de la cefalea / Headache and something else? Neuroimaging in the study of headaches

Se revisa la iconografía de los hallazgos por tomografía computada (TC) y resonancia magnética (RM) de la cefalea, según nuestra experiencia. De acuerdo con la base MESH, esta entidad se define como un dolor craneano, que puede ser de ocurrencia benigna o la manifestación de una amplia gama de desórdenes. Las cefaleas se clasifican por su evolución temporal (aguda o crónica), presentación (en estallido, gravativa, etc.) o coexistencia de síntomas asociados, como auras, convulsiones o déficits focales. También se dividen en primarias o secundarias, según la existencia o no de una patología subyacente. Las primarias pueden tener manifestaciones clínicas definidas, pero en las secundarias ciertos signos y síntomas deben alertar sobre la presencia de una patología estructural. En este caso, las neuroimágenes tienen un rol esencial al detectar las causantes del cuadro. Nuestros hallazgos correspondieron a cefaleas primarias (p. ej: infarto migrañoso) y a etiologías orgánicas, entre las que se destacaron causas vasculares, como patología venosa (trombosis), vasoespasmo y leucoencefalopatía posterior reversible; hemorragias intraparen-quimatosas y extraaxiales; cefaleas postraumáticas y posquirúrgicas; y causas infecciosas y tumorales (apoplejía hipofisaria e hipertensión endocraneana). Además, hubo malformaciones (Arnold-Chiari, p.ej.) y otras como hipotensión endocraneana. En algunos casos inicialmente se realizó una TC y luego una RM, mientras que en otros la RM fue el método de elección. Las neuroimágenes facilitan el estudio de la cefalea, caracterizando la afección en primaria o secundaria. En el segundo caso permiten, a su vez, clasificar los hallazgos

A review is presented of the radiological findings (computed tomography -CT- and magnetic resonance imaging -MRI-) of headache, according to our experience. According to MESH database this entity is a skull based pain that can have a benign cause or be an expression of a wide spectrum of disorders. Headaches can be classified according to their temporal evolution (acute or chronic), presentation (blow up, aura, rapidly evolutionary, etc.), or according to associated symptoms, such as seizures or focal deficits. They could also be classified into primary or secondary, depending on the presence or absence of demonstrable disease. The primary headaches can have known symptoms (i.e. migraine), but in secondary ones certain symptoms and signs should alert on the existence of structural disease. At this point imaging methods have an outstanding role, as they allow detecting and identifying structural causes in patients with headache. Our findings corresponded to primary headaches (i.e.: migraine infarction) and organic aetiologies, such as vascular causes (venous thrombosis, vasospasm and posterior reversible leukoencephalopathy); intracerebral and extra-axial haemorrhage; post-surgical and post- traumatic headaches; and those due to infections and tumours (pituitary apoplexy or intracranial hypertension). Malformations, such as Arnold-Chiari's, and intracranial hypotension have also been found. In some cases a CT is initially performed and then an MR, whilst in others MR is the method of choice. Neuroimaging facilitates the study of headache, helping to characterise them into primary or secondary. In the latter case, the imaging also enables the findings to be classified

Chronic Daily Headache and Medication Overuse Headache in First-Visit Headache Patients in Korea: A Multicenter Clinic-Based Study

BACKGROUND AND PURPOSE: Chronic daily headache (CDH) is defined as a headache disorder in which headaches occur on a daily or near-daily basis (at least 15 days/month) for more than 3 months. Chronic migraine (CM) and medication overuse headache (MOH) are very disabling headaches that remain underdiagnosed. The aim of this study was to establish the frequency of CDH and its various subtypes, and examine the associations with MOH among first-visit headache patients presenting at neurology outpatient clinics in Korea. METHODS: Eleven neurologists enrolled first-visit patients with complaints of headaches into outpatient clinics for further assessment. Headache disorders were classified according to the International Classification of Headache Disorder (third edition beta version) by each investigator. RESULTS: Primary CDH was present in 248 (15.2%) of the 1,627 included patients, comprising CM (143, 8.8%), chronic tension-type headache (CTTH) (98, 6%), and definite new daily persistent headache (NDPH) (7, 0.4%). MOH was associated with headache in 81 patients (5%). The association with MOH was stronger among CM patients (34.5%) than patients with CTTH (13.3%) or NDPH (14.3%) (p=0.001). The frequency of CDH did not differ between secondary and tertiary referral hospitals. CONCLUSIONS: The frequencies of CDH and MOH diagnoses were 15.2% and 5%, respectively in first-visit headache patients presented at secondary or tertiary referral hospitals in Korea. CM was the most common subtype of CDH and was most frequently associated with MOH.

Characteristics of Elderly-Onset (≥65 years) Headache Diagnosed Using the International Classification of Headache Disorders, Third Edition Beta Version

BACKGROUND AND PURPOSE: New-onset headache in elderly patients is generally suggestive of a high probability of secondary headache, and the subtypes of primary headache diagnoses are still unclear in the elderly. This study investigated the characteristics of headache with an older age at onset (≥65 years) and compared the characteristics between younger and older age groups. METHODS: We prospectively collected demographic and clinical data of 1,627 patients who first visited 11 tertiary hospitals in Korea due to headache between August 2014 and February 2015. Headache subtype was categorized according to the International Classification of Headache Disorders, Third Edition Beta Version. RESULTS: In total, 152 patients (9.3%, 106 women and 46 men) experienced headache that began from 65 years of age [elderly-onset group (EOG)], while the remaining 1,475 patients who first experienced headache before the age of 65 years were classified as the younger-age-at-onset group (YOG). Among the primary headache types, tension-type headache (55.6% vs. 28.8%) and other primary headache disorders (OPH, 31.0% vs. 17.3%) were more common in the EOG than in the YOG, while migraine was less frequent (13.5% vs. 52.2%) (p=0.001) in the EOG. Among OPH, primary stabbing headache (87.2%) was more frequent in the EOG than in the YOG (p=0.032). The pain was significantly less severe (p=0.026) and the frequency of medication overuse headache was higher in EOG than in YOG (23.5% vs. 7.6%, p=0.040). CONCLUSIONS: Tension-type headache and OPH headaches, primarily stabbing headache, were more common in EOG patients than in YOG patients. The pain intensity, distribution of headache diagnoses, and frequency of medication overuse differed according to the age at headache onset.

Temporomandibular disorder is more prevalent among patients with primary headaches in a tertiary outpatient clinic / Disfunção temporomandibular é mais prevalente entre pacientes com cefaleias primárias em um ambulatório de nível terciário

Objective The aim of this study was to estimate the prevalence of signs and symptoms of temporomandibular disorders (TMD) in patients with primary headaches attended in a tertiary neurology ambulatory.Method Authorized by the Ethics Committee, the present cross-sectional study was conducted with a random sample of patients screened for orofacial pain and primary headaches at a tertiary hospital in Northeast of Brazil.Results The sample consisted in 42 patients with primary headache, 59.5% male. The prevalence of > 6 TMD signs and symptoms was 54.8%. In those patients with migraine TMD was present in 71.4% and in tension-type headache in 38.1% (p = 0.030; OR = 4.1). TMD was related to the clinical status of headache associated or attributed to medication overuse (p = 0.001).Conclusion TMD has a high prevalence in patients with primary headaches (54.8%). Special attention must be given to patients with migraine and headache associated or attributed to medication overuse.

Objetivo Estimar a prevalência de sinais e sintomas de disfunção temporomandibular (DTM) e fatores associados em pacientes com cefaleias primárias atendidos em um ambulatório de neurologia.Método Autorizado pelo Comitê de Ética, o presente estudo transversal foi conduzido com uma amostra aleatória de pacientes investigados para dor orofacial e cefaleias primárias em um hospital terciário no nordeste do Brasil.Resultados A amostra consistiu em 42 pacientes com cefaleias primárias, sendo 59,5% homens. A prevalência de > 6 sinais e sintomas de DTM foi 54,8%. Naqueles pacientes com migrânea, DTM estava presente em 71,4% e em 38,1% daqueles com cefaleia do tipo tensional (p = 0,030; OR = 4,1). DTM foi relacionada à condição clínica de cefaleia por abuso de medicamentos (p = 0,001).Conclusão A DTM é uma condição com alta prevalência em pacientes com cefaleias primárias (54,8%). Atenção especial deve ser dada a pacientes com migrânea e cefaleia por abuso de medicamentos.

Study of the use of analgesics by patients with headache at a specialized outpatient clinic (ACEF) / Estudo do uso de analgésicos em pacientes com cefaleia em um ambulatório especializado (ACEF)

Objective : To evaluate the use of analgesics in headache diagnosed in Outpatients Headache Clinic (ACEF), as well as his involvement in the activities of the patients. Method : 145 patients with headache seen at ACEF during the period August/July 2009/2010 underwent a questionnaire and interview with neurologist responsible for the final diagnosis according to ICHD-II. Results : Relationship Women:Men 7:1. 1) Prevalence: Migraine without aura (52.4%), migraine with aura (12.4%), chronic migraine (15.2%) and medication overuse headache (MOH) (20%). 2) Analgesic drugs used: Compounds with Dipyrone (37%), Dipyrone (23%), Paracetamol (16%) compound with Paracetamol (6%), triptans (6%) and non steroidal anti-inflammatory drugs (12%). There was a significant decrease in the duration of pain and less interference in the activities of the headache patients after the use of analgesics. Conclusion : Prevalence of MOH has been increasing in population level and specialized services. New studies emphasizing the MOH are needed to assist in the improvement of their diagnostic and therapeutic approach. .

Objetivo : Avaliar a utilização de analgésicos nas cefaleias diagnosticadas no Ambulatório de Cefaleias (ACEF), bem como a sua intervenção nas atividades dos pacientes. Método : 145 pacientes com cefaleia atendidos no ACEF durante o período entre Agosto/2009 a Julho/2010 foram submetidos a um questionário e à entrevista com médico neurologista responsável pelo diagnóstico final, segundo a ICHD-II. Resultados : Relação Mulheres:Homens de 7:1. 1) Prevalência: Migrânea sem aura (52,4%), migrânea com aura (12,4%), migrânea crônica (15,2%) e CEM (20%). 2) Analgésicos utilizados: Compostos com Dipirona (37%), Dipirona (23%), Paracetamol (16%), compostos com Paracetamol (6%), triptanos (6%) e drogas antiinflamatórias esteroidais (12%). Houve uma diminuição significativa da duração da dor e menor interferência da cefaleia nas atividades dos pacientes após o uso dos analgésicos. Conclusão : Prevalência da cefaleia por uso excessivo de medicamento (CEM) vem aumentando em nível populacional e em serviços especializados. Novos estudos enfatizando a CEM são necessários para auxiliar na melhora da sua abordagem diagnóstica e terapêutica. .

Como identificar uma cefaléia secundária na emergência / How to identify a secondary headache in the emergency room

É importante a identificação de uma cefaléia de causa secundária na emergência, pois torna-se necessária uma investigação complementar através de exames laboratoriais, de neuroimagem, assim como avaliação de líquor quando indicado. Há fatores de alarme identificáveis durante o atendimento, que podem facilitar essa identificação, possibilitando um tratamento adequado.

The identification of a secondary cause of headache in the emergency room is important because is necessary further investigation through laboratorial tests, neuroimaging, and lumbar puncture when indicated. There are identifiable danger signs on history and examination, which can facilitate this identification, enabling appropriate treatment.

Clinical Application of Korean Version of the International Classification of Headache Disorders, 3rd Edition, Beta Version

BACKGROUND: The International Classification of Headache Disorders, an essential tool in the diagnosis of headache disorders, has been revised as its 3rd edition, beta (ICHD-IIIbeta). The clinical application in practice is needed to test the feasibility and usefulness of the Korean version of ICHD-IIIbeta. METHODS: Neurologists enrolled consecutive first-visit headache patients from February to March 2014. The classification of headache disorder was done by each investigator according to ICHD-IIIbeta based on the initial structured questionnaire, clinical evaluation, and neuroimaging studies, if needed. A consensus meeting dealt with the cases that were difficult to diagnose. The feasibility and usefulness of this version was assessed by the proportion of unclassified headache disorders using ICHD-IIIbeta compared to the previous version. RESULTS: A total of 207 patients were enrolled: the mean age was 41 years (16-87 years) and women constituted 63.3%. Primary headache disorders were diagnosed in 167 patients (80.7%): 82 migraines, 37 tension-type headaches, 3 cluster headaches, and 45 other primary headache disorders. Thirty-five patients (16.9%) had secondary headache disorders or painful cranial neuropathies/other facial pain and 5 patients (2.4%) could not be classified by ICHD-IIIbeta. The diagnoses differed as compared to the previous version in 32 patients (15.5%): 14.5% differed due to the mitigation of the previous strict criteria and 1% differed due to the introduction of a new diagnostic category. CONCLUSIONS: Classifications by ICHD-IIIbeta are possible in more than 97% of the first-visit headache patients and ICHD-IIIbeta has proved to be more useful than its previous version.

Cefalea por uso excesivo de analgésicos en Bucaramanga, Colombia: Prevalencia y factores asociadosCefalea por uso excesivo de analgésicos enBucaramanga, Colombia:Prevalencia y factores asociados / Medication overuse in Bucaramanga, Colombia: Prevalence and associated factors

(AU)Introducción: el uso de analgésicos es frecuente en pacientes con cefalea; sin embargo no hay datos sobre laprevalencia de la cefalea por uso excesivo de medicaciones (CUEM) en Colombia.Objetivo: determinar la prevalencia de CUEM en Bucaramanga-Colombia y los factores asociados a este consumo.Se realizó un estudio de prevalencia mediante un cuestionario autoadministrado en habitantes de Bucaramangaseleccionados al azar. Las comparaciones se realizaron mediante la prueba t o el chi (χ2)i cuadrado los factoresasociados con el uso excesivo de medicación fueron estimados con modelos de regresión logística.Materiales y métodos: la prevalencia de CUEM fue de 4.8%. Los factores asociados fueron la migraña, el estratosocial bajo, uso de profilaxis, haber consultado con el médico y la automedicación. Con excepción del naproxen,todos los tipos de analgésicos estudiados fueron consumidos más frecuentemente por las personas con CUEM. Elacetaminofen y la combinación de acetaminofen, ácido acetil salicílico y cafeína fueron consumidos en cantidadessignificativamente mayores por personas con CUEM.Conclusión: la prevalencia de CUEM en la población general de Bucaramanga es alta comparada con otros paísesdesarrollados. La CUEM posiblemente está asociada a falta de acceso o de adecuación de los servicios de salud,y a la automedicación entre los pacientes con cefaleas primarias, principalmente la migraña

Alopecia After Occipital Nerve Blockade

Occipital nerve blockade is a widely used procedure in the treatment of primary and secondary headache disorders. The procedure is generally well tolerated, although local side effects such as cutaneous atrophy, hyperpigmentation, and alopecia can occur. The present study describes a case of alopecia following occipital nerve blockade with triamcinolone. This complication can be avoided by precautions such as local injection and the use of alternative steroid preparations.

Alopecia After Occipital Nerve Blockade

Occipital nerve blockade is a widely used procedure in the treatment of primary and secondary headache disorders. The procedure is generally well tolerated, although local side effects such as cutaneous atrophy, hyperpigmentation, and alopecia can occur. The present study describes a case of alopecia following occipital nerve blockade with triamcinolone. This complication can be avoided by precautions such as local injection and the use of alternative steroid preparations.