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1.
Arq Neuropsiquiatr ; 76(7): 467-472, 2018 Jul.
Article in English | MEDLINE | ID: mdl-30066798

ABSTRACT

OBJECTIVE: To determine the prevalence of cluster headache (CH) in Barbacena, a medium-size city in the State of Minas Gerais, Brazil. METHODS: The total population of Barbacena is 126,284 inhabitants and the Family Health Strategy Program covers 84,610 of them. In order to identify patients with cluster headache, 36,145 of these inhabitants were screened, following which, a questionnaire was completed by 181 health agents distributed throughout the 28 health posts belonging to the Family Health Strategy network. The completed questionnaires were selected based on the clinical criteria established by the International Headache Society, and those patients (18 years of age or older) with a possible CH diagnosis were later assessed by a headache specialist. This was an observational, cross-sectional study. RESULTS: In all, 15 patients were diagnosed as having CH, comprising a prevalence of 0.0414%; or 41.4/100,000 inhabitants. CONCLUSION: The prevalence of cluster headache in Barbacena was lower than that observed in many locations worldwide.


Subject(s)
Cluster Headache/epidemiology , Adult , Aged , Brazil/epidemiology , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Prevalence , Socioeconomic Factors , Surveys and Questionnaires
2.
Arq. neuropsiquiatr ; 76(7): 467-472, July 2018. tab, graf
Article in English | LILACS | ID: biblio-950565

ABSTRACT

ABSTRACT To determine the prevalence of cluster headache (CH) in Barbacena, a medium-size city in the State of Minas Gerais, Brazil. Methods The total population of Barbacena is 126,284 inhabitants and the Family Health Strategy Program covers 84,610 of them. In order to identify patients with cluster headache, 36,145 of these inhabitants were screened, following which, a questionnaire was completed by 181 health agents distributed throughout the 28 health posts belonging to the Family Health Strategy network. The completed questionnaires were selected based on the clinical criteria established by the International Headache Society, and those patients (18 years of age or older) with a possible CH diagnosis were later assessed by a headache specialist. This was an observational, cross-sectional study. Results In all, 15 patients were diagnosed as having CH, comprising a prevalence of 0.0414%; or 41.4/100,000 inhabitants. Conclusion The prevalence of cluster headache in Barbacena was lower than that observed in many locations worldwide.


RESUMO Determinar a prevalência de cefaléia em Salvas (CS) em Barbacena, uma cidade de tamanho médio do Estado de Minas Gerais, Brasil. Métodos A população total de Barbacena, totaliza 126.284 habitantes e o Programa de Estratégia de Saúde da Família cobre 84.610 deles. A fim de identificar pacientes com Cefaléia em Salvas, 36.145 deles foram rastreados através de um questionário que foi completado por 181 agentes de saúde, distribuídos entre os 28 postos de saúde pertencentes à rede de Estratégia de Saúde da Família. Os questionários preenchidos foram selecionados com base nos critérios clínicos estabelecidos pela International Headache Society, e aqueles pacientes (com idade igual ou maior de 18 anos) com um possível diagnóstico de CH foram posteriormente avaliados por um especialista em dor de cabeça. Este é um estudo observacional, transversal. Resultados No total, 15 pacientes foram diagnosticados com CH, compreendendo uma prevalência de 0,0414%; ou 41,4 / 100,000 habitantes. Conclusão A prevalência de Cefaleia em Salvas em Barbacena foi menor do que a observada em muitos locais do mundo.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Cluster Headache/epidemiology , Socioeconomic Factors , Brazil/epidemiology , Prevalence , Cross-Sectional Studies , Surveys and Questionnaires
3.
Headache ; 56(2): 422-35, 2016 Feb.
Article in English | MEDLINE | ID: mdl-26853085

ABSTRACT

OBJECTIVES: The relationship between indomethacin (IMC) and headache treatment has long intrigued clinicians and clinical researchers in Headache Medicine. Why is it efficacious in many types of headache disorders when other medications are not, and what is the mechanism behind its efficacy? IMC and headache related topics that have been explored in detail in the literature include IMC-responsive headache disorders ("traditional"), pharmacology of IMC, symptomatic headaches responsive to IMC, "novel" headache conditions that respond, cluster headache and IMC, IMC provoking headache, the issue about" absolute" and "non-absolute" effect of IMC on headache disorders, and the morphing trigeminal autonomic cephalalgias (TACs). DATA SOURCE: A PubMed/MEDLINE search was used for Clinical Studies Categories and Systematic Reviews on the PubMed Clinical Queries. The search details were "indomethacin" AND "headache" spanning all previous years until February 1, 2015. Methods were in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. REVIEW METHODS: Articles were excluded if IMC had not been used to treat headache disorders in adults, if the article concerned IMC-responsive headaches but made no reference to the use of IMC, and articles not addressing the above mentioned topics. RESULTS AND CONCLUSIONS: The "velocity" of publications on IMC and headache seems to be decreasing, particularly on the use of IMC for the treatment of TACs. The science behind the understanding of the putative mechanisms of IMC's action on headache has moved forward, but the answer to why it works better than other nonsteroidal anti-inflammatory drugs has been elusive. There are case reports of other rare headache disorders that may be responsive to IMC. The dosages of IMC used as a tool for detecting IMC responsive disorders vary according to different centers of investigation. In many circumstances, headache disorders similar to "primary" IMC-responsive disorders are actually symptomatic disorders. Cluster headache as an IMC-resistant headache disorder may not be as absolute as once thought. Sometimes, IMC has been found to provoke headache; differentiating IMC-provoked headache from IMC-resistant headache can make headache diagnosis and management difficult. As for the "absolute" responsiveness of IMC, it is possible that using higher dosages leads to higher sensitivity, probably at the expense of decreased specificity. There are many reports about the occurrence of two or more IMC-responsive disorders (latu sensu) in the same patient, which may be coincidental.


Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Databases, Bibliographic/statistics & numerical data , Headache/drug therapy , Indomethacin/therapeutic use , Humans
4.
Cephalalgia ; 31(13): 1409-14, 2011 Oct.
Article in English | MEDLINE | ID: mdl-21911413

ABSTRACT

BACKGROUND: Cluster headache (CH) is a rare cause of headache in children. Onset before 12 years of age is unusual, and long-term follow-up of pediatric cases has been not reported. OBJECTIVES: To report three cases of CH with onset at childhood and at least ten years of follow-up. METHODS: Case report. RESULTS: The first case is that of a 12-year-old boy with episodic CH with unilateral pain and striking, bilateral autonomic manifestations, remitted for over eight years. The second case is unique in that it reports a case of chronic CH in a 13-year-old boy with Down syndrome. The third case is that of a 9-year-old girl with episodic CH with remissions of 2 and 5 years. All cases had prominent autonomic features. The frequency and duration of the attacks were similar to those that have been reported in adults. Good response to indomethacin was obtained in two cases, although tolerability issues occurred in one. CONCLUSION: Sustained, long-term, medical and/or spontaneous remission occurs in CH of early onset. The phenotype and response to therapy in children, at least in these case examples, are similar to equivalent observations in adult patients with CH.


Subject(s)
Cluster Headache/epidemiology , Adolescent , Age of Onset , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Anticonvulsants/therapeutic use , Child , Cluster Headache/complications , Cluster Headache/drug therapy , Down Syndrome/complications , Drug Therapy, Combination , Dyspepsia/chemically induced , Female , Follow-Up Studies , Fructose/analogs & derivatives , Fructose/therapeutic use , Humans , Incidence , Indomethacin/adverse effects , Indomethacin/therapeutic use , Lithium/therapeutic use , Male , Melatonin/therapeutic use , Prednisolone/therapeutic use , Topiramate , Toxoplasmosis, Cerebral/complications
5.
Handb Clin Neurol ; 97: 627-42, 2010.
Article in English | MEDLINE | ID: mdl-20816459

Subject(s)
Headache , Homeostasis , Humans
6.
Headache ; 49(5): 726-31, 2009 May.
Article in English | MEDLINE | ID: mdl-18783446

ABSTRACT

OBJECTIVE: To contrast the cervical range of motion (CROM) in women with episodic migraine (EM), transformed migraine (TM), and controls without migraine headaches. BACKGROUND: Migraineurs often complain about neck pain. Furthermore, neck problems can worsen the headaches in individuals with migraine. Individuals with neck pain usually have reduced CROM. Nonetheless, studies assessing the CROM in migraineurs are scarce. METHODS: Our sample was selected in an outpatient headache clinic, and consisted of 45 women aged 20-54 years old, 15 per group. Cervical mobility was evaluated in movements of flexion, extension, right lateral flexion, left lateral flexion, right rotation, and left rotation using the CROM technique, and was contrasted among the groups. Migraine clinical patterns were also evaluated (frequency, duration of migraine, pain in the moment of evaluation, pain in movement, and pain localization) as a function of CROM. RESULTS: Compared with controls, individuals with TM had numerically inferior CROM in all parameters, and significant reduction in 3 of them: extension (59.3 vs 68.1, P = .02), left lateral flexion (44.5 vs 49.1, P = .03), and right rotation (62.2 vs 69.6, P = .02). Compared with individuals with migraine, the TM group presented significantly reduced mobility only for extension (59.3 vs 68.4, P = .02). Migraineurs also had numerically inferior ROM, contrasted to controls, in 5 of the 6 parameters, although significance was seen just for right rotation (60.8 vs 68.6 P < .01). There was no correlation between cervical mobility and migraine parameters. The CROM was not reduced for the symptomatic side of migraine, in cases of unilateral pain. CONCLUSION: Contrasted to controls, individuals with episodic and TM have decreased cervical range of motion.


Subject(s)
Cervical Vertebrae/physiopathology , Migraine Disorders/diagnosis , Migraine Disorders/epidemiology , Neck Pain/diagnosis , Neck Pain/epidemiology , Range of Motion, Articular/physiology , Adult , Cervical Plexus/physiopathology , Comorbidity , Disability Evaluation , Female , Head Movements/physiology , Humans , Middle Aged , Migraine Disorders/physiopathology , Neck Muscles/physiopathology , Neck Pain/physiopathology , Observer Variation , Pain Measurement/methods , Pilot Projects , Predictive Value of Tests , Sensitivity and Specificity , Trigeminal Caudal Nucleus/physiopathology , Trigeminal Nerve/physiopathology , Young Adult , Zygapophyseal Joint/physiopathology
7.
J Headache Pain ; 9(5): 277-88, 2008 Oct.
Article in English | MEDLINE | ID: mdl-18668199

ABSTRACT

Thunderclap headache attributed to reversible cerebral vasoconstriction (THARCV) is a syndrome observed in a number of reported cases. In this article we reviewed this new headache entity (idiopathic form) using the clinical-radiological findings of 25 reported patients. In this series of patients 72% were women, the mean age at the onset of first headache episode was 39.4 +/- 2.3 years. In addition to the sine qua non condition of being abrupt and severe (thunderclap) at the onset, the headache was usually described as being explosive, excruciating, or crushing. The feature of pulsatility, accompanied or not by nausea was described by 80% of the patients. Forty percent of the cases manifested vomiting and 24% photophobia. Usually the headache was generalized, and in three cases it was unilateral at least at the onset. In 21 of 25 patients (84%) there was at least one recurrence or a sudden increase in the intensity of the headache. A past history of migraine was present in 52% of the patients. Precipitating factors were identified in 56% of the patients. Sexual intercourse was described by six patients. Of the 25 patients with THARCV syndrome studied, 12 (48%) developed focal neurological signs, transitory ischemic attack (n = 1), or ischemic stroke (n = 11, 44%), and two (8%) of them manifested seizures. The THARCV syndrome is a neurological disturbance perhaps more frequent than expected, preferentially affecting middle aged female migraineurs, and having an unpredictable prognosis, either showing a benign course or leading to stroke.


Subject(s)
Headache Disorders, Primary/etiology , Valsalva Maneuver , Vascular Diseases/complications , Vasoconstriction/physiology , Adult , Female , Humans , Male , Middle Aged , Young Adult
8.
Arq Neuropsiquiatr ; 65(2A): 352-4, 2007 Jun.
Article in English | MEDLINE | ID: mdl-17607444

ABSTRACT

BACKGROUND: Cases of patients who developed cluster headache-like symptoms after different putative causes have been reported, indicating a direct relationship between brain lesion and this particular type of headache. Long term, delayed, neurological sequelae after lightning have also been described. CASE REPORT: We describe the case of a woman who, at the age of 10, was struck by lightning. Six years later she developed cluster headache-like attacks. CONCLUSION: We hypothesize that a relationship between the lightning and the cluster headache-like episodes observed in our patient. This case study may have helped throw some light into the still unknown pathophysiology of this particular type of primary headache.


Subject(s)
Cluster Headache/etiology , Lightning Injuries/complications , Adolescent , Child , Cluster Headache/physiopathology , Female , Humans , Lightning Injuries/physiopathology
9.
Arq. neuropsiquiatr ; 65(2A): 352-354, jun. 2007. ilus
Article in English | LILACS | ID: lil-453942

ABSTRACT

BACKGROUND: Cases of patients who developed cluster headache-like symptoms after different putative causes have been reported, indicating a direct relationship between brain lesion and this particular type of headache. Long term, delayed, neurological sequelae after lightning have also been described. CASE REPORT: We describe the case of a woman who, at the age of 10, was struck by lightning. Six years later she developed cluster headache-like attacks. CONCLUSION: We hypothesize that a relationship between the lightning and the cluster headache-like episodes observed in our patient. This case study may have helped throw some light into the still unknown pathophysiology of this particular type of primary headache.


INTRODUÇÃO: Foram descritos casos de pacientes que desenvolveram cefaléia em salvas como manifestação secundária à diferentes causas, indicando uma relação direta entre uma lesão cerebral e este tipo particular de cefaléia. Seqüelas neurológicas tardias após injúria elétrica por raio também têm sido descritas. RELATO DO CASO: Nós descrevemos o caso de uma mulher que aos 10 anos de idade foi atingida por um raio. Seis anos mais tarde desenvolveu sintomatologia de cefaléia em salvas. CONCLUSÃO: Acreditamos que pode haver relação entre a injúria elétrica causada pelo raio e o aparecimento dos episódios semelhantes à cefaléia em salvas observados na nossa paciente. A provável fisiopatologia envolvida na gênese da cefaléia em salvas de origem secundária é discutida, particularmente em relação ao intervalo latente entre a injúria precipitante inicial e a fase álgica da cefaléia.


Subject(s)
Adolescent , Child , Female , Humans , Cluster Headache/etiology , Lightning Injuries/complications , Cluster Headache/physiopathology , Lightning Injuries/physiopathology
10.
Curr Pain Headache Rep ; 10(4): 306-11, 2006 Aug.
Article in English | MEDLINE | ID: mdl-16834947

ABSTRACT

The connection between headache and the cervical spine has been a theme of debate for decades. Cervicogenic headache is a headache related to the cervical spine that often is misdiagnosed and treated inadequately because of confusing and varying terminology. In this article, we discuss our experience in diagnosing and treating cervicogenic headache.


Subject(s)
Post-Traumatic Headache/diagnosis , Post-Traumatic Headache/physiopathology , Humans , Post-Traumatic Headache/drug therapy , Post-Traumatic Headache/surgery
11.
Headache ; 46(2): 312-6, 2006 Feb.
Article in English | MEDLINE | ID: mdl-16492241

ABSTRACT

OBJECTIVE: In this study we compare the clinical features of migraine attacks occurring in the elderly (60 to 70 years) and in younger migraineurs (20 to 40 years). BACKGROUND: Studies comparing the clinical features of migraine at different ages are still lacking. These studies are important for a better comprehension of the natural history of migraine, as well as to refine our recognition of the disease. METHODS: We retrospectively assessed subjects seen from 1995 to 2000 in a university-based outpatient headache clinic in Brazil. We reviewed 144 charts from patients 60 to 70 years (mean = 66.4). We applied a questionnaire based on the first edition of the International Classification of Headache Disorders (criteria for episodic migraine remained unchanged in the second edition). Controls were migraineurs from 20 to 40 years (mean = 32.6). RESULTS: Migraine occurred in 25% of the elderly and 29% of younger migraineurs (NS). A lower proportion of migraine attacks in the elderly were unilateral (38% vs. 57%, P < .01), or with associated symptoms (nausea = 75% vs. 86%, P = .05; vomiting = 30% vs. 54%, P < .05, photophobia and phonophobia = 83% vs. 94%, P < .05). Other symptoms such as paleness (P = .0441), dry mouth (P = .0093), and anorexia (P = .05) were more common in the elderly. CONCLUSION: Migraine is less typical in the elderly and more frequently associated with vegetative symptoms. Therefore, the diagnosis of migraine in elderly subjects may be more challenging, and many seniors with this primary headache can be misdiagnosed.


Subject(s)
Migraine Disorders/complications , Migraine Disorders/physiopathology , Adult , Age Factors , Aged , Brazil/epidemiology , Female , Humans , Male , Medical Records , Middle Aged , Migraine Disorders/epidemiology , Outpatients/statistics & numerical data , Pain Clinics/statistics & numerical data , Retrospective Studies , Surveys and Questionnaires
12.
J Headache Pain ; 6(5): 387-91, 2005 Oct.
Article in English | MEDLINE | ID: mdl-16362711

ABSTRACT

The purpose of our study was to prospectively evaluate the impact of preventive drug treatment on the quality of life of patients with episodic migraine (EM). Quality of life evaluations can enhance traditional measures of therapeutic efficacy. Thirty-five consecutive EM without aura patients attending a tertiary care unit (Batatais Headache Clinic) entered the study. They were given a prescription for preventive medication and completed the validated Portuguese version of the generic instrument Short Form-36 (SF-36) questionnaire. Six months later, patients were given another SF-36. We compared the pre-treatment and post-treatment scores for the SF-36 and analysed the headache diaries. The mean age of the 35 patients (32 women and 3 men) was 40.2 years (range 18-60 years). All 35 patients completed the pretreatment and follow-up SF-36. The pre-treatment and post-treatment mean frequency of migraine attacks was 9.16 and 2.4 crises per month, respectively (p<0.05). After the six months of preventive treatment, six of the eight domains evaluated by the SF-36 (role physical, bodily pain, general health, vitality, social function and mental health) showed statistically significant (p<0.05) improvement. The preventive treatment of migraine leads to a significant improvement in the quality of life of patients with EM. This improvement was measurable by the general quality of life instrument SF-36.


Subject(s)
Migraine Disorders/drug therapy , Migraine Disorders/prevention & control , Quality of Health Care/trends , Quality of Life/psychology , Surveys and Questionnaires/standards , Activities of Daily Living/psychology , Adolescent , Adult , Emotions/drug effects , Female , Humans , Male , Middle Aged , Migraine Disorders/psychology , Patient Satisfaction/statistics & numerical data , Predictive Value of Tests , Prospective Studies , Social Behavior
13.
Arq Neuropsiquiatr ; 62(3B): 769-73, 2004 Sep.
Article in English | MEDLINE | ID: mdl-15476066

ABSTRACT

OBJECTIVE: To evaluate the impact of ETTH on HRQoL in a sample of employees of a Brazilian public hospital. METHOD: Three hundred and sixty Mário Gatti Hospital employees were asked about headache occurrence in the previous 6 months and completed a SF-36 and a pain questionnaires concerning impact of pain (0 to 10 scale) on daily activities, work efficiency, leisure and social activities in previous six months. Two groups were studied: 1. Episodic Tension-type headache group: 127 employees -- 81 (63.8%) female and 46 (36.2%), male. 2. CONTROL GROUP: 124, 71 (57.3%) female and 53 (42.7%) male. RESULTS: ETTH had lowers scores than control in all domains of SF-36; in vitality and bodily pain the difference was statistically significant. CONCLUSION: Our results indicate that ETTH suffers have impact on HRQoL predominantly in vitality. Psychological factors associated to pain may explain this finding.


Subject(s)
Health Personnel , Quality of Life , Tension-Type Headache/psychology , Brazil , Case-Control Studies , Female , Hospitals, Public , Humans , Male , Pain Measurement , Surveys and Questionnaires
14.
Arq. neuropsiquiatr ; 62(3B): 769-773, set. 2004. graf
Article in English | LILACS | ID: lil-384123

ABSTRACT

OBJETIVO: Avaliar o Impacto de CTTE na QVRS em funcionários de um hospital brasileiro. MÉTODO: Trezentos e sessenta empregados do Hospital Mário Gatti, foram entrevistados. O questionário para avaliação da QVRS SF-36 foi aplicado e a ocorrência de cefaléia nos últimos seis meses foi avaliada. O impacto da dor nas atividades diárias, de lazer, sociais e eficiência no trabalho foi estimado(escala de zero a dez). RESULTADOS: Foram estudados dois grupos: 1. Cefaléia do tipo tensional episódica: 127 empregados - 81 (63,8%) mulheres e 46 (36,2%), homens. 2. Grupo Controle: 124 funcionários, 71 (57,3%) mulheres e 53 (42,7%) homens. As médias do grupo CTTE foram menores que as do grupo controle nos oito aspectos avaliados pelo SF-36. Nos aspectos vitalidade e dor a diferença foi estatisticamente significativa. CONCLUSÃO: os indivíduos com CTTE apresentaram pior QVRS, predominantemente no aspecto vitalidade. É possível que fatores psicológicos associados à dor possam explicar este achado.


Subject(s)
Female , Humans , Male , Health Personnel , Quality of Life , Tension-Type Headache/psychology , Brazil , Case-Control Studies , Hospitals, Public , Pain Measurement , Surveys and Questionnaires
15.
Headache ; 44(3): 244-8, 2004 Mar.
Article in English | MEDLINE | ID: mdl-15012662

ABSTRACT

BACKGROUND: The pathophysiology of the explosive type of headache associated with sexual activity is not completely understood. Five reported cases of patients with thunderclap headache, precipitated by sexual activity, in association with concomitant cerebral arterial narrowing, were found in the literature. METHODS: A 44-year-old woman with both coital and masturbatory headaches during orgasm associated with segmental reversible cerebral artery vasospasm was investigated. Cerebral anatomy and eventual spasm was documented by magnetic resonance imaging or digital angiography before, during, and after resolution of the orgasmic headache-vasospasm clinical manifestation. CONCLUSION: Findings of cerebral arterial narrowing, presented by some patients shortly after orgasmic headache attacks, support the hypothesis that segmental vasospasm may exert a role in the pathogenesis of this uncommon type of headache. The literature is reviewed, and possible mechanisms underlying the development of orgasmic headache are discussed.


Subject(s)
Coitus/physiology , Headache/physiopathology , Masturbation/physiopathology , Orgasm/physiology , Vasospasm, Intracranial/physiopathology , Acute Disease , Adult , Cerebral Angiography , Female , Humans , Magnetic Resonance Imaging , Vasospasm, Intracranial/diagnostic imaging
16.
Arq Neuropsiquiatr ; 61(3A): 596-600, 2003 Sep.
Article in Portuguese | MEDLINE | ID: mdl-14513164

ABSTRACT

About 60% of women with migraine associate their headache attacks to the menstrual period. Regarding the non-migrainous headaches, this relationship is not so clear. The aim of this study is to present a clinical evaluation of menstrual headaches. Menstrual headache in our study was defined as the headache that begins in the interval of time from 2 days before menstruation until the last day of the menstrual period. The analyzed parameters were: intensity, character and localization of the pain, and associated symptoms. The headaches of 100 women (154 periods) whose ages ranged from 20 to 45 years were analyzed. Most headaches were classified as migraine without aura; the headaches had strong intensity in the first day of pain and reduced gradually until the last day of pain. The headaches were mostly of throbbing character and, in some moment of the menstrual period, referred as unilateral; the duration of these headaches was of longer duration than the migraine attacks reported in medical literature. Most part of the headaches began two days before the first day of the menstrual flow. Nauseas and/or vomiting were the most frequent associated symptoms. Finally, we found, among the menstrual headaches, 9 cases of tension type headache, 2 cases of cervicogenic headache and 1 case of stabbing headache.


Subject(s)
Headache/etiology , Menstrual Cycle , Adult , Female , Headache/classification , Headache/physiopathology , Humans , Middle Aged , Migraine Disorders/etiology , Migraine Disorders/physiopathology , Pain Measurement , Prospective Studies , Tension-Type Headache/etiology , Tension-Type Headache/physiopathology , Time Factors
17.
Arq. neuropsiquiatr ; 61(3A): 596-600, Sept. 2003. tab, graf
Article in Portuguese | LILACS | ID: lil-345773

ABSTRACT

Ao redor de 60 por cento das mulheres com migrânea associam o período menstrual com a desencadear das crises. Para cefaléias näo migranosas, essa relaçäo é menos evidente. O objetivo desse estudo é apresentar a caracterizaçäo clínica da cefaléia menstrual. Cefaléia menstrual foi conceituada, em nosso estudo, como aquela cefaléia compreendida entre dois dias antes do primeiro dia da menstruaçäo e o último dia da mesma. As variáveis avaliadas foram: intensidade, características e localizaçäo da dor e dos sintomas associados. Foi analisada a cefaléia de 100 mulheres (154 períodos menstruais), com idades entre 20 e 45 anos. A maior parte foi classificada como migrânea sem aura; a intensidade era severa no primeiro dia de dor, com reduçäo gradativa nos dias subseqüentes; as cefaléias eram predominantemente de qualidade latejante, referidas como unilaterais em algum momento do ciclo menstrual; a duraçäo foi maior que a tradicionalmente referida na literatura. A maior parte se iniciou dois dias antes do início do ciclo menstrual. Náuseas e/ou vômitos foram os sintomas associados mais freqüentes. Foram diagnosticados 9 casos de cefaléia do tipo tensional, 2 casos de cefaléia cervicogênica e 1 caso de cefaléia em pontadas


Subject(s)
Humans , Female , Adult , Middle Aged , Headache , Menstrual Cycle , Headache , Migraine Disorders , Pain Measurement , Prospective Studies , Tension-Type Headache , Time Factors
18.
Headache ; 43(7): 742-54, 2003.
Article in English | MEDLINE | ID: mdl-12890129

ABSTRACT

BACKGROUND: The search for rationality in health expenses in developing countries collides with the lack of effectively conducted epidemiologic studies. PURPOSE: To present an estimate of the impact and costs of migraine in the Brazilian public health system and to estimate the impact on these costs and the effectiveness of a model of stratified care in the management of migraine. METHODS: An analytical model of utilization of the Brazilian public health system was constructed. Data refer to 1999 and were obtained in accordance with the following steps: (1) Brazilian demographic characteristics; (2) characteristics of the public health system related to its 3 hierarchical levels-primary, secondary, and tertiary care, the last being subdivided into emergency department and hospital care; and (3) estimation of the number of migraine consultations at each complexity level. In Brazil, migraineurs seen in the public health system are most often discharged with an acute treatment, usually a nonspecific medication. We compared this treatment with a proposed stratified care model that uses a triptan as an acute care medication. We have made the following assumptions: (1) 15% of the patients would fall into the Migraine Disability Assessment (MIDAS) grade I category, 25% would fall into the MIDAS grade II category, 30% into the grade III category, and 30% into the MIDAS grade IV category; (2) the mean number of migraine attacks per year are: MIDAS I, 7.49; MIDAS II, 8.02; MIDAS III, 12.22; and MIDAS IV, 27.01. The annual costs of the treatment were calculated according to the following equation: AC = P x N x C + P x Cp + P x Cat x AMA, where P is the number of patients; N, the number of consultations per patient; C, the cost of consultation per level; Cp, the cost of preventive drugs; Cat, the cost of acute therapy drugs; and AMA is the number of migraine attacks per year. Results.-The public health system resources included 55 735 ambulatory units (primary and secondary) and 6453 emergency department and public hospital units, with a corresponding budget of US $2 820 899 621.26. The estimated cost of a consultation on the primary care level was US $11.53; on the secondary care level, US $22.18; in the emergency department, $34.82; and for hospitalization, US $217.93. The total estimated public health system expenses for migraine were US $140 388 469.60. The proposed model would imply a cost reduction of 6.2% (US $7 514 604.40) with an improvement in the quality of the public health system from the actual 18.2% to an estimated 84.5%. CONCLUSION: Migraine seems to pose a huge burden on the Brazilian public health system. The implementation of a stratified care model of treatment that would include specific acute migraine therapies could result in a dramatic increase in the quality of migraine care and a significant reduction in cost.


Subject(s)
Cost of Illness , Migraine Disorders/economics , Migraine Disorders/therapy , National Health Programs/economics , Brazil/epidemiology , Cost-Benefit Analysis , Costs and Cost Analysis , Drug Therapy/classification , Drug Therapy/economics , Humans , Migraine Disorders/epidemiology , Models, Theoretical , National Health Programs/statistics & numerical data
19.
Arq Neuropsiquiatr ; 61(2A): 313-20, 2003 Jun.
Article in English | MEDLINE | ID: mdl-12806521

ABSTRACT

The migraine-specific triptans have revolutionized the treatment of migraine and are usually the drugs of choice to treat a migraine attack in progress. Different triptans are available in different strengths and formulations including oral tablets, orally disintegrating tablets, nasal sprays and subcutaneous injections. In Europe, sumatriptan is also available as a suppository. Specific differences among the triptans exist as evidenced by different pharmacological profiles including T1/2, Tmax, Cmax, AUC, metabolism, drug-drug interaction profiles, amongst other parameters. How or whether these differences translate to clinical efficacy and tolerability differences is not well differentiated. Clinical distinctions among these agents are subtle and proper choice of triptan requires attention to the specific characteristics of each individual patient, knowledge of patient preference, accurate history of the efficacy of previous acute care medications as well as individual features of the drug being considered. Delivery systems may play an important role in the onset of action of triptans. The selection of an acute antimigraine drug for a patient depends upon the stratification of the patient's migraine attack by peak intensity, time to peak intensity, level of associated symptoms such as nausea and vomiting, time to associated symptoms, comorbid diseases, and concomitant treatments that might cause drug-drug interactions. The clinician has in his armamentarium an ever-expanding variety of medications, available in multiple formulations and dosages, with good safety and tolerability profiles. Continued clinical use will yield familiarity with the various triptans, and it should become possible for the interested physician to match individual patient needs with the specific characteristics of a triptan to optimize therapeutic benefit.


Subject(s)
Analgesics/therapeutic use , Migraine Disorders/drug therapy , Serotonin Receptor Agonists/therapeutic use , Analgesics/pharmacology , Humans , Serotonin Receptor Agonists/pharmacology
20.
Arq. neuropsiquiatr ; 61(2A): 313-320, Jun. 2003. tab
Article in English | LILACS | ID: lil-339511

ABSTRACT

The migraine-specific triptans have revolutionized the treatment of migraine and are usually the drugs of choice to treat a migraine attack in progress. Different triptans are available in different strengths and formulations including oral tablets, orally disintegrating tablets, nasal sprays and subcutaneous injections. In Europe, sumatriptan is also available as a suppository. Specific differences among the triptans exist as evidenced by different pharmacological profiles includingT«, Tmax, Cmax, AUC, metabolism, drug-drug interaction profiles, amongst other parameters. How or whether these differences translate to clinical efficacy and tolerability differences is not well differentiated. Clinical distinctions among these agents are subtle and proper choice of triptan requires attention to the specific characteristics of each individual patient, knowledge of patient preference, accurate history of the efficacy of previous acute care medications as well as individual features of the drug being considered. Delivery systems may play an important role in the onset of action of triptans. The selection of an acute antimigraine drug for a patient depends upon the stratification of the patient's migraine attack by peak intensity, time to peak intensity, level of associated symptoms such as nausea and vomiting, time to associated symptoms, comorbid diseases, and concomitant treatments that might cause drug-drug interactions. The clinician has in his armamentarium an ever-expanding variety of medications, available in multiple formulations and dosages, with good safety and tolerability profiles. Continued clinical use will yield familiarity with the various triptans, and it should become possible for the interested physician to match individual patient needs with the specific characteristics of a triptan to optimize therapeutic benefit


Subject(s)
Humans , Analgesics , Migraine Disorders , Serotonin Receptor Agonists , Analgesics , Serotonin Receptor Agonists
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