ABSTRACT
BACKGROUND: High-frequency repetitive transcranial magnetic stimulation of the left dorsolateral prefrontal cortex (rTMS-DLPFC) is an effective treatment for depression. Preliminary studies indicated beneficial effects of rTMS-DLPFC on pain relief in patients treated for depression, and in patients with chronic migraine. METHODS: In this randomized, double-blind, parallel-group, single-center, proof-of-principle clinical trial, we tested the hypothesis that 23 sessions of active rTMS-DLPFC delivered over eight weeks would be feasible, safe and superior to sham rTMS to decrease the number of headache days in 18 patients with chronic migraine without severe depression. Per-protocol analysis was performed. RESULTS: rTMS-DLPFC applied over eight weeks was feasible and safe in patients with chronic migraine. Contrary to our primary hypothesis, the number of headache days decreased significantly more in the sham group than in the group treated with active rTMS-DLPFC at eight weeks. Average decrease in headache days was >50% in the sham group, indicating a powerful placebo response. Pain intensity improved in both groups to a similar extent. CONCLUSIONS: Positive results of M1 stimulation in other studies, and the absence of significant benefits of active high-frequency rTMS of the DLPFC in the present study, point to M1 as a more promising target than the DLPFC, for larger trials of noninvasive brain stimulation in patients with chronic migraine.
Subject(s)
Migraine Disorders/therapy , Transcranial Magnetic Stimulation/methods , Adult , Double-Blind Method , Feasibility Studies , Female , Humans , Male , Migraine Disorders/physiopathology , Prefrontal Cortex/physiopathology , Treatment OutcomeABSTRACT
AIMS: The aim of the present study was to evaluate the association between generalized anxiety disorder, subthreshold anxiety (SubAnx) and anxiety symptoms in the prevalence of primary headache. METHODS: This cross-sectional study evaluated 383 people from a Brazilian low-income community. One-year prevalence rates of migraine, chronic migraine and tension-type headache were calculated. Anxiety symptoms were then separated into the following groups (based on DSM-IV criteria): no anxiety criteria; one anxiety criterion; two anxiety criteria; and generalized anxiety disorder (GAD). The control group (no headaches) was compared with headache sufferers for each anxiety group using an adjusted model controlled for confounding factors. RESULTS: GAD was present in 37.0% of participants and SubAnx in 16.6%. Those with SubAnx had a 2.28-fold increased chance of having migraine; 3.83-fold increased chance of having chronic migraine, a 5.94-fold increased chance of having tension-type headache and a 3.27-fold increased chance of having overall headache. Some anxiety criteria (irritability, difficulty with sleep, concentration problems, muscle tension and fatigue) had similar prevalence to International Classification of Headache Disorders (ICHD-II) headache criteria such as unilateral pain and nausea for migraine and chronic migraine. CONCLUSION: Headache sufferers seem to have a high prevalence of anxiety symptoms and SubAnx. In addition, the presence of two or more anxiety criteria (not necessarily fulfilling all the criteria for GAD) was associated with having a headache disorder.
Subject(s)
Anxiety Disorders/epidemiology , Anxiety/epidemiology , Headache Disorders/epidemiology , Headache/epidemiology , Adolescent , Adult , Anxiety/psychology , Anxiety Disorders/psychology , Brazil/epidemiology , Comorbidity , Cross-Sectional Studies , Female , Headache/psychology , Headache Disorders/psychology , Humans , Male , Middle Aged , Poverty , PrevalenceABSTRACT
OBJETIVO: Avaliar a prevalência de transtornos psiquiátricos em pacientes com diagnóstico de enxaqueca crônica com e sem uso excessivo de medicação sintomática. MÉTODOS: Setenta e dois voluntários foram recrutados a partir de um Programa de Saúde da Família da comunidade de Paraisópolis, na cidade de São Paulo (SP). Esses pacientes foram submetidos a exames clínico e neurológico. As seguintes variáveis foram analisadas: idade, gênero, nível educacional, índice de massa corporal, tipo de uso excessivo de medicação, características da cefaleia, consumo de cafeína, presença de ansiedade e distúrbios de humor. RESULTADOS: Dos 72 pacientes, 50 (69%) tinham cefaleia crônica, com uso exagerado de medicação, e 22 (31%) tinham cefaleia crônica, sem uso excessivo de medicação. Os fatores idade, gênero, nível educacional, índice de massa corporal, tipo de uso excessivo de medicação, características da cefaleia e consumo de cafeína não mostraram diferença significante entre os grupos estudados. Os diagnósticos de ansiedade e de distúrbios de humor ao longo da vida foram mais comuns nos pacientes com uso excessivo de medicação (p=0,003 e p=0,045, respectivamente). CONCLUSÃO: Este estudo mostrou uma associação significativa entre cefaleia crônica e uso excessivo de medicação nos pacientes avaliados, quanto ao diagnóstico de transtornos de ansiedade e de humor ao longo da vida. Não foi encontrada nenhuma associação com outros distúrbios psiquiátricos pesquisados.
OBJECTIVE: To evaluate the prevalence of psychiatric disorders in patients diagnosed with chronic migraine with and without acute medication overuse. METHODS: Seventy-two volunteers were recruited from a Family Health Program of the Paraisópolis community in São Paulo (SP), Brazil. These patients were submitted to a detailed headache questionnaire. All participants were submitted to physical and neurological examinations. The following variables were analyzed: age, gender, education level, body mass index, type of overused medication, headache characteristics, and caffeine consumption, lifetime anxiety and mood disorders. RESULTS: Out of 72 patients, 50 (69%) had chronic migraine with medication overuse, and 22 (31%) had chronic migraine without medication overuse. Factors such as age, gender, education level, body mass index, type of overused medication, headache characteristics, and caffeine consumption were not significantly different between the two studied groups. Lifetime anxiety and mood disorders were more common in patients with acute medication overuse (p=0.003 and p=0.045, respectively). CONCLUSION: This study has shown a significant association among chronic migraine and medication overuse with lifetime mood and anxiety disorders in patients of the studied population. No association was found for other researched psychiatric disorders.
Subject(s)
Chronic Disease , Comorbidity , Mental Disorders , Prevalence , Migraine Disorders/drug therapyABSTRACT
OBJECTIVE: To evaluate the prevalence of psychiatric disorders in patients diagnosed with chronic migraine with and without acute medication overuse. METHODS: Seventy-two volunteers were recruited from a Family Health Program of the Paraisópolis community in São Paulo (SP), Brazil. These patients were submitted to a detailed headache questionnaire. All participants were submitted to physical and neurological examinations. The following variables were analyzed: age, gender, education level, body mass index, type of overused medication, headache characteristics, and caffeine consumption, lifetime anxiety and mood disorders. RESULTS: Out of 72 patients, 50 (69%) had chronic migraine with medication overuse, and 22 (31%) had chronic migraine without medication overuse. Factors such as age, gender, education level, body mass index, type of overused medication, headache characteristics, and caffeine consumption were not significantly different between the two studied groups. Lifetime anxiety and mood disorders were more common in patients with acute medication overuse (p=0.003 and p=0.045, respectively). CONCLUSION: This study has shown a significant association among chronic migraine and medication overuse with lifetime mood and anxiety disorders in patients of the studied population. No association was found for other researched psychiatric disorders.
Subject(s)
Analgesics/adverse effects , Mental Disorders/chemically induced , Migraine Disorders/drug therapy , Adolescent , Adult , Aged , Body Mass Index , Brazil , Chronic Disease , Educational Status , Female , Humans , Male , Middle Aged , Risk Factors , Surveys and Questionnaires , Young AdultABSTRACT
Studies have suggested that the high comorbidity observed between chronic migraine and anxiety disorders can be mediated through a third factor namely increased sensitivity to aversive stimulation. This trait may predispose for both chronic migraines, through medication overuse as an avoidance response, and anxiety disorders. Additional studies have shown that hyper sensitivity to aversive stimulation, migraine chronification and anxiety disorders share other characteristics such as serotonergic mediation and personality traits. Preliminary analysis of empirical data comparing the frequency the impact of traumatic events over chronic [CM] and episodic migraine [EM] patients gives further support to this hypothesis. In spite of CM and EM did not differ in terms of the occurrence of traumatic events, CM patients that had experienced at least one traumatic event during their lives had higher scores in re-experiencing and avoidance (but not in hyperarousal) symptoms than CM patients. These observations suggest that traumatic events have greater impact over CM than over EM patients.
Subject(s)
Avoidance Learning , Migraine Disorders/physiopathology , Stress Disorders, Post-Traumatic/physiopathology , HumansABSTRACT
BACKGROUND: Migraine is a chronic neurological disease with several trigger factors, including dietary, hormonal and environmental factors. PURPOSE: To analyse precipitating factors in a sample of migraine patients. METHOD: Two hundred consecutive migraine patients were interviewed about possible trigger factors for migraine attacks. RESULTS: Most patients showed at least one dietary trigger, fasting was the most frequent one, followed by alcohol and chocolate. Hormonal factors appeared in 53%, being the pre-menstrual period the most frequent trigger. Physical activities caused migraine in 13%, sexual activities in 2.5% and 64% reported emotional stress a trigger factor. 81% related some sleep problem as a trigger factor. Regarding environmental factors, smells were reported by 36.5%. CONCLUSION: Trigger factors are frequent in migraine patients, its avoidance may decrease headache frequency and also improve patients' quality of life.
Subject(s)
Diet/adverse effects , Fasting/adverse effects , Migraine Disorders/etiology , Cacao , Candy/adverse effects , Chronic Disease , Environment , Ethanol/adverse effects , Female , Gonadal Steroid Hormones/physiology , Humans , Male , Middle Aged , Migraine Disorders/chemically induced , Motor Activity , Premenstrual Syndrome/complications , Sexual Behavior , Sleep Wake Disorders/complications , Smell , Stress, Psychological/complicationsABSTRACT
BACKGROUND: Migraine is a chronic neurological disease with several trigger factors, including dietary, hormonal and environmental factors. PURPOSE: To analyse precipitating factors in a sample of migraine patients. METHOD: Two hundred consecutive migraine patients were interviewed about possible trigger factors for migraine attacks. RESULTS: Most patients showed at least one dietary trigger, fasting was the most frequent one, followed by alcohol and chocolate. Hormonal factors appeared in 53 percent , being the pre-menstrual period the most frequent trigger. Physical activities caused migraine in 13 percent, sexual activities in 2.5 percent and 64 percent reported emotional stress a trigger factor. 81 percent related some sleep problem as a trigger factor. Regarding environmental factors, smells were reported by 36.5 percent. CONCLUSION: Trigger factors are frequent in migraine patients, its avoidance may decrease headache frequency and also improve patients' quality of life.
INTRODUÇÃO: A enxaqueca é uma doença neurológica crônica que apresenta diversos desencadeantes como fatores alimentares, hormonais e ambientais. OBJETIVO: Analisar os fatores desencadeantes em uma amostra de pacientes com enxaqueca. MÉTODO: Duzentos pacientes com diagnóstico de enxaqueca foram questionados sobre fatores que pudessem desencadear suas crises. RESULTADOS: 83,5 por cento apresentaram algum fator alimentar, jejum foi o fator mais freqüente, seguido de álcool e chocolate. Dos fatores hormonais, o período pré-menstrual foi o mais freqüente. Atividade física causou enxaquecas em 13 por cento, atividade sexual em 2,5 por cento, estresse em 64 por cento e 81 por cento relataram o sono como fator desencadeante. Em relação aos fatores ambientais, odores foram desencadeantes em 36,5 por cento. CONCLUSÃO: Os fatores desencadeantes são freqüentes em enxaqueca e a sua detecção deve ser pormenorizada para que se reduza a freqüência de crises e melhore a qualidade de vida do paciente.
Subject(s)
Female , Humans , Male , Middle Aged , Diet/adverse effects , Fasting/adverse effects , Migraine Disorders/etiology , Cacao , Chronic Disease , Candy/adverse effects , Environment , Ethanol/adverse effects , Gonadal Steroid Hormones/physiology , Motor Activity , Migraine Disorders/chemically induced , Premenstrual Syndrome/complications , Sexual Behavior , Smell , Sleep Wake Disorders/complications , Stress, Psychological/complicationsABSTRACT
INTRODUCTION: Chronic migraine is a common, debilitating condition affecting quality of life and social functioning with significant impact. Migraine is highly comorbid with anxiety and mood disorders, but little is known about psychiatric comorbidities impact in the migraine patient quality of life. METHOD: Fifty patients with chronic migraine diagnosed according to the International Headache Society (2004) were interviewed and met diagnostic criteria for mental disorders, according to the structured interview SCID-I/P and were evaluated by the SF-36 Health Survey questionnaire. Patients were divided in the following groups: chronic migraine with both mood and anxiety disorders, with only anxiety disorders, with generalized anxiety disorder, with only a mood disorder, and without psychopathology. The scores in the group without psychopathology were compared with the other groups. All eight domains of the SF-36 scale were compared in those groups. RESULTS: Significantly lower (p<0.05) quality of life was found on all eight SF-36 domains for CM psychiatric comorbidity patients compared to no-co morbidity patients. On the SF-36 General Health domain alone, quality of life was not significantly lower for all four CM psychiatric comorbidity groups. On the SF-36 Physical Aspects domain alone, quality of life was not significantly lower only for the Anxiety Disorders group. CONCLUSION: Chronic migraine comorbidity with mental disorder is a significant factor affecting patients' quality of life.
Subject(s)
Anxiety Disorders/epidemiology , Depressive Disorder, Major/epidemiology , Migraine Disorders/epidemiology , Quality of Life , Anxiety Disorders/diagnosis , Anxiety Disorders/psychology , Chronic Disease , Comorbidity , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/psychology , Female , Humans , Interview, Psychological , Male , Migraine Disorders/psychology , Surveys and QuestionnairesABSTRACT
INTRODUÇÃO: A enxaqueca apresenta elevada comorbidade com os transtornos de humor e de ansiedade e extremo impacto no grau de incapacidade e qualidade de vida do indivíduo afetado, mas pouco se sabe sobre a qualidade de vida dos pacientes com enxaqueca crônica e o impacto das comorbidades psiquiátricas. MÉTODO: Cinquenta pacientes com diagnóstico de enxaqueca crônica (Sociedade Internacional de Cefaléias, 2004) foram diagnosticados quanto à presença de transtornos mentais, através da entrevista estruturada SCID-I/P e do questionário de qualidade de vida SF-36. Pacientes foram divididos nos seguintes grupos: enxaqueca crônica com transtornos de ansiedade, transtorno de ansiedade generalizada, transtornos de ansiedade com pelo menos um episódio depressivo maior, com episódio depressivo maior, comparados a pacientes sem comorbidade psiquiátrica. RESULTADOS: Constatou-se qualidade de vida significativamente inferior nos oito domínios da SF-36, nos pacientes com enxaqueca crônica associada a comorbidade psiquiátrica tais como transtornos de ansiedade, transtorno de ansiedade generalizada, transtornos de ansiedade com pelo menos um episódio depressivo maior, assim como nos pacientes apenas com episódio depressivo maior, comparados a pacientes com enxaqueca crônica sem comorbidade psiquiátrica (p<0,05). Somente no domínio Estado Geral de Saúde do SF-36, a qualidade de vida não foi significativamente inferior em todos os grupos de pacientes com enxaqueca crônica associada a comorbidade psiquiátrica. Nos domínios do SF-36 relacionados aos aspectos físicos, a qualidade de vida não foi significativamente inferior somente nos transtornos de ansiedade. CONCLUSÃO: A comorbidade da enxaqueca crônica e transtornos mentais é fator associado à piora da qualidade de vida dos pacientes e deve ser ativamente pesquisada nesta população.
INTRODUCTION: Chronic migraine is a common, debilitating condition affecting quality of life and social functioning with significant impact. Migraine is highly comorbid with anxiety and mood disorders, but little is known about psychiatric comorbidities impact in the migraine patient quality of life. METHOD: Fifty patients with chronic migraine diagnosed according to the International Headache Society (2004) were interviewed and met diagnostic criteria for mental disorders, according to the structured interview SCID-I/P and were evaluated by the SF-36 Health Survey questionnaire. Patients were divided in the following groups: chronic migraine with both mood and anxiety disorders, with only anxiety disorders, with generalized anxiety disorder, with only a mood disorder, and without psychopathology. The scores in the group without psychopathology were compared with the other groups. All eight domains of the SF-36 scale were compared in those groups. RESULTS: Significantly lower (p<0.05) quality of life was found on all eight SF-36 domains for CM psychiatric comorbidity patients compared to no-co morbidity patients. On the SF-36 General Health domain alone, quality of life was not significantly lower for all four CM psychiatric comorbidity groups. On the SF-36 Physical Aspects domain alone, quality of life was not significantly lower only for the Anxiety Disorders group. CONCLUSION: Chronic migraine comorbidity with mental disorder is a significant factor affecting patients' quality of life.
Subject(s)
Female , Humans , Male , Anxiety Disorders/epidemiology , Depressive Disorder, Major/epidemiology , Migraine Disorders/epidemiology , Quality of Life , Anxiety Disorders/diagnosis , Anxiety Disorders/psychology , Chronic Disease , Comorbidity , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/psychology , Interview, Psychological , Migraine Disorders/psychology , Surveys and QuestionnairesABSTRACT
Psychiatric comorbidity, mainly anxiety and depression, are common in chronic migraine (CM). Phobias are reported by half of CM patients. Phobic avoidance associated with fear of headache or migraine attack has never been adequately described. We describe 12 migraine patients with particular phobic-avoidant behaviours related to their headache attacks, which we classified as a specific illness phobia, coined as cephalalgiaphobia. All patients were women, mean age 42, and all had a migraine diagnosis (11 CM, all overused acute medications). Patients had either a phobia of a headache attack during a pain-free state or a phobia of pain worsening during mild headache episodes. Patients overused acute medication as phobic avoidance. It is a significant problem, associated with distress and impairment, interfering with medical care. Cephalalgiaphobia is a possible specific phobia of illness, possibly linked to progression of migraine to CM and to acute medication overuse headache.
Subject(s)
Migraine Disorders/complications , Migraine Disorders/psychology , Phobic Disorders/etiology , Adult , Disease Progression , Female , Humans , Middle Aged , Phobic Disorders/pathologyABSTRACT
BACKGROUND: Comorbidity of chronic migraine (CM) with psychiatric disorders, mostly anxiety and mood disorders, is a well-recognized phenomenon. Phobias are one of the most common anxiety disorders in the general population. Phobias are more common in migraineurs than non-migraineurs. The clinical profile of phobias in CM has never been studied. METHOD: We investigated the psychiatric profile in 56 patients with CM using the SCID I/P interview. RESULTS: Lifetime criteria for at least one mental disorder was found in 87.5 percent of the sample; 75 percent met criteria for at least one lifetime anxiety disorder and 60.7 percent of our sample fulfilled DSM-IV criteria for lifetime phobic avoidant disorders. Mood and anxiety scores were higher in phobic patients than in non-phobic CM controls. Number of phobias correlated with higher levels of anxiety and depression. CONCLUSION: Phobias are common in CM. Its recognition may influence its management. Early treatment may lead to better prognosis.
INTRODUÇÃO: As comorbidades psiquiátricas das enxaquecas crônicas são bem conhecidas. As fobias, transtorno ansioso mais comum, são mais prevalentes entre enxaquecosos do que entre não enxaquecosos. O perfil clínico de fobias em uma população enxaquecosa nunca foi estudado. MÉTODO: Estudamos aspectos psiquiátricos de uma população de 56 pacientes com enxaqueca crônica. RESULTADOS: Usando o SCID I/P para o DSM-IV, critérios diagnósticos para ao menos algum transtorno psiquiátrico durante a vida foram preenchidos por 87,5 por cento de nossa amostra, 75 por cento para ao menos um transtorno ansioso e 60,7 por cento para condições fóbicas em algum momento de suas vidas. Os escores de ansiedade e humor foram maiores entre os fóbicos e o número de fobias teve correlação positiva com o grau de ansiedade e depressão. CONCLUSÃO: Fobias são comuns na enxaqueca crônica e seu reconhecimento poderia influenciar seu manejo e melhorar seu prognóstico.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Migraine Disorders/psychology , Phobic Disorders/epidemiology , Chronic Disease , Comorbidity , Incidence , Psychiatric Status Rating Scales , Phobic Disorders/diagnosis , Phobic Disorders/psychology , Severity of Illness IndexABSTRACT
BACKGROUND: Comorbidity of chronic migraine (CM) with psychiatric disorders, mostly anxiety and mood disorders, is a well-recognized phenomenon. Phobias are one of the most common anxiety disorders in the general population. Phobias are more common in migraineurs than non-migraineurs. The clinical profile of phobias in CM has never been studied. METHOD: We investigated the psychiatric profile in 56 patients with CM using the SCID I/P interview. RESULTS: Lifetime criteria for at least one mental disorder was found in 87.5% of the sample; 75% met criteria for at least one lifetime anxiety disorder and 60.7% of our sample fulfilled DSM-IV criteria for lifetime phobic avoidant disorders. Mood and anxiety scores were higher in phobic patients than in non-phobic CM controls. Number of phobias correlated with higher levels of anxiety and depression. CONCLUSION: Phobias are common in CM. Its recognition may influence its management. Early treatment may lead to better prognosis.
Subject(s)
Migraine Disorders/psychology , Phobic Disorders/epidemiology , Adult , Chronic Disease , Comorbidity , Female , Humans , Incidence , Male , Middle Aged , Phobic Disorders/diagnosis , Phobic Disorders/psychology , Psychiatric Status Rating Scales , Severity of Illness IndexABSTRACT
INTRODUCTION: Chronic migraine (CM) is a common medical condition affecting 2.4% of the general population. Depression is one of the most frequent comorbid disorders in CM. METHOD: Seventy patients diagnosed with chronic migraine were studied. All patients evaluated filled out the Beck Depression Inventory (BDI). Depression severity was divided into none or minimal depression, mild, moderate, and severe. RESULTS: BDI ranged from 4 to 55, mean 21 +/- 10.7. Moderate or severe depression, were present in 58.7% of the patients. Some degree of depression appeared in 85.8% of patients. The BDI scores correlated with pain intensity (p = 0.02). Severe depression was more frequent in patients with comorbid fibromyalgia and in patients reporting fatigue. CONCLUSION: The BDI is an easy tool to access depression in CM patients. Suicide risk assessment is needed in CM patients. Patients with fibromyalgia and fatigue are at even higher risk for severe depression.
Subject(s)
Depression/epidemiology , Migraine Disorders/psychology , Adolescent , Adult , Aged , Analysis of Variance , Chronic Disease , Comorbidity , Depression/diagnosis , Female , Humans , Male , Middle Aged , Migraine Disorders/epidemiology , Psychiatric Status Rating Scales , Risk Factors , Severity of Illness IndexABSTRACT
INTRODUÇÃO: A migrânea crônica (MC) é uma doença comum, que afeta 2,4% da população geral. A depressão é uma das comorbidades mais frequentes em enxaqueca. MÉTODO: Setenta pacientes diagnosticados com migrânea crônica foram estudados. Todos os pacientes preencheram o Inventário de Depressão Beck.(BDI). A gravidade da depressão foi dividida em nenhuma ou leve, mínima, moderada, e grave. RESULTADOS: O BDI variou de 4 a 55, média 21 ± 10,7. A depressão moderada ou grave esteve presente em 58,7% dos pacientes. Algum grau de depressão foi observado em 85,8% dos pacientes. Os escores de depressão correlacionaram-se com a intensidade da dor. A depressão grave foi mais freqüente em paciente com comorbidade com fibromialgia e fadiga. CONCLUSÃO: O BDI é um instrumento de fácil avaliação da depressão em MC. A identificação do risco de suicídio é necessária nestes pacientes. Fibromialgia e fadiga são fatores de risco para depressão grave.
