Association of mental health symptoms with the migraine-tension-type headache spectrum in the Brazilian longitudinal study of adult health.

OBJECTIVE: To investigate the relationship between mental health symptoms and the migraine-tension-type headache (TTH) spectrum in middle-aged adults from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil study). METHODS: In this cross-sectional analysis (baseline data: 2008-2010), it was evaluated the relationship between each mental health symptom assessed by the Clinical Interview Schedule-Revised (CIS-R) questionnaire and headache subtypes (migraine and TTH) according to international criteria. It was performed binary logistic regression models, with estimated odds ratios (OR) with their respective 95% confidence intervals (CI) adjusted for confounders including migraine attack frequency. RESULTS: Among 13,916 participants, 70.1% reported any major primary headache subtype within the last year. The most common subtype was definite TTH (33.4%), followed by probable migraine (21.0%), definite migraine (8.5%), and probable TTH (7.2%). Our main findings indicated positive associations between anxiety-related symptoms and the migraine-tension type headache (TTH) spectrum with a clear trend toward definite migraine more than tension-type headache. The presence of somatic symptoms presented a high likelihood for the associations with headaches, mainly definite migraine (OR: 7.9, 95% CI: 6.4-9.8), probable migraine (OR: 4.5, 95% CI 3.7-5.4) and probable TTH (OR: 3.0, 95% CI: 2.3-3.8). Other symptoms associated with headache disorders included fatigue, panic, irritability, anxiety symptoms, concentration problems, forgetfulness, depressive symptoms, and worry. The effect of associations remained significant after controlling for headache attack frequency. CONCLUSION: This study provides evidence of consistent associations between mental health symptoms and primary headache disorders, with a higher burden of anxiety-based symptoms observed in people with migraine than those with TTH.

Profile of leisure-time physical activity and sedentary behavior in adults in Brazil: a nationwide survey, 2019.

OBJECTIVES: to estimate the prevalence of leisure-time physical activity and sedentary behavior in adults in Brazil. METHODS: this was a cross-sectional, population-based study carried out in a sample of 88,531 Brazilians, using data from the 2019 National Health Survey; leisure-time physical activity (overall and aerobic exercise) was measured according to the World Health Organization guidelines; the weighted prevalence and respective 95% confidence intervals (95%CI) of physical activity, physical inactivity and sedentary behavior were estimated. RESULTS: according to the selected sample, 26.4% (95%CI 25.9;27.1) of Brazilian adults were physically active, 14.0% (95%CI 13.5;14.4) were insufficiently physically active and 59.5% (95%CI 58.8;60.2) were physically inactive; sedentary behavior ≥ 6 hours was reported by 30.1% (95%CI 29.5;30.8) of the population; only 8.6% (95%CI 8.2;8.9) met the recommendations for muscle-strengthening activities. CONCLUSION: most Brazilian adults were physically inactive and did not meet international recommendations for leisure-time physical activity and reduction in sedentary behavior.

The increasing role of electronic media in headache.

Most individuals with access to the internet use social media platforms. These platforms represent an excellent opportunity to disseminate knowledge about management and treatment to the benefit of patients. The International Headache Society, The European Headache Federation, and The American Headache Society have electronic media committees to promote and highlight the organizations' expertise and disseminate research findings. A growing mistrust in science has made dealing with infodemics (i.e., sudden access to excessive unvetted information) an increasing part of clinical management. An increasing role of these committees will be to address this challenge. As an example, recent studies have demonstrated that the most popular online content on migraine management is not evidence-based and is disseminated by for-profit organizations. As healthcare professionals and members of professional headache organizations, we are obliged to prioritize knowledge dissemination. A progressive social media strategy is associated not only with increased online visibility and outreach, but also with a higher scientific interest. To identify gaps and barriers, future research should assess the range of available information on headache disorders in electronic media, characterize direct and indirect consequences on clinical management, and recognize best practice and strategies to improve our communication on internet-based communication platforms. In turn, these efforts will reduce the burden of headache disorders by facilitating improved education of both patients and providers.

Migraine preventive treatment failure: A cross-sectional study in a tertiary center in Brazil / Falha no tratamento preventivo da enxaqueca: um estudo transversal em um centro terciário no Brasil

BACKGROUND: In Brazil, there is a scarcity of evidence on migraine burden in patients who have experienced previous preventive treatment failure (PPTF). OBJECTIVE: To evaluate the associations between ≥ 3 PPTF and clinical, psychiatric, and medical history data. METHODS: In a retrospective, cross-sectional study, the medical records of migraine patients who first visited a tertiary specialized clinic were examined. We selected adults of both sexes aged ≥ 18 who attended their first appointment between March and July 2017. Ordinal logistic regression models estimated the associations between number of PPTF (no previous treatment, 1 PPTF, 2, and ≥ 3 PPTF) and chronic migraine, the number of diagnosis exams performed, abortive drugs classes used, and non-pharmacological treatments tried (all categorized as none, 1- 3, and ≥ 4), and severe depression (PHQ-9 ≥ 15) and anxiety (GAD-7 ≥ 15), adjusted for sex, age, and years with disease. RESULTS: Data from 440 patients (72.1 % female) with a mean (SD) age of 37.3 (13.0) years were analyzed. The frequency of no previous treatment was 37.7 % (166/440), while 31.8 % (140/440) showed ≥ 3 PPTF. In patients with ≥ 3 PPTF, 35.7 % (50/140) had episodic, and 64.3 % (90/140) had chronic migraine. Compared to no previous treatment, patients with ≥ 3 PPTF showed higher odds (95 % confidence interval) for chronic migraine [2.10 (1.47, 2.98)], ≥ 4 diagnosis exams [6.59 (3.38, 12.84)], ≥ 4 abortive drug classes [16.03 (9.53, 26.94)], ≥ 4 non-pharmacological treatments [5.91 (3.07,11.35)], and severe depression [1.75 (1.07, 2.88)] and anxiety [1.73 (1.05, 2.85)]. CONCLUSION: Patients first visiting a headache specialist had a high frequency of non-response treatment associated with higher migraine burden in terms of chronification, psychiatric comorbidity, acute medication and non-pharmacological treatment inefficacy, and unnecessary exams.

FUNDAMENTO: No Brasil, há escassez de evidências sobre a carga da enxaqueca em pacientes que apresentaram falha prévia no tratamento preventivo (FTPP). OBJETIVO: Avaliar as associações entre ≥ 3 PPTF e dados clínicos, psiquiátricos e de história médica. MÉTODOS: Em um estudo retrospectivo e transversal, foram examinados os prontuários de pacientes com enxaqueca que visitaram pela primeira vez uma clínica especializada terciária. Foram selecionados adultos de ambos os sexos com idade ≥ 18 anos que compareceram à primeira consulta entre março e julho de 2017. Modelos de regressão logística ordinal estimaram as associações entre número de PPTF (sem tratamento prévio, 1 PPTF, 2 e ≥ 3 PPTF) e enxaqueca crônica, o número de exames de diagnóstico realizados, classes de medicamentos abortivos utilizados e tratamentos não farmacológicos tentados (todos categorizados como nenhum, 1-3 e ≥ 4) e depressão grave (PHQ-9 ≥ 15) e ansiedade (GAD-7 ≥ 15), ajustado por sexo, idade e anos de doença. RESULTADOS: Foram analisados ​​dados de 440 pacientes (72,1% mulheres) com idade média (DP) de 37,3 (13,0) anos. A frequência de nenhum tratamento prévio foi de 37,7% (166/440), enquanto 31,8% (140/440) apresentaram ≥ 3 PPTF. Em doentes com ≥ 3 PPTF, 35,7% (50/140) tiveram enxaqueca episódica e 64,3% (90/140) tiveram enxaqueca crónica. Em comparação com nenhum tratamento anterior, pacientes com ≥ 3 PPTF apresentaram chances mais altas (intervalo de confiança de 95%) para enxaqueca crônica [2,10 (1,47, 2,98)], ≥ 4 exames de diagnóstico [6,59 (3,38, 12,84)], ≥ 4 classes de medicamentos abortivos [16,03 (9,53; 26,94)], ≥ 4 tratamentos não farmacológicos [5,91 (3,07;11,35)] e depressão grave [1,75 (1,07; 2,88)] e ansiedade [1,73 (1,05; 2,85)]. CONCLUSÃO: Os pacientes que consultaram pela primeira vez um especialista em dor de cabeça tiveram uma alta frequência de não resposta ao tratamento associada a maior carga de enxaqueca em termos de cronificação, comorbidade psiquiátrica, medicação aguda e ineficácia do tratamento não farmacológico e exames desnecessários.

Perfil de atividade física no tempo livre e tempo sedentário em adultos no Brasil: inquérito nacional, 2019 / Profile of leisure-time physical activity and sedentary behavior in adults in Brazil: a nationwide survey, 2019 / Perfil de la actividad física en el tiempo libre y sedentario em adultos en Brasil: encuesta nacional, 2019

Objetivos: estimar a prevalência de atividade física no tempo livre e comportamento sedentário em adultos no Brasil. Métodos: estudo seccional, populacional, na amostra de 88.531 brasileiros da Pesquisa Nacional de Saúde de 2019; a atividade física (geral e modalidades aeróbias) no tempo livre foi mensurada conforme as diretrizes da Organização Mundial da Saúde; estimaram-se as prevalências ponderadas, e respectivos intervalos de confiança de 95% (IC95%), de atividade física, inatividade física e tempo sedentário. Resultados: a partir da amostra selecionada, 26,4% (IC95% 25,9;27,1) dos adultos brasileiros eram fisicamente ativos, 14,0% (IC95% 13,5;14,4) eram insuficientemente ativos e 59,5% (IC95% 58,8;60,2) eram inativos; o tempo sedentário ≥ 6 horas foi relatado por 30,1% (IC95% 29,5;30,8) da população; apenas 8,6% (IC95% 8,2;8,9) atenderam às recomendações de atividade física para fortalecimento muscular. Conclusão: a maioria dos brasileiros adultos era inativa e não atendeu às recomendações internacionais de atividade física no tempo livre e restrição de tempo sedentário.

Objectives: to estimate the prevalence of leisure-time physical activity and sedentary behavior in adults in Brazil. Methods: this was a cross-sectional, population-based study carried out in a sample of 88,531 Brazilians, using data from the 2019 National Health Survey; leisure-time physical activity (overall and aerobic exercise) was measured according to the World Health Organization guidelines; the weighted prevalence and respective 95% confidence intervals (95%CI) of physical activity, physical inactivity and sedentary behavior were estimated. Results: according to the selected sample, 26.4% (95%CI 25.9;27.1) of Brazilian adults were physically active, 14.0% (95%CI 13.5;14.4) were insufficiently physically active and 59.5% (95%CI 58.8;60.2) were physically inactive; sedentary behavior ≥ 6 hours was reported by 30.1% (95%CI 29.5;30.8) of the population; only 8.6% (95%CI 8.2;8.9) met the recommendations for muscle-strengthening activities. Conclusion: most Brazilian adults were physically inactive and did not meet international recommendations for leisure-time physical activity and reduction in sedentary behavior.

Objetivos: estimar la prevalencia de actividad física en el tiempo libre y comportamiento sedentario de adultos en Brasil. Métodos: estudio seccional, poblacional, de la muestra de la Encuesta Nacional de Salud de 2019 a partir de lo cual, se estimó la prevalencia ponderada (porcentaje e intervalo de confianza del 95%) de actividad física (general y aeróbica), la inactividad física y el comportamiento sedentario. Resultados: según la muestra elegida, 26,4% (IC95% 25,9;27,1) son físicamente activos, 59,5% (IC95% 58,8;60,2) son inactivos, 14,0% (IC95% 13,5;14,4) son insuficientemente activos y 30,1% (IC95% 29,5;30,8) pasan ≥6 horas sedentarios en su tiempo libre; sólo el 8,6% (IC95% 8,2;8,9) de los adultos cumple con las recomendaciones de actividad física para fortalecimiento muscular. Conclusión: la mayoría de los adultos brasileños son inactivos, no cumplen con las recomendaciones internacionales de actividad física en el tiempo libre y la restricción del tiempo sedentario.

Physical activity pattern and migraine according to aura symptoms in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort: A cross-sectional study.

OBJECTIVE: To estimate the associations of physical activity (PA) levels with migraine subtypes. BACKGROUND: Physical activity has been associated with reduced migraine prevalence, but less is known about its relationship with migraine subtypes and PA levels as recommended by World Health Organization (WHO). METHODS: In this cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), we estimated the odds ratios (ORs) of migraine with aura (MA) and migraine without aura (MO), compared to participants without headaches, according to PA levels in the leisure time (LTPA), commuting time (CPA), and combined PA domains. RESULTS: In total, 2773 participants provided complete data, 1556/2773 (56.1%) were women, mean (SD) age of 52.3 (9.1) years. In this study's sample, 1370/2773 (49.4%) participants had overall migraine, 480/2773 (17.3%) had MA, and 890/2773 (32.0%) had MO. In the LTPA domain, there were reduced odds of MA (OR 0.72, 95% confidence interval [CI] 0.53-0.96; p = 0.030) and MO (OR 0.71, 95% CI 0.56-0.90; p = 0.005) in participants who met the WHO PA guidelines after adjustment for confounder variables. In the analyses stratified by intensity, moderate LTPA was associated with reduced odds of MA (OR 0.56, 95% CI 0.320-0.99; p = 0.049), while vigorous LTPA was associated with reduced odds of MO (OR 0.55, 95% CI 0.395-0.77; p = 0.001). There were no significant associations between migraine subtypes and CPA or combined PA domains. In the whole migraine sample, meeting the WHO PA guidelines in the LTPA (OR 0.275, 95% CI 0.083-0.90; p = 0.034), CPA (OR 0.194, 95% CI 0.064-0.58; p = 0.004), and combined domains (OR 0.115, 95% CI 0.032-0.41; p = 0.001) was associated with reduced odds of daily migraine attack frequency. CONCLUSIONS: Meeting the WHO PA guidelines for LTPA, but not CPA or combined PA domains, is associated with lower migraine occurrence. Moderate LTPA favors MA reduction, while vigorous LTPA favors MO reduction.

Bridging the gaps of headache care for underserved populations: Current status of the headache field in Latin America.

OBJECTIVE: To evaluate the current status of specialized headache care and research in Latin America. BACKGROUND: Latin America corresponds to about 9% of the global population. There is considerably limited access to headache services, and very few resources are allocated to headache research in this region. METHODS: The study consisted of two parts. First, in order to evaluate headache-related scientific output from Latin American countries we performed a 10-year bibliometric analysis and contrasted the results with a human developmental index-adjusted projection model. Secondly, we conducted a survey addressing different aspects of headache research, education, clinical practice, and awareness among members of the Latin American Headache Society. RESULTS: During the last 10 years 70% of Latin American countries published less than three articles regarding headache disorders. This contrasts with an average expected publication rate of 889 scientific papers. Indeed, none of the countries fulfilled their human developmental index - adjusted projected scientific output, with Brazil being the closest reaching 84.1% of what would be considered optimal according to the model. From the 86 headache-dedicated professionals that responded to the survey, most (64%) reported not having a headache specialization programme of any kind available in their countries. The biggest impediments towards conducting research observed by participants were the lack of time (39%), resources (22%), and training (21%). CONCLUSIONS: Latin American countries have a considerable gap in headache-related scientific production, and also in formal education, research, and implementation of multidisciplinary services. Access to specialized headache care is particularly limited for patients with lower economic income.

Headache disability, lifestyle factors, health perception, and mental disorder symptoms: a cross-sectional analysis of the 2013 National Health Survey in Brazil.

OBJECTIVE: To evaluate the past 2-week headache disability and explore its association with lifestyle factors, health perception, and mental disorder symptoms in the PNS 2013 survey. BACKGROUND: The prevalence of headache disorders has been associated with lifestyle factors, mental disorders, and health perception. However, less is known regarding their influence on headache-related disability. METHODS: In a cross-sectional analysis, chi-squared tests and logistic regression models computed the associations between headache-related disability (defined as days lost from work, school, or household chores in the past 2 weeks) and the variables of interest, compared to other disease-related disabilities groups or no day lost group. The adjusted models controlled for the effects of age, sex, income, and educational levels. RESULTS: In the sample aged ≥ 18 years (n = 145,580), 10,728 (7.4%) participants reported any disease-related disability in the past 2 weeks (median interquartile range (IQR) for age = 47 (33-59) years, 62% women), with the median (IQR) days lost = 5 (2-14). Headache disability represented 5.3% (572/10,728) of all diseases, constituting the 4th most prevalent disease-related disability [median (IQR) days lost = 3 (3-4)]. Among people aged 18-25 years, headache disorders ranked 2nd as the most prevalent disability (13%), headache-related disability positively associated with physical inactivity, poorer health perception, and frequent mental disorders symptoms, and negatively associated with overweight, obesity, and alcohol consumption. CONCLUSION: Headache disability represents a leading cause of disease-related disability in Brazil and associates with unhealthy lifestyle factors, poorer health perception, and frequent mental disorder symptoms.

Physical inactivity and headache disorders: Cross-sectional analysis in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

BACKGROUND: Physical inactivity has been linked to headache disorders but estimates based on the current World Health Organization physical activity guidelines are unknown. OBJECTIVE: To test the associations between headache disorders and physical inactivity in the ELSA-Brasil cohort. METHODS: In a cross-sectional analysis, linear (continuous variables) and logistic regression models (categorical variables) tested the associations of physical activity levels in the leisure time, commuting time, and combined leisure time physical activity + commuting time physical activity domains with headache disorders, adjusted for the effects of sociodemographic data, cardiovascular risk variables, psychiatric disorders, and migraine prophylaxis medication. RESULTS: Of 15,105 participants, 14,847 (54.4% women) provided data on physical activity levels and headache. Higher physical activity levels (continuous values) in the leisure time physical activity domain associated with lower migraine and tension-type headache occurrence and lower headache attack frequency, while in the commuting time physical activity domain it associated with more frequent headache attacks. Compared to people who met World Health Organization physical activity levels in the leisure time physical activity or combining leisure time physical activity + commuting time physical activity domains (i.e. ≥150 min.wk-1 of moderate and/or ≥75 min.wk-1 of vigorous physical activity), physical inactivity associated with higher migraine occurrence, while somewhat active (i.e. not meeting World Health Organization recommendations) associated with higher migraine and tension-type headache occurrence. Physical inactivity in the commuting time physical activity domain associated with higher tension-type headache in men and lower migraine in women. Physical inactivity within vigorous leisure time physical activity intensity, but not moderate leisure time physical activity, associated with higher migraine, mostly in women. Finally, physical inactivity associated with higher headache attack frequency regardless headache subtype. CONCLUSION: Physical inactivity and unmet World Health Organization physical activity levels associate with primary headaches, with heterogeneous associations regarding headache subtype, sex, physical activity domain/intensity, and headache frequency in the ELSA-Brasil study.

Mental Health and Quality of Life Among Adults With Single, Multiple, and No Religious Affiliations.

Few studies have investigated the "multiple religious affiliations" phenomenon. This study aims to understand those with "multiple religious affiliations," describing its prevalence and investigating if there are differences in mental health and quality of life between this group and those with a single religious affiliation and those with no religious affiliation. A total of 1169 adults were included, and 58% had a single religious affiliation, 27.7% had multiple religious affiliations, and 12.3% had no religious affiliation. Participants with a single religious affiliation presented better mental health and quality of life than those with multiple or no religious affiliations. Although most outcomes were similar between multiple and no religious affiliations, happiness and optimism were higher in the multiple religious group, and anxiety was lower in the no religious group. Health care professionals should be aware of the secondary religious affiliations of their patients to identify possible conflicts and to treat them comprehensively.

Public policies in headache disorders: needs and possibilities.

Although headaches have recognized impact, there are no public policies in Brazil addressing this problem. The Brazilian Headache Society and the Brazilian Association of Cluster Headache and Migraine promoted a summit to discuss Public Policy and Advocacy for headache disorders. Professionals from various segments, representing various sectors of society, gathered in April 2019 in Brasília, defining the most important points for achieving advances in public policies in headache in Brazil, such as: inclusion in the chronic diseases surveillance agenda; improving public understanding and access to diagnosis and treatment; teaching in colleges and medical residences, structuring care networks, intervention models, clinical protocols and legislation supporting public policies in headache.

Public policies in headache disorders: needs and possibilities / Políticas públicas em cefaleias: necessidades e possibilidades

Abstract Although headaches have recognized impact, there are no public policies in Brazil addressing this problem. The Brazilian Headache Society and the Brazilian Association of Cluster Headache and Migraine promoted a summit to discuss Public Policy and Advocacy for headache disorders. Professionals from various segments, representing various sectors of society, gathered in April 2019 in Brasília, defining the most important points for achieving advances in public policies in headache in Brazil, such as: inclusion in the chronic diseases surveillance agenda; improving public understanding and access to diagnosis and treatment; teaching in colleges and medical residences, structuring care networks, intervention models, clinical protocols and legislation supporting public policies in headache.

Resumo Embora as cefaleias tenham reconhecido impacto, não há no Brasil políticas públicas voltadas para este problema. A Sociedade Brasileira de Cefaleia e Associação Brasileira de Cefaleia e Enxaqueca promoveram um seminário para a discussão de Políticas Públicas e Advocacy (defesa dos direitos dos pacientes) em Cefaleias. Reuniram-se em abril de 2019 em Brasília, profissionais de vários segmentos, representando diversos setores da sociedade, definindo os pontos mais importantes para que se obtenham avanços nas políticas públicas em cefaleias no Brasil, tais como: inclusão na agenda de vigilância das doenças crônicas não transmissíveis; melhora do entendimento do público e seu acesso a diagnóstico e tratamento; ensino em faculdades e residências médicas, estruturação de redes de atendimento, modelos de intervenção, protocolos clínicos e legislação de apoio às políticas públicas em cefaleia.

Annual indirect costs secondary to headache disability in Brazil.

BACKGROUND: Disability imposed by headache disorders constitutes an expressive economic burden, mostly from indirect costs due to absenteeism and presenteeism. OBJECTIVE: To estimate indirect costs from absenteeism and presenteeism due to headache disorders in Brazil. METHODS: In a secondary, descriptive analysis of two nationwide databases, we estimated indirect costs based on headache-related disability and socioeconomic data. RESULTS: In the first database analyzed (n = 3838), 12.8% of the employed population with headache disorders missed at least 1 day of work in the last 3 months (mean, 95% CI = 4.2 days [3.7-4.6]). Based on the prevalence of headache disorders, days lost due to headaches and income data, R$ 40.4 billion (Int$ 20 billion) are lost due to headache-related absenteeism annually. For presenteeism, 26.2% of the employed population with headache disorders worked at least 1 day in the last 3 months with 50% reduced productivity (mean, 95% CI = 5.7 days [5.3-6.2]), amounting to R$ 27.3 billion (Int$ 13.5 billion) of financial loss annually. In the other database analysed (n = 205,546), 14,052 (6.8%) respondents missed work/school or household duties in the past 2 weeks due to some disease. Of these, 4.7% attributed their days lost to headaches disorders in the economically active population, which ranked 4th as main cause of days lost due to disease, among 23 common diseases. CONCLUSIONS: The economic burden of headache disorders in Brazil, mostly due to migraine (55.4%), may cost up to R$ 67.6 billion (Int$ 33.5 billion) annually, and headache disorders represent a leading cause of absenteeism due to disease.

Allodynia in Menstrually Related Migraine: Score Assessment by Allodynia Symptom Checklist (ASC-12).

OBJECTIVE: The aim of this study was to compare the allodynia score in headache attacks related and not related to menstruation in women diagnosed with menstrually related migraine without aura. BACKGROUND: Allodynia is an important symptom in migraine and has been associated with migraine chronification. No study has yet compared prospectively allodynia in menstrual vs non-menstrual attacks within the same cohort of patients. METHODS: This is a prospective cohort study, where participants had the 12-item Allodynia Symptom Checklist (ASC-12) assessed after 1, 2, 4, and 24 hours from the onset of migraine attacks in 2 different conditions, with menstrual migraine attack (MM+) and with non-menstrual migraine attack (MM-). RESULTS: A total of 600 women with headache complaints were screened from March 2013 to July 2014 in a headache outpatient or headache tertiary clinic. From these, 55 participants were recruited, and 32 completed the study. Participants' mean age was 27 years, BMI was 22.1, menarche age 12 years, migraine history was 11.5 years, and most women were young (ranged from 17 to 44 years of age), were in higher school (13/32 = 41%), single (20/32 = 63%), and used contraceptives (22/32 = 69%). Multiple pairwise comparisons of ANCOVA's test showed significant higher ASC-12 scores in MM+ group compared to MM- group at 2 hours [mean, 95% CI of difference: 2.3 (0.31, 4.7), P = .049)]. For the ASC-12 categorical scores (absent, mild, moderate, and severe) MM+ yielded higher scores than MM- at 1 hour (z = -3.08, P = .021) and 4 hours (z = -2.97, P = .03). CONCLUSION: This study demonstrated that in the patents from tertiary headache center assessed, menstrual-related migraine attacks augment allodynia scores in the beginning of attacks compared to non-menstrual migraine attacks.

Anandamide Is Related to Clinical and Cardiorespiratory Benefits of Aerobic Exercise Training in Migraine Patients: A Randomized Controlled Clinical Trial.

Introduction: Since endocannabinoids have been implicated in migraine pathophysiology, we conducted a randomized, controlled clinical trial to test the effects of a 12-week aerobic exercise intervention on plasma anandamide (AEA) and its relation with clinical, psychological, and cardiorespiratory outcomes. Materials and Methods: Episodic migraine patients taking no preventive drugs and nonheadache individuals were recruited from Hospital São Paulo and a tertiary headache clinic between March 2012 and March 2015. Participants were randomly assigned to receive aerobic exercise or enter the waitlist. Primary outcome was changes in plasma AEA; secondary outcome was number of days with migraine/month; and other clinical variables, mood scores, and cardiorespiratory fitness were chosen as tertiary outcomes. Measurements were taken on headache-free days. Data were analyzed by generalized linear models. Discussion: Fifty participants concluded the study (mean±SD age=36.2±10.9, and BMI=26.5±4.5). The plasma AEA reduced in migraine exercise (p<0.05) and control exercise groups (p<0.01). The number of days with migraine (p<0.01), migraine attacks (p<0.05), and abortive medication used (p<0.05) reduced in the migraine exercise group, whereas cardiorespiratory fitness increased in migraine exercise and control exercise groups (both p<0.05). Anxiety, depression, anger, and fatigue scores improved in the migraine exercise group (p<0.05 for all). Significant correlations between reduction in abortive medication used and cardiorespiratory fitness (r=-0.81 p<0.001), and reduced AEA (r=0.68 p<0.05) were found. Conclusions: This study suggests that peripheral AEA metabolism may be partly linked to the clinical and cardiorespiratory benefits of regular aerobic exercise in migraine patients. Trials registration: #NCT01972607.

Migraine patients' journey until a tertiary headache center: an observational study.

BACKGROUND: Migraine diagnosis is based on clinical aspects and is dependent on the experience of the attending physician. This study aimed to describe the patients journey profile until they start their experience in a tertiary headache center. METHODS: In a cross-sectional study, medical charts from migraine patients were reviewed to describe which treatments, procedures and follow-up strategies are performed until the first appointment with a headache specialist. Patients from both sexes, ≥18 years old, which came to their first visit from March to July 2017 were included. Sociodemographic information, headache characteristics, diagnostic methods previously used, clinical history, family history and the treatments previously used were assessed in the first appointment with a specialist. Patient Health Questionnaire-9 and General Anxiety Disorder-7 were also applied. Descriptive analyses were performed to describe the sample profile and statistical tests were used to evaluate factors associated with the type of migraine (chronic or episodic). RESULTS: The sample consisted of 465 patients. On average, the pain started 17.1 (SD = 11.4) years before the first appointment with a headache specialist. Most of patients were classified as having chronic migraine (51.7%), with an average frequency of 15.5 (SD = 9.9) days per month. Regarding patients' journey until a specialist, most patients were submitted to laboratory tests (74.0%), cranial tomography (66.8%) and magnetic resonance imaging (66.8%) as diagnostic methods, and preventive drugs (70.2%) and acupuncture (61.0%) as treatments. After stratification by migraine type as episodic or chronic, patients with chronic migraine were submitted to more magnetic resonance imaging test, acupuncture, psychotherapy, used preventive drugs, and reported to have used topiramate without beneficial effects. CONCLUSIONS: Brazilian patients with migraine experiment a long journey until getting to a headache specialist and are submitted to a great number of unnecessary exams, especially those with chronic migraine.

Optimism, Pessimism, and Migraine: A Cross-Sectional, Population-Based Study.

BACKGROUND: Optimism and pessimism are related to several mental health and brain disorders, are significant predictors of physical and psychological health outcomes, and implicated as psychosocial determinants of the pain experience. Despite this promising evidence, limited information is available on optimism and pessimism in headache disorders. OBJECTIVE: To evaluate the influence of optimism and pessimism in meeting criteria for migraine and related disability in a population-based sample. METHODS: This is an observational, cross-sectional study. The sample population was selected through a stratified, multi-stage area probability sample of households, as used by the last Brazilian Census. A validated questionnaire eliciting data on demographics, headache features, migraine-related disability, depression (PHQ-9), anxiety (GAD-7), optimism, and pessimism (life orientation test - revised) was administered to people with migraine and headache-free control participants from the general population in São Paulo, Brazil via trained interviewers. Six hundred individuals were contacted. The odds for having migraine/no headache diagnosis were calculated by binary logistic regression, and ordinal regression was performed to check associations between migraine-related disability and optimism. RESULTS: A total of 302 individuals (mean ± SD age: 39.7 ± 12.7; BMI: 26.5 ± 5.9) met inclusion criteria and were included, 140 controls (with no history of headache disorders) and 162 people meeting criteria for migraine (29 with chronic migraine, that is, 15 or more headache days/month). People with migraine were less optimistic and more pessimistic than controls, and endorsed higher levels of anxious and depressive symptoms. Pessimism (OR 95% CI = 1.16 [1.05-1.28], P = .005) and anxiety (OR 95% CI = 1.19 [1.10-1.29], P < .001) were predictors of meeting criteria for migraine, while optimism (ß 95% CI = -0.915 [-1.643, -0.188], P = .01) was inversely associated with migraine-related disability. CONCLUSIONS: Optimism and pessimism are associated with migraine and migraine-related disability. These concepts should be further explored in people with migraine with regard to their potential influences on clinical research outcomes and treatments.

Religious landscape in Brazil: Comparing different representative nationwide approaches to obtain sensitive information in healthcare research.

Although the basis of religious studies start with demographics, nation-wide data are often extracted from face-to-face interviews (leading to a social-desirability bias) and in studies not originally designed to assess religion. This study aims to understand the religious landscape in Brazil and to investigate the feasibility of carrying out a representative nation-wide survey without interviewers, comparing it with other representative face-to-face surveys. We conducted a nationwide online survey representing all regions in Brazil. These results were compared with five other Brazilian representative surveys. A total of 1169 individuals completed the online questionnaires. The percentage of participants according to the gender and in relation to the Brazilian region was quite similar for all surveys. However, the online survey had the higher level of education among all surveys. In relation to the religious characteristics, the percentage of each variable varied from survey to survey. Those surveys originally designed to assess religion tended to yield more religious affiliations and less ceiling effects. The online survey was able to identify more diverse religious affiliations and more balanced responses in the religious attendance and importance of religion in life. The present study found that, even in nation-wide representative surveys, there are important differences in the results obtained while investigating religion. These differences could be associated with the type of data collection (face-to-face and online), the design of the study (originally designed to investigate religion or not) and options and the type of the questions used.

Unbalanced plasma TNF-α and IL-12/IL-10 profile in women with migraine is associated with psychological and physiological outcomes.

Increased plasma pro-inflammatory and decreased anti-inflammatory cytokines have been implicated in physiological and behavioural aspects of mood- and pain-related disorders, including migraine. In this case-control study, we assessed mood scores, cardiorespiratory fitness (VO2Peak), and plasma concentrations of TNF-α, IL-1ß, IL-6, IL-8, IL-10, and IL-12p70 interictally in women with episodic migraine with/without aura (ICHD-II), taking no preventive medicine, and in healthy women recruited from São Paulo Hospital and local community, respectively. Thirty-seven participants (mean±SD age=34±10 and BMI=26.5±4.9) were assessed. Groups (Control, n=17; Migraine, n=20) showed no differences in age, BMI, and VO2Peak. Migraine patients showed higher tension (p=0.019) and anxiety scores (p=0.046), TNF-α (p<0.01), and IL-12p70 (p=0.01), while IL-6 (p<0.01), IL-8 (p<0.01), and IL-10 (p<0.01) were decreased compared to control group. Multiple linear regression models showed that migraine was positively associated with TNF-α and IL-12p70, and negatively associated with IL-6, IL-8, and IL-10. Anxiety scores were positively associated with IL-12p70, and VO2Peak was negatively associated with TNF-α. In conclusion, an exaggeratedly skewed cytokine profile, in particular the TNF-α and 12p70/IL-10 balance may be related to migraine pathomechanisms, and its psychiatric comorbidities and functional capacity. Additional studies are needed to confirm these results.

Exercise-Induced Change in Plasma IL-12p70 Is Linked to Migraine Prevention and Anxiolytic Effects in Treatment-Naïve Women: A Randomized Controlled Trial.

OBJECTIVE: To conduct a randomized controlled trial to evaluate the effect of a 12-week aerobic exercise program for migraine prevention, plasma cytokines concentrations (TNF-α, interleukin [IL]-1ß, IL-6, IL-8, IL-10, and IL-12p70), and anxiety in women with migraine. METHODS: Women with episodic migraine (ICHD-II), aged between 20 and 50 years, who had never taken any prophylactic medication, and were physically inactive in the past 12 months were recruited from the university's hospital and a tertiary headache clinic between March 2012 and March 2015. Migraine attacks were recorded in headache diaries, cytokines were quantified by flow cytometry, and anxiety was assessed by the 7-item General Anxiety Disorder (GAD-7) scale. Blood sampling and psychometric interviews were undertaken on headache-free days. RESULTS: Twenty participants ([mean ± SD] age 33.8 ± 10.5; BMI 26 ± 5.2) were randomly assigned and received intervention ("trained": n = 10) or entered on a waitlist ("inactive": n = 10). There were no differences between groups regarding patients' characteristics and baseline data. Days with migraine (p = 0.001), IL-12p70 levels (p = 0.036), and GAD-7 score (p = 0.034) were significantly reduced in the trained group after the intervention period, but there were no significant changes in these variables in the inactive group. There was no change in the levels of the other cytokines in either group. There were positive correlations between a reduction in IL-12p70 level and a reduction in the number of days with migraine (R2 = 0.19, p = 0.045), and GAD-7 score (R2 = 0.53, p < 0.001). CONCLUSION: The clinical and psychological therapeutic effects of aerobic exercise in treatment-naïve women with migraine may involve the downregulation of IL-12p70.