Frecuencia de migraña y discapacidad generada en estudiantes de medicina humana de una universidad privada en Lima, Perú / Frequency of migraine and disability generated in medical students at a private university in Lima Peru

Objetivo : Estimar la frecuencia de migraña, y discapacidad generada en estudiantes de medicina de una universidad privada de Lima Metropolitana. Métodos : Estudio transversal en una muestra no probabilística por conveniencia, mediante la aplicación online del autocuestionario ALCOI-95, para evaluar la presencia de migraña, seguido por el cuestionario MIDAS para medir la discapacidad en los positivos al primer cuestionario. El rendimiento académico fue evaluado mediante el promedio ponderado de sus calificaciones. Resultados : Cuarenticinco (21,6%) de 208 estudiantes experimentaron migraña (12,5% con aura y 9,1% sin aura), 14 (33,3%) de los cuales mostraron discapacidad severa y 12 (28,6%) moderada. Los portadores de migraña con aura tuvieron una media menor del promedio ponderado acumulado de sus calificaciones, comparado con aquellos con migraña sin aura. Los factores independientemente asociados a la migraña fueron tener un miembro de la familia nuclear con migraña y problemas para mantener el sueño. Conclusión : Dos de cada 10 estudiantes presentaron migraña y 1/3 de los afectados experimentó discapacidad severa.

SUMMARY Objective: To estimate the frequency of migraine, associated factors and disability generated (including its relationship with academic performance) in medical students at a private university in Metropolitan Lima. Methods: Cross-sectional study in a non-probabilistic convenience sample using the online application of the ALCOI-95 self-questionnaire, to assess the presence of migraine, followed by the MIDAS questionnaire to measure disability in those positive to the first questionnaire. . Results: Fourty-five (21.6%) of 208 students experienced migraine (12.5% with aura and 9.1% without aura), 14 (33.3%) of whom showed severe, and 12 (28.6%) moderate disability. Migraine with aura carriers had a lower mean than the cumulative weighted average of their academic scores. Independent factors associated with migraine were to have a nuclear family member with migraine, and sleep-maintenance problems. Conclusion: Two out of 10 students had migraine, and one third of them had severe disability.

Consensus of the Brazilian Headache Society (SBCe) for prophylactic treatment of episodic migraine: part II / Consenso da Sociedade Brasileira de Cefaleia (SBCe) para o tratamento profilático da migrânea episódica: parte II

Abstract Background Migraine affects 1 billion people worldwide and > 30 million Brazilians; besides, it is an underdiagnosed and undertreated disorder. Objective The need to disseminate knowledge about the prophylactic treatment of migraine is known, so the Brazilian Headache Society (SBCe, in the Portuguese acronym) appointed a committee of authors with the objective of establishing a consensus with recommendations on the prophylactic treatment of episodic migraine based on articles from the world literature as well as from personal experience. Methods Meetings were held entirely online, with the participation of 12 groups that reviewed and wrote about the pharmacological categories of drugs and, at the end, met to read and finish the document. The drug classes studied in part II of this Consensus were: antihypertensives, selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, calcium channel blockers, other drugs, and rational polytherapy. Results From this list of drugs, only candesartan has been established as effective in controlling episodic migraine. Flunarizine, venlafaxine, duloxetine, and pizotifen were defined as likely to be effective, while lisinopril, enalapril, escitalopram, fluvoxamine, quetiapine, atorvastatin, simvastatin, cyproheptadine, and melatonin were possibly effective in prophylaxis of the disease. Conclusions Despite an effort by the scientific community to find really effective drugs in the treatment of migraine, given the large number of drugs tested for this purpose, we still have few therapeutic options.

Resumo Antecedentes Migrânea afeta um bilhão de pessoas em todo o mundo e mais de 30 milhões de brasileiros; além disso, é um distúrbio subdiagnosticado e subtratado. Objetivo Sabe-se sobre a necessidade de difundir o conhecimento sobre o tratamento profilático da migrânea; por isso, a Sociedade Brasileira de Cefaleias (SBCe) nomeou um comitê de autores com o objetivo de estabelecer um consenso com recomendações sobre o tratamento profilático da migrânea episódica com base em artigos da literatura mundial, assim como da experiência pessoal. Métodos As reuniões foram realizadas inteiramente online, com a participação de 12 grupos que revisaram e escreveram sobre as categorias farmacológicas dos medicamentos e, ao final, reuniram-se para a leitura e conclusão do documento. As classes de medicamentos estudadas na parte II deste Consenso foram: anti-hipertensivos, inibidores seletivos de recaptação de serotonina, inibidores de recaptação de serotonina e noradrenalina, bloqueadores dos canais de cálcio, outros medicamentos e politerapia racional. Resultados Desta lista de medicamentos, apenas o candesartan foi estabelecido como eficaz no controle da migrânea episódica. Flunarizina, venlafaxina, duloxetina e pizotifeno foram definidos como provavelmente eficazes, enquanto lisinopril, enalapril, escitalopram, fluvoxamina, quetiapina, atorvastatina, sinvastatina, ciproheptadina e melatonina foram possivelmente eficazes na profilaxia da doença. Conclusões Apesar do esforço da comunidade científica em encontrarmedicamentos realmente eficazes no tratamento da migrânea, dado o grande número de medicamentos testados para este fim, ainda dispomos de poucas opções terapêuticas.

Headaches and obesity / Obesidade e cefaleia

ABSTRACT Obesity and headache disorders are two very common conditions in the general population that have been increasing in incidence over the last decades. Recent studies have shown a significant relationship between obesity and headaches, particularly migraine, with an important role in whether the disease is chronic. On the other hand, no such association was found with tension-type headaches. Studies showing an overlapping of hunger-control pathways and those involved in the pathophysiology of migraine may justify the close association between obesity and migraine. Moreover, a secondary headache for which obesity is a strong risk factor is idiopathic Intracranial Hypertension (pseudotumor cerebri), with several studies showing the impact of weight reduction/bariatric surgery in the treatment of the disease. In conclusion, since obesity is a modifiable risk factor, it is important for physicians treating patients with headaches, and particularly migraine, to be aware of the association between these two disorders.

RESUMO Obesidade e cefaleias são duas condições muito frequentes na população geral e que vem aumentando em incidência nas últimas décadas. Estudos recentes têm demonstrado uma significativa relação entre obesidade e cefaleia, particularmente na enxaqueca, com papel importante na cronificação da doença. Por outro lado, não se observa tal associação com cefaleia do tipo tensão. Trabalhos que mostram uma sobreposição das vias de controle da fome e daquelas envolvidas na fisiopatologia da enxaqueca podem justificar a íntima associação entre obesidade e enxaqueca. Além disso, uma cefaleia secundária para a qual a obesidade é um forte fator de risco é a Hipertensão Intracraniana Idiopática (pseudotumor cerebral), inclusive com diversos estudos mostrando o impacto da redução do peso/cirurgia bariátrica no tratamento da doença. Concluindo, visto que a obesidade é um fator de risco modificável, é importante para os médicos que tratam de pacientes com cefaleia e, particularmente, enxaqueca, estarem cientes da associação entre essas duas comorbidades.

Investigation of serum vaspin, visfatin, chemerin and IL-18 levels in migraine patients / Investigação dos níveis séricos de vaspina, visfatina, quemerina e IL-18 em pacientes com migrânea

Abstract Background: Migraines are headaches caused by changes in the trigeminovascular metabolic pathway. Migraine headache attacks are associated with neurovascular inflammation, but their pathophysiological mechanisms have not been fully explained. Objective: To investigate the relationship between serum vaspin, visfatin, chemerin and interleukin-18 (IL-18) levels and the frequency of attacks in migraine headache. Methods: Three groups were established: migraine with aura (n = 50), migraine without aura (n = 50) and control group (n = 50). The migraine diagnosis was made in accordance with the International Classification of Headache Disorders-III beta diagnostic criteria. The analyses on serum vaspin, visfatin, chemerin and IL-18 levels were performed using the enzyme-linked immunosorbent assay method. Results: The serum vaspin, visfatin, chemerin and IL-18 levels were found to be significantly higher in the migraine patients than in the control group (p < 0.01). No statistically significant differences in serum vaspin, visfatin, chemerin and IL-18 levels were found among the migraine patients during attacks or in the interictal period (p>0.05). The serum visfatin and chemerin levels of the migraine patients were positively correlated with their serum IL-18 levels (p < 0.01), while their serum chemerin and visfatin levels were positively correlated with their serum vaspin levels (p < 0.05). Conclusions: This study showed that these biomarkers may be related to migraine pathogenesis. Nonetheless, we believe that more comprehensive studies are needed in order to further understand the role of vaspin, visfatin, chemerin and IL-18 levels in the pathophysiology of migraine headaches.

Resumo Introdução: A migrânea é causada por alterações nas vias metabólicas do sistema trigeminovascular. Crises de migrânea estão associadas à inflamação neurovascular, mas seus mecanismos patofisiológicos ainda não são totalmente explicados. Objetivo: Investigar a relação entre níveis séricos de vaspina, visfatina, quemerina e interleucina-18 (IL-18) e a frequência de crises de migrânea. Métodos: Três grupos foram formados: migrânea com aura (n = 50), migrânea sem aura (n = 50) e grupo controle (n = 50). A migrânea foi diagnosticada de acordo com os critérios da Classificação Internacional das Cefaleias (ICHD-III). As análises dos níveis séricos de vaspina, visfatina, quemerina e IL-18 foram realizadas utilizando-se o método imunoenzimático (ELISA). Resultados: Os níveis séricos de vaspina, visfatina, quemerina e interleucina-18 (IL-18) foram significativamente mais elevados em pacientes com migrânea do que no grupo controle (p < 0.01). Nenhuma diferença estatisticamente significativa foi observada nos níveis séricos de vaspina, visfatina, quemerina e interleucina-18 (IL-18) entre os pacientes com migrânea durante crises ou no período interictal (p>0,05). Os níveis séricos de visfatina e quemerina em pacientes com migrânea se correlacionaram positivamente com os níveis séricos de IL-18 (p < 0,01), ao passo que os níveis séricos de quemerina e visfatina se correlacionaram positivamente com os níveis séricos de vaspina (p < 0,05). Conclusões: Este estudo demonstrou que estes biomarcadores podem estar relacionados à patogênese da migrânea. Contudo, acreditamos que estudos mais abrangentes são necessários a fim de melhor compreendermos o papel dos níveis de vaspina, visfatina, quemerina e IL-18 na fisiopatologia da migrânea.

Terapias complementarias en migraña y variables relacionadas. Encuesta Europea / Complementary therapies in migraine and related variables. European Survey

Objetivo: valorar el uso de terapias alternativas no farmacológicas en migraña y variables relacionadas. La migraña afecta a una de cada diez personas en el mundo, con aumento creciente y mayor prevalencia entre mujeres de zonas urbanas. Aunque los tratamientos habituales son farmacológicos, se ha incrementado el uso de terapias alternativas no farmacológicas en migraña y variables relacionadas. Materiales y métodos: estudio observacional transversal mediante encuesta anónima vía web a 3.342 pacientes de países europeos sobre el uso de terapias alternativas para tratamiento de migraña. Variables de estudio: edad, género, país, tipo de localidad, nivel de estudios, ámbito rural o urbano y respuesta al tratamiento. Resultados: la utilización de terapias alternativas en migraña es un fenómeno creciente, con mayor uso en pacientes entre 41-60 años y estudios superiores. Conclusiones: en migraña se observan diferencias por edad, género, nivel cultural y país de procedencia. El uso de la medicina complementaria como alternativa terapéutica en la migraña es poco habitual y se debería indagar con mayor profundidad estableciendo relaciones que permitan apoyar al paciente afectado y priorizar las de mayor evidencia científica..(Au)

Objective: to evaluate the use of alternative non-pharmacological therapies in migraine and related variables. Migraine affects one in ten people worldwide, with a growing increase and a higher prevalence among women in urban areas. Although the usual treatments are pharmacological, the use of alternative techniques is increasing. Materials and methods: cross-sectional observational study by anonymous web survey of 3,342 patients from European countries on the use of alternative therapies. Study variables: age, gender, country, type of locality, educational level, rural or urban setting and treatment response. Results: the use of alternative therapies in migraine treatment is a growing phenomenon, with greater use in patients between 41-60 years of age and higher education. Conclusions: in Migraine, differences are observed by age, gender, cultural level and country of origin. The use of complementary medicine as an therapeutic alternative in migraine is uncommon and should be investigated in greater depth, establishing relationships that allow supporting the affected patient and prioritizing, if possible, some over others with scientific evidence..(Au)

[Typical visual aura without headache: a case report.] / Aura visual típica sin cefalea: a propósito de un caso.

Introduction: The typical aura without headache is a type of migraine with aura regularly assessed by ophthalmology. It is defined as at least two recurrent attacks, lasting from 5 to 60 minutes, of reversible, visual, sensorial and / or language unilateral neurological symptoms.Methods: We present a case report of a male with typical aura without headache. Results: Male with a history of migraine without aura in adolescence and without vascular risk factors. Referred from ophthalmology by biweekly episodes characterized by central teicopsia that progressively covers the entire visual field in 20 minutes, without being influenced by opening or closing eyes, which disappears after 40 minutes from the beginning. The episodes are not stereotyped, they are not followed by headache, nor do they associate other neurological symptoms. Neurological examination and complementary tests were normal. It is concluded in favor of typical aura without headache and after six months of starting treatment with Lamotrigine there were no recurrences. Final conclusion: The diagnosis of typical aura without headache begins with an adequate anamnesis. Due to the nature of its manifestations it is necessary to differentiate it from other etiologies such as transient ischemic attacks and focal seizures due to the diagnostic, therapeutic and prognostic implications. It may appear, as in this case, in patients with migraine without aura. Lamotrigine is an excellent therapeutic option in the typical aura without headache.

Introducción: El aura típica sin cefalea es un tipo de migraña con aura valorada al inicio regularmente por oftalmología. Se define como al menos dos ataques recurrentes, de 5 a 60 minutos de duración, de síntomas neurológicos unilaterales reversibles, visuales, sensoriales y/o lenguaje. Métodos: Presentamos el caso clínico de un varón con aura migrañosa sin cefalea. Resultados: Varón con antecedente de migraña sin aura en la adolescencia y sin factores de riesgo vascular. Remitido desde oftalmología por episodios bisemanales caracterizados por teicopsia central que progresivamente abarca todo el campo visual en 20 minutos, sin influenciarse con la apertura o cierre ocular, que desaparece tras 40 minutos desde el inicio. Los episodios no son estereotipados, no se siguen de cefalea, ni asocian otros síntomas neurológicos. La exploración neurológica y las pruebas complementarias fueron normales. Se concluye a favor de aura típica sin cefalea y tras seis meses de iniciar el tratamiento con Lamotrigina no existieron recurrencias. Conclusión final: El diagnóstico de aura típica sin cefalea inicia con una anamnesis adecuada. Por la naturaleza de sus manifestaciones se hace necesario diferenciarle de otras etiologías como accidentes isquémicos transitorios y crisis epilépticas focales por las implicaciones diagnósticas, terapéuticas y pronósticas. Puede aparecer, como en este caso, en pacientes con migraña sin aura. La lamotrigina es una excelente opción terapéutica en el aura típica sin cefalea.

Migraine and cerebrovascular diseases: Epidemiology, pathophysiological, and clinical considerations.

Migraine and cerebrovascular diseases are disabling disorders, which are possibly closely interrelated. Heterogeneous and scattered evidence in literature remains a challenge. We searched for systematic reviews including diverse cerebrovascular events in migraineurs and reported relevant original studies to update the evidence when necessary. The studies show that migraine is associated with increased risk of transient ischemic attacks, any stroke, and possibly hemorrhagic stroke. In addition, migraine with aura increases the risk of ischemic stroke and white matter abnormalities. Migraine without aura increases the risk of cervical artery dissection as a cause of ischemic stroke. Groups with specific risk profiles are women, young people, smokers, and oral contraceptive users. The pathophysiology of the association remains uncertain. However, genetic and environmental factors may be involved in intricate mechanisms responsible for oxidative stress, vascular dysfunction and, ultimately, vascular events. In conclusion, migraine is a potential risk factor for cerebrovascular diseases. Migraineurs should be carefully evaluated considering their vascular risk assessment based on current evidence, so that healthcare professionals can provide appropriate and individualized management of other cardiovascular risk factors, notably quitting smoking and restricting use of oral contraceptives.

Prevalencia de migraña y caracterización de una población estudiantil universitaria, Medellín, 2014 / Migraine prevalence and characterization of a representative subset of university students from Medellin, 2014 / Prevalência de enxaqueca e caracterização de uma população estudiantil universitária, medellín, 2014

Objetivo: determinar la prevalencia de migraña y las características epidemiológicas y clínicas en una población universitaria de Medellín, 2014. Metodología: estudio transversal descriptivo. Se encuestó una muestra de estudiantes mayores de 18 años, matriculados en las distintas escuelas de una institución privada, quienes dieron su consentimiento verbal para participar en el estudio. La encuesta fue diseñada teniendo en cuenta los criterios diagnósticos de migraña de la Sociedad Internacional de Cefalea (IHS) versión beta 2013, y otras variables de interés (sociodemográficas, comorbilidades, antecedentes familiares y tratamiento). Resultados: se encuestaron 650 estudiantes cuya mediana de edad fue 21 (rango intercuartílico: 19-23 años), 427 (65.7%) eran del sexo femenino. La prevalencia de migraña fue del 27.7%; en estos, los antecedentes personales más frecuentes fueron colon irritable (24.4%) y trastornos depresivos (8.9%); 103 (57.2%) tenían antecedente familiar de migraña y un 51% ya había sido diagnosticado por un médico. Los desencadenantes más comunes fueron períodos largos de ayuno (71.3%), períodos cortos de sueño (69.1%) y época de parciales (63.8%); 168 (93.3%) estudiantes refirieron el uso de analgésicos para lograr mejoría de la cefalea y solo 44.6% de estas medicinas fueron formuladas por un médico. Los medicamentos más usados para la prevención de las crisis fueron naproxeno (19.6%%) y propanolol (12.3%) y para el alivio del dolor fueron acetaminofén (70.8%) e ibuprofeno (44.4%). Conclusiones: se observó una prevalencia de migraña mayor a la reportada en población general y la presencia de factores tradicionalmente descritos con esta patología.

Objective: To determine the prevalence of migraine and the clinical and epidemiological characteristics of a representative subset of university students from Medellin in 2014. Methods: Descriptive, cross-sectional study. Data was collected from a private university student subset. All participants were over 18 (legal age in Colombia) and were enrolled in different university programs. They all verbally agreed to participate before submitting their personal data to the study. Data was collected using a survey developed by researchers and was based on the 2013 International Headache Society (IHS) diagnostic criteria (beta version) and other variables of interest to the study, such as sociodemographic data, comorbidities, family disease history, and treatment methods. Results: A total of 650 students completed and submitted the survey. The median age was 21 years (interquartile range: 19-23 years), and 427 students (65.7%) were female participants. Migraine prevalence was determined to be 27.7%. Among students who met migraine diagnostic criteria (n=180), irritable bowel syndrome (24.4%) and depressive disorders (8.9%) were the two most common conditions in their medical records. A total of 103 (57.2%) students had a family history of migraine, and only 51% of those who met migraine diagnostic criteria had already been diagnosed by a qualified physician. The most common migraine episode triggers identified included long periods of fasting (71.3%), sleep deprivation (69.1%), and university testing (63.8%). Of the participants, 168 (93.3%) expressed that they use analgesics to treat their migraine episodes, but only 44.6% were using analgesic therapy prescribed by a qualified physician. The most common medications used as a prophylactic approach were naproxen (19.6%) and propranolol (12,3%). The most common medications used as a therapeutic approach were acetaminophen (70.8%) and ibuprofen (44.4%). Conclusions: A greater migraine prevalence was observed than that which was reported in the general population and the presence of factors traditionally described with this pathology.

Objetivo: determinar a prevalência de enxaqueca e as características epidemiológicas e clínicas numa população universitária de Medellín, 2014. Metodologia: estudo transversal descritivo. Se entrevistou uma amostra de estudantes maiores de 18 anos, matriculados nas distintas escolas de uma instituição privada, quem deram seu consentimento verbal para participar no estudo. A enquete foi desenhada tendo em conta os critérios diagnósticos de enxaqueca da Sociedade Internacional de Cefalea (IHS) versão beta 2013, e outras variáveis de interesse (sócio-demográficas, comorbidades, antecedentes familiares e tratamento). Resultados: se entrevistaram 650 estudantes cuja a idade média foi de 21 anos (faixa interquartílico: 19-23 anos), 427 (65.7%) eram do sexo feminino. A prevalência de enxaqueca foi de 27.7%; nestes, os antecedentes pessoais mais frequentes foram cólon irritável (24.4%) e transtornos depressivos (8.9%); 103 (57.2%) tinham antecedente familiar de enxaqueca e um 51% já havia sido diagnosticado por um médico. Os desencadeantes mais comuns foram períodos longos de jejum (71.3%), períodos curtos de sono (69.1%) e época de provas (63.8%); 168 (93.3%) estudantes referiram o uso de analgésicos para conseguir melhoria da cefaleia e só 44.6% destas medicinas foram formuladas por um médico. Os medicamentos mais usados para a prevenção das crise foram naproxeno (19.6%%) e propanolol (12.3%) e para o alivio da dor foram acetaminofen (70.8%) e ibuprofeno (44.4%). Conclusoes: se observou uma prevalência de enxaqueca maior à reportada na população geral e a presença de fatores tradicionalmente descritos com esta patologia.

Exclusive breastfeeding protects against postpartum migraine recurrence attacks? / O aleitamento materno exclusivo protege contra a recorrência de crises de enxaqueca no pós-parto?

OBJECTIVES: To observe postpartum migraine recurrence among migraine sufferers before pregnancy, its classifications and associated factors and to compare women, who were exclusively breastfeeding, with those that used other forms of infant feeding. METHODS: Out of 686 consecutively assisted women, at the first postnatal week, 266 were identified as migraine sufferers before pregnancy. Among those, one in five that were exclusively breastfeeding (53) and all the ones consecutively using others forms of infant feeding (40) were interviewed at the first and forth postpartum weeks. RESULTS: After multivariable analysis, exclusive breastfeeding, no breastfeeding problems, and low income were associated with decrease in migraine recurrence at the first postpartum week. At the fourth week, exclusive breastfeeding continued to be a protective factor. CONCLUSIONS: A decrease in postpartum migraine recurrence seems to be another advantage of exclusive breastfeeding.

OBJETIVOS: Observar a recorrência de enxaqueca no período pós-parto em mulheres com enxaqueca antes da gestação, suas classificações e fatores associados e comparar mulheres que apenas amamentavam com aquelas que alimentavam seus filhos de outro modo. MÉTODOS: De 686 mulheres consecutivamente assistidas na primeira semana pós-parto, 266 foram identificadas como portadoras de enxaqueca antes da gestação. Destas, uma em cada cinco que se encontravam amamentando exclusivamente (53) e aquelas que usavam outras modalidades de alimentação (40) foram entrevistadas na primeira e quarta semanas pós-parto. RESULTADOS: Após análise multivariada, observou-se que praticar aleitamento materno exclusivo, não ter problemas relacionados à amamentação e ter baixa renda estavam associados à diminuição da recorrência da enxaqueca na primeira semana pós-parto. Na quarta semana, a prática do aleitamento materno exclusivo continuou sendo fator protetor em relação à enxaqueca. CONCLUSÕES: A diminuição da recorrência da enxaqueca pós-parto parece ser uma vantagem adicional do aleitamento materno exclusivo.

Ultrassom estático e terapia manual para tratamento da enxaqueca refratária. Relato de caso / Static ultrasound and manual therapy in refractory migraine. Case report

JUSTIFICATIVA E OBJETIVOS: Limiares reduzidos de dor a pressão (LDP) e presença de pontos de gatilho musculares costumam ser observadas em pacientes com enxaqueca. A fisioterapia costuma ser útil para esses pacientes. O objetivo deste estudo foi demonstrar os benefícios do ultrassom estático no tratamento de pacientes com enxaqueca. RELATO DE CASO: Paciente do sexo feminino, 25 anos, com enxaqueca desde os 15 anos de idade. Foi enviada por especialista em cefaleia devido à refratariedade ao tratamento farmacológico. Tinha aproximadamente 8 crises incapacitantes por mês que duravam 2 a 3 dias. Foram examinados os músculos craniocervicais, medido o LDP e a amplitude de movimento cervical. Participou de 20 sessões, duas vezes por semana com duração de 40 a 50 minutos, de alongamento global e tração cervical, além de liberação miofascial e desativação dos pontos de gatilho musculares. Após a 6ª sessão introduziu-se o ultrassom estático ao protocolo. CONCLUSÃO: Houve redução significativa na frequência e duração dos ataques de enxaqueca, além de aumento do LDP. A fisioterapia com ultrassom estático pode ser útil para pacientes com enxaqueca refratária.

BACKGROUND AND OBJECTIVES: Reduced pressure pain thresholds (PPT) and presence of muscular trigger points are often observed in patients with migraine. Physical therapy is frequently helpful in these patients. The objective of this study was to demonstrate the benefits of static ultrasound in the treatment of patients with migraine. CASE REPORT: Female patient, 25 years-old with migraine since the age of 15 years. She was referred by a headache specialist due to refractoriness to pharmacological treatment. She had around 8 disabling attacks per months, lasting from 2 to 3 days. We examined the craniocervical muscles, measured the PPT and cervical range of motion. She participated in 20 sessions twice a week, lasting from 40 to 50 minutes, of global stretching, stretching and cervical traction, as well as myofascial vibration and deactivation of muscular trigger points. From the 6th section after, static ultrasound was added to the protocol. CONCLUSION: There has been significant reduction in the frequency and duration of migraine attacks, as well as increased PPT. Physical therapy using Static Ultrasound may be of value for patients with refractory migraine.

Cefalea en la infancia: experiencia clínica en la Unidad de Neuropediatría del Hospital Doctor Miguel Pérez Carreño, Caracas, Venezuela / Headache in children: clinical experience at the the Neuropediatric Unit, Hospital Doctor Miguel Pérez Carreño, Caracas, Venezuela

Introducción: la cefalea es común en la infancia y su frecuencia aumenta en la adolescencia; raras veces está relacionada con enfermedades graves, pero sí repercute negativamente en la calidad de vida. Objetivo: determinar las características clínicas y epidemiológicas de la cefalea en una cohorte de niños, clasificarla y evaluar la respuesta al tratamiento profiláctico. Métodos: estudio descriptivo, prospectivo y longitudinal en el que se analizaron las siguientes variables: edad, sexo, antecedentes perinatales y personales, historia familiar de cefalea, características de los episodios, tratamiento recibido y respuesta al mismo. Se clasificaron los casos de acuerdo con los criterios de la Sociedad Internacional de Cefalea y según su patrón temporal. Resultados: el grupo más afectado fueron los escolares y predominaron las niñas. El antecedente familiar de migraña estuvo presente en 64,7%. Predominó la migraña sin aura (63,9%). Recibieron tratamiento profiláctico 88,6% y hubo buena respuesta en 88,2%. Los estudios de neuroimágenes y el EEG hechos de rutina no tuvieron utilidad. Conclusiones: no existen criterios estandarizados para la clasificación de la cefalea en la infancia, pero debe hacerse un seguimiento adecuado de todos los síntomas para validar los criterios diagnósticos y reducir el impacto negativo sobre la calidad de vida.

Introduction: headache is common in children, and its frequency increases during adolescence; it is rarely related with severe diseases, but it does affect the quality of life. Objective: To determine the clinical and epidemiological characteristics of headache in a cohort of children, to classify the episodes, and to evaluate responses to prophylactic treatment. Methods: Prospective, descriptive, longitudinal study. The following variables were analyzed: age, sex, perinatal and personal history, family history of headache, characteristics of the episode, prophylactic treatment and response to it. Cases were classified according to the International Headache Society and the temporal pattern of episodes. Results: Schoolchildren and girls were more affected. Family history of migraine was present in 64.7%. Migraine without aura was predominant (63.9%). Prophylactic treatment was given to 88.6% and responses to it were good in 88.2%. Routinely done neuro-images studies and EEG were not useful. Conclusion: Although standardized criteria for the classification of headache in children are not available, an appropriate follow-up of symptoms must be done in order to validate the diagnostic criteria, and to reduce the negative impact on the quality of life.

Course of migraine during pregnancy among migraine sufferers before pregnancy / Comportamento da enxaqueca durante a gestação em mulheres portadoras de enxaqueca pré-gestacional

OBJECTIVE: To describe the course of migraine without aura and migraine with aura during pregnancy and factors that could influence its course, among migraine sufferers before pregnancy. METHOD: A cross sectional study undertaken at the IMIP, Brazil. Out of 686 consecutively assisted women, at the first postnatal week, 266 were identified as migraine sufferers before pregnancy. RESULTS: There was migraine remission in 35.4 percent, 76.8 percent and 79.3 percent among migraine without aura sufferers and 20.7 percent, 58.6 percent and 65.5 percent among those with migraine with aura, respectively in the first, second and third trimesters. Statistically significant difference was found when the first trimester was compared with the second and third trimesters. The factors associated with the presence of migraine during pregnancy were: multiparity, menstrually related migraine without aura prior to pregnancy and illness during pregnancy. CONCLUSION: The study contributed to elucidate the course of migraine during pregnancy in migraine sufferers prior to pregnancy.

OBJETIVO: Descrever o comportamento da enxaqueca com e sem aura durante a gestação e fatores que possam influenciar o seu curso, em mulheres com enxaqueca antes da gestação. MÉTODO: Estudo transversal realizado no IMIP, Brasil. De 686 mulheres consecutivamente assistidas na primeira semana pós-parto, 266 foram identificadas como portadoras de enxaqueca antes da gestação. RESULTADOS: Houve desaparecimento das crises de enxaqueca, tanto na enxaqueca sem aura em 35,4 por cento, 76,8 por cento e 79,3 por cento, como na enxaqueca com aura em 20,7 por cento, 58,6 por cento e 65,5 por cento, respectivamente no primeiro, segundo e terceiro trimestres de gestação, com diferença estatisticamente significante quando se comparou o primeiro, com o segundo e terceiro trimestres. Os fatores associados à presença de crises de enxaqueca foram: multiparidade, enxaqueca sem aura relacionada à menstruação antes de gestação e doença durante a gestação. CONCLUSÃO: O estudo contribuiu para elucidar o comportamento da enxaqueca durante a gestação em mulheres com enxaqueca antes da gestação.

Evaluación de la mutación A3243G delADN mitocondrial en pacientes con subtipos específicos de migraña / Assessment of mitochondrial DNA A3243G mutation in patients with migraine specific subtypes

En algunos subtipos de migraña se ha demostrado la existencia de hiperexcitabilidad cortical y metabolismo energético cerebral anormal debido probablemente a disfunción mitocondrial. En estos pacientes es alta la sospecha sobre la existencia de mutaciones en el ADN mitocondrial implicadas como mecanismos fisiopatológicos en esta entidad. Objetivo. Identificar la mutación A3243G del ADN mitocondrial en pacientes con complicaciones de la migraña, y la migraña hemipléjica esporádica, basilar y retiniana. Material y métodos. Se realizó un estudio descriptivo-prospectivo en una serie de pacientes de consulta externa neurológica de la ciudad de Medellín, con diagnóstico de los diferentes subtipos de migraña, desde agosto de 2006 a diciembre de 2007. Resultados. Se incluyeron en el estudio 19 pacientes, 14 mujeres y 5 hombres, con edad promedio de 33,4 ± 13,5 años. De los diferentes subtipos la hemipléjica fue la más prevalente (11 pacientes), seguida de la migraña basilar (3 pacientes), el estado migrañoso (2 pacientes), la migraña retinal (2 pacientes) y el aura prolongada (1 paciente). La mutación A3243G en el ADN de leucocitos de sangre periférica, que fue la única evaluada en el estudio, no estuvo presente en ninguna de las muestras analizadas. Conclusiones. La mutación A3243G del ADN mitocondrial no está relacionada con la presentación de los diferentes subtipos en la población estudiada. Futuros estudios con mayor número de pacientes de cada sub-tipo de migraña permitirán ampliar el conocimiento sobre el papel de ésta y otras mutaciones mitocondriales en este trastorno.

Hyperexitability and abnormal brain metabolism due to mitochondrial dysfunction has been described in somespecific types of migraine. In these patients there are high suspicion of mutations in mitochondrial DNA thatare implicated as pathophysiologic mechanisms in this entity. Objective. To identify the A3243G mutation of mitochondrial DNA in patients with complications of migraine, sporadic hemiplegic migraine, basilar type migraine, retinal migraine. Materials and methods. A prospective descriptive study of a series of neurological patients in an outpatient of the city of Medellin, with a diagnosis of that subtypes, from August 2006 to December 2007. Results. This study included 19 patients, 14 women and 5 men with mean age 33.4 ± 13.54 years. Of the different subtypes hemiplegic was the most prevalent (11 patients), followed by basilar migraine (3 patients), migraine status (2 patients), retinal migraine (2 patients) and prolonged aura (1 patient). The A3243G mutation in the DNA of peripheral blood leukocytes, which was only evaluated in the study, was not found in any of the samples. Conclusions. The mitochondrial DNA A3243G mutation is not related to the presentation of different subtypes in the population studied. Future clinical trials, with a representative number of patients for each subtypes, may draw conclusions about whether the mitochondrial dysfunction caused by this and other mutations associated with the clinical presentation of this type of migraine.

Síntomas prodrómicos de migraña / Prodromic symptoms in migraine

Introducción. Los síntomas prodrómicos pueden ofrecer una oportunidad terapéutica a los pacientes con migraña. Objetivos. Determinar las características clínicas de los síntomas prodrómicos y comparar las diferencias de las características entre la migraña con y sin aura y la migraña crónica, en un grupo de estudiantes universitarios colombianos. Material y métodos. Efectuamos un estudio descriptivo de corte transversal a través de una entrevista semiestructurada validada en español para el diagnóstico de cefaleas primarias en estudiantes universitarios. Los estudiantes respondieron un cuestionario diagnóstico de migraña; de ellos, a quienes se les detectó migraña fueron evaluados por un neurólogo mediante entrevista semiestructurada. Resultados. Se entrevistaron 141 pacientes con migraña; el 29,8% de ellos tienen síntomas prodrómicos con características variadas y una duración mediana de 30 minutos. El tiempo de máxima intensidad de la cefalea también es variable, con mediana de 13,5 minutos. El 24,1% refieren intensidad máxima de la cefalea desde el inicio. No hubo diferencias en la frecuencia de síntomas prodrómicos, duración o tiempo de máxima intensidad del dolor entre pacientes con migraña con aura, migraña sin aura o migraña crónica. Conclusión. Las medicaciones usadas clínicamente para prevenir un ataque de migraña durante la fase prodrómica sólo son utilizables en la tercera parte de los pacientes con migraña y deben actuar antes de 30 minutos. Estos hallazgos limitan la utilidad clínica de los síntomas prodrómicos y las opciones terapéuticas a utilizar durante la fase prodrómica del ataque de migraña.

Introduction. Prodromic symptoms can offer a therapeutic opportunity to the patients with migraine. Objectives: to determine clinical characteristics of prodromic symptoms and to compare the differences between migraine with and without aura and chronic migraine in an colombian university population. Materials and methods. We guided a cross sectional study by means of a semi-structured, interview validated in spanish designed to identify primary headaches among university students. Students answered a diagnosticquestionnaire of migraine; who were detected with migraine then were interviewed face to face bya a neurologist by a semi structured interview. Results. 141 patients were interviewed with migraine. 29.8% patients with migraine had prodromic symptoms with varied characteristic and a median duration of 30 minutes. The time of maximum intensity of migraine is also variable with a median of 13.5 minutes. 24.1% of the patients describe a maximum intensity of the headache from the beginning. There were not differences in frequency and duration of prodromic symptoms, or time of maximum intensity of the pain among patients with migraine with aura, migraine without aura or chronic migraine. Conclusions. The medication used to prevent a migraine attack during the prodromic phase are only usable in the third part of the patients with migraine and they shoud act before 30 minutes. These findings limit the clinical usefulness of the prodromic symptoms and the therapeutic options to use during the prodrome of the migraine attack.

Cefaléias primárias: abordagem diagnóstica por médicos não-neurologistas / Primary headaches: a diagnostic approach by non-neurologist doctors

OBJETIVO: Avaliar o conhecimento do diagnóstico e conduta de médicos não-neurologistas quanto às cefaléias primárias. MÉTODO: 91 médicos foram solicitados a diagnosticar e estabelecer condutas em três histórias de pacientes com características clínicas de migrânea sem aura (MSA), cefaléia do tipo tensional crônica (CTTC) e migrânea com aura (MCA), elaboradas de acordo com a Classificação Internacional das Cefaléias - 2ª Edição (CIC-II). RESULTADOS: MSA: dois profissionais (2,2 por cento) fizeram o diagnóstico correto, 54 (59,3 por cento) diagnosticaram migrânea sem especificar o subtipo. CTTC: 15 médicos (16,5 por cento) diagnosticaram cefaléia de tensão sem especificar o subtipo. MCA: 26 (28,6 por cento) fizeram o diagnóstico de migrânea e apenas um médico (1,1 por cento) fez o diagnóstico correto do subtipo. Dezesseis médicos (17,6 por cento) afirmaram conhecer a CIC-II. CONCLUSÃO: A maioria dos médicos não-neurologistas desconhece os critérios utilizados para diagnóstico e classificação das formas mais freqüentes de cefaléias primárias.

OBJECTIVE: To evaluate the knowledge of diagnostic and posture of non-neurologist doctors concerning primary headaches. METHOD: 91 doctors were asked to diagnose and establish procedures on three patient histories presenting clinic characteristics of migraine without aura (MA), chronic tension-type headache (CTTH) and migraine with aura (MO), according to the International Classification of Headaches - 2nd Edition (CIC-II). RESULTS: MSA: Two professionals (2.2 percent) were accurate in their diagnostic, 54 (59.3 percent) said it was migraine but did not specify the subtype. CTTC: 15 doctors (16.5 percent) diagnosed tension-type headache but did not specify the subtype. MCA: 26 (28.6 percent) said it was migraine, and only one doctor (1.1 percent) was right about the subtype. Sixteen doctors (17.6 percent) said to be aware of CIC-II. CONCLUSION: Most of non-neurologist doctors do not know the diagnostic criteria used to diagnose and to classify the most frequent forms of primary headaches.