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1.
Eur J Neurol ; 27(3): 536-541, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31574197

RESUMO

BACKGROUND AND PURPOSE: Although migraine is the second most disabling condition worldwide, there is poor awareness of it. The objective was to assess the awareness of migraine and previous diagnostic and therapeutic consultations and treatments in a large international population of migraineurs. METHODS: This was a multicentre study conducted in 12 headache centres in seven countries. Each centre recruited up to 100 patients referred for a first visit and diagnosed with migraine. Subjects were given a structured clinical questionnaire-based interview about the perceptions of the type of headache they suffered from, its cause, previous diagnoses, investigations and treatments. RESULTS: In all, 1161 patients completed the study. Twenty-eight per cent of participants were aware that they suffered from migraine. Sixty-four per cent called their migraine 'headache'; less commonly they used terms such as 'cervical pain' (4%), tension headache (3%) and sinusitis (1%). Eight per cent of general practitioners and 35% of specialists (of whom 51% were neurologists and/or headache specialists) consulted for migraine formulated the correct diagnosis. Before participating in the study, 50% of patients had undergone X-ray, computed tomography and/or magnetic resonance imaging of the cervical spine and 76% underwent brain and/or cervical spine imaging for migraine. Twenty-eight per cent of patients had received symptomatic migraine-specific medications and 29% at least one migraine preventive medication. CONCLUSIONS: Although migraine is a very common disease, poor awareness of it amongst patients and physicians is still an issue in several countries. This highlights the importance of the promotion of migraine awareness to reduce its burden and limit direct and indirect costs and the risk of exposure to useless investigations.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/psicologia , Adulto , Idoso , Encéfalo/diagnóstico por imagem , Estudos de Coortes , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Cefaleia/diagnóstico , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/terapia , Médicos , Inquéritos e Questionários , Tomografia Computadorizada por Raios X , Adulto Jovem
2.
Arq. bras. med. vet. zootec. (Online) ; 70(5): 1355-1361, set.-out. 2018. ilus
Artigo em Português | LILACS, VETINDEX | ID: biblio-946806

RESUMO

Os tumores da bainha perineural são pouco frequentes em animais domésticos. Relata-se o caso de um cão, sem raça definida, de cinco anos, fêmea, com histórico de aumento de volume em região retrobulbar do globo ocular direito (GOD) havia três semanas. Ao exame clínico, constatou-se a presença de uma neoformação retrobulbar direita com deslocamento do globo ocular cranialmente. Aos exames realizados durante o internamento, não foi possível localizar a origem e a extensão da neoformação. O animal veio a óbito por parada cardiorrespiratória e foi encaminhado para a necropsia. À avaliação macroscópica, observou-se neoformação esbranquiçada fixada à base do crânio em região selar, com possível origem no terceiro (III) par de nervos cranianos, a qual se infiltrava no encéfalo na altura do hipotálamo, estendia-se caudalmente em direção ao tronco encefálico e cranialmente à órbita direita, comprimindo, assim, o GOD. Microscopicamente consistia de feixes curtos entrelaçados ou enovelados de células fusiformes com pleomorfismo discreto a moderado, alternando-se a áreas de necrose multifocalmente, compatível com tumor da bainha perineural. Ao exame imuno-histoquímico, apresentou marcação fraca para S100 e GFAP e marcação positiva para vimentina, o que indica caráter maligno.(AU)


Tumors of the perineural sheath are uncommon in domestic animals. We report the case of a 5-year-old female dog with a history of increased volume in the retrobulbar region of the right eye (RE) three weeks ago. The clinical examination revealed a presence of a right retrobulbar neoformation with cranial ocular globe displacement. In the examinations carried out during hospitalization, it was not possible to locate a source and an extension of the neoformation. The animal died of cardiorespiratory arrest and was referred to an autopsy. The macroscopic evaluation revealed a whitish neoformation fixated to the base of the skull in a seal region, with a possible non-III origin of cranial nerves, infiltrating non-encephalon at the height of the hypothalamus, extending caudally towards the brainstem and cranially to the orbit right, compressing RE. Microscopically it consisted of short bundles intertwined or enovelados of spindle cells with discrete to moderate pleomorphism, alternating to areas of multifocal necrosis, compatible with tumor of the perineural sheath. Immunohistochemical examination showed weak marking for S100 and GFAP and positive marking for vimentin, indicating malignancy.(AU)


Assuntos
Animais , Cães , Bradicardia/veterinária , Cães/anormalidades , Síndrome de Horner/veterinária , Neoplasias/diagnóstico
3.
Cephalalgia ; 26(10): 1234-7, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16961792

RESUMO

Nummular headache is proposed as a distinct type of headache in the Appendix of the second edition of the International Classification of Headache Disorders (ICHD-II). It is a chronic condition, with the following characteristics: pain is felt on a small circumscribed cranial area; pain is of mild to moderate intensity; there is no evidence of a structural abnormality. Herein, three cases fulfilling the ICHD-II proposed criteria (code A13.7.1) for nummular headache are reported.


Assuntos
Transtornos da Cefaleia Primários/classificação , Transtornos da Cefaleia Primários/fisiopatologia , Adulto , Analgésicos/uso terapêutico , Doença Crônica , Feminino , Cabeça , Transtornos da Cefaleia Primários/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença
5.
Cephalalgia ; 23(9): 869-76, 2003 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-14616928

RESUMO

This was a randomized, double-blind study designed to evaluate the comparative efficacy and tolerability of the 40-mg dose of eletriptan and the 2.5-mg dose of naratriptan. Patients (n = 548) meeting International Headache Society (IHS) criteria for migraine were randomized to treat a single migraine attack with either eletriptan 40 mg, naratriptan 2.5 mg, or placebo. Headache response rates at 2 h and 4 h, respectively, were 56% and 80% for eletriptan, 42% and 67% for naratriptan (P < 0.01 for both time-points vs. eletriptan), and 31% and 44% for placebo (P < 0.0001 vs. both active drugs at both time-points). Eletriptan also showed a significantly greater pain-free response at 2 h (35% vs. 18%; P < 0.001) as well as lower use of rescue medication (15% vs. 27%; P < 0.01) and higher sustained headache response at 24 h (38%) compared with naratriptan (27%; P < 0.05) and placebo (19%; P < 0.01). Both eletriptan and naratriptan were well tolerated. The results confirm previous meta-analyses that have suggested the superiority of eletriptan vs. naratriptan in the acute treatment of migraine.


Assuntos
Indóis/uso terapêutico , Transtornos de Enxaqueca/tratamento farmacológico , Piperidinas/uso terapêutico , Pirrolidinas/uso terapêutico , Agonistas do Receptor de Serotonina/uso terapêutico , Adulto , Método Duplo-Cego , Feminino , Humanos , Indóis/efeitos adversos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Piperidinas/efeitos adversos , Pirrolidinas/efeitos adversos , Agonistas do Receptor de Serotonina/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Triptaminas
6.
Cephalalgia ; 23(2): 146-9, 2003 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-12603372

RESUMO

The International Headache Society (IHS) criteria for headache related to haemodialysis consider that the headaches must begin during haemodialysis and terminate within 24 h. Twenty-eight patients whose headaches started by the time they entered the dialysis programme were prospectively studied. We were not able to classify eight patients that presented the headaches between the sessions. Despite the small number of patients in our study being too low to provide a basis for change in the IHS classification, it serves as an observational report demonstrating possible varieties of headache related to haemodialysis.


Assuntos
Cefaleia/classificação , Cefaleia/etiologia , Guias de Prática Clínica como Assunto/normas , Diálise Renal/efeitos adversos , Adulto , Feminino , Cefaleia/diagnóstico , Humanos , Cooperação Internacional , Masculino , Valor Preditivo dos Testes , Insuficiência Renal/complicações , Insuficiência Renal/terapia , Reprodutibilidade dos Testes , Sociedades Médicas
7.
Braz J Med Biol Res ; 35(10): 1139-45, 2002 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-12424485

RESUMO

Acute headaches are responsible for a significant percentage of the case load at primary care units and emergency rooms in Brazil. Dipyrone (metamizol) is easily available in these settings, being the most frequently used drug. We conducted a randomized, placebo-controlled, double-blind study to assess the effect of dipyrone in the acute treatment of episodic tension-type headache. Sixty patients were randomized to receive placebo (intravenous injection of 10 ml saline) or 1 g dipyrone in 10 ml saline. We used seven parameters of analgesic evaluation. The patients receiving dipyrone showed a statistically significant improvement (P<0.05) of pain compared to placebo up to 30 min after drug administration. The therapeutic gain was 30% in 30 min and 40% in 60 min. The number of patients needed to be treated for at least one to have benefit was 3.3 in 30 min and 2.2 in 60 min. There were statistically significant reductions in the recurrence (dipyrone = 25%, placebo = 50%) and use of rescue medication (dipyrone = 20%, placebo = 47.6%) for the dipyrone group. Intravenous dipyrone is an effective drug for the relief of pain in tension-type headache and its use is justified in the emergency room setting.


Assuntos
Analgésicos/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Dipirona/uso terapêutico , Cefaleia do Tipo Tensional/tratamento farmacológico , Distribuição de Qui-Quadrado , Método Duplo-Cego , Feminino , Humanos , Injeções Intravenosas , Masculino , Medição da Dor , Resultado do Tratamento
8.
Braz. j. med. biol. res ; 35(10): 1139-1145, Oct. 2002. tab, graf
Artigo em Inglês | LILACS | ID: lil-326240

RESUMO

Acute headaches are responsible for a significant percentage of the case load at primary care units and emergency rooms in Brazil. Dipyrone (metamizol) is easily available in these settings, being the most frequently used drug. We conducted a randomized, placebo-controlled, double-blind study to assess the effect of dipyrone in the acute treatment of episodic tension-type headache. Sixty patients were randomized to receive placebo (intravenous injection of 10 ml saline) or 1 g dipyrone in 10 ml saline. We used seven parameters of analgesic evaluation. The patients receiving dipyrone showed a statistically significant improvement (P<0.05) of pain compared to placebo up to 30 min after drug administration. The therapeutic gain was 30 percent in 30 min and 40 percent in 60 min. The number of patients needed to be treated for at least one to have benefit was 3.3 in 30 min and 2.2 in 60 min. There were statistically significant reductions in the recurrence (dipyrone = 25 percent, placebo = 50 percent) and use of rescue medication (dipyrone = 20 percent, placebo = 47.6 percent) for the dipyrone group. Intravenous dipyrone is an effective drug for the relief of pain in tension-type headache and its use is justified in the emergency room setting


Assuntos
Humanos , Masculino , Feminino , Anti-Inflamatórios não Esteroides , Dipirona , Cefaleia do Tipo Tensional , Distribuição de Qui-Quadrado , Método Duplo-Cego , Injeções Intravenosas , Medição da Dor , Resultado do Tratamento
9.
Cephalalgia ; 22(5): 345-53, 2002 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-12110110

RESUMO

Magnesium sulphate has been used in the acute treatment of migraines; some studies found it to be a highly effective medication in the acute control of migraine pain and associated symptoms. This randomized, double-blind, placebo-controlled study assesses the effect of magnesium sulphate on the pain and associated symptoms in patients with migraine without aura and migraine with aura. Sixty patients in each group were assigned at random to receive magnesium sulphate, 1000 mg intravenously, or 0.9% physiological saline, 10 ml. We used seven parameters of analgesic evaluation and an analogue scale to assess nausea, photophobia and phonophobia. In the migraine without aura group there was no statistically significant difference in the patients who received magnesium sulphate vs. placebo in pain relief. The analgesic therapeutic gain was 17% and number needed to treat was 5.98 at 1 h. There was also no statistical difference in relief of nausea. We did observe a significant lower intensity of photophobia and phonophobia in patients who received magnesium sulphate. In the migraine with aura group patients receiving magnesium sulphate presented a statistically significant improvement of pain and of all associated symptoms compared with controls. The analgesic therapeutic gain was 36.7% at 1 h. A smaller number of patients continued to have aura in the magnesium sulphate group compared with placebo 1 h after the administration of medication. Our data support the idea that magnesium sulphate can be used for the treatment of all symptoms in migraine with aura, or as an adjuvant therapy for associated symptoms in patients with migraine without aura.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Sulfato de Magnésio/uso terapêutico , Enxaqueca com Aura/tratamento farmacológico , Enxaqueca sem Aura/tratamento farmacológico , Doença Aguda , Adulto , Anti-Inflamatórios não Esteroides/administração & dosagem , Método Duplo-Cego , Feminino , Humanos , Injeções Intravenosas , Sulfato de Magnésio/administração & dosagem , Masculino , Enxaqueca com Aura/complicações , Enxaqueca sem Aura/complicações , Náusea/tratamento farmacológico , Náusea/etiologia , Medição da Dor , Resultado do Tratamento
12.
Arq Neuropsiquiatr ; 59(3-A): 504-11, 2001 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-11588626

RESUMO

Despite the high prevalence, impact and economic importance of headaches, studies on this subject are rare in Brazil. The aim of the present study was to estimate the prevalence of headaches in the public health system of a town in the interior of the State of São Paulo, as well as to estimate the costs resulting from its management. Data refer to the year of 1998 and were obtained according to the following steps: 1) territorial and demographic characterization of the municipality; 2) characterization of the financial indices and social well-being; 3) budget characteristics of the municipality; 4) evaluation of the structuring of the medical service; 5) determination of the prevalence of headaches at different patient care levels; and 6) calculation of the costs of headaches. Headaches represented 7.9% of all visits at basic health units, 9.7% in the emergency room and 1.1% of hospital admissions. The total costs were R$ 85,131.31 (US$ 70,942.76) corresponding to R$ 7.59 (US$ 6,32) per inhabitant/year. The present study shows the need for epidemiological and economic impact studies, which would provide the basis for the rational use of health funds.


Assuntos
Cefaleia/epidemiologia , Custos de Cuidados de Saúde , Serviços de Saúde/economia , Adolescente , Adulto , Distribuição por Idade , Brasil/epidemiologia , Orçamentos , Criança , Pré-Escolar , Feminino , Cefaleia/economia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Prevalência , Seguridade Social
13.
Arq Neuropsiquiatr ; 59(3-A): 552-8, 2001 Sep.
Artigo em Português | MEDLINE | ID: mdl-11588634

RESUMO

This study presents an evaluation of placebo response in the acute treatment of migraine with or without aura and episodic tension type headache. We studied patients admitted between March 1st,1997 and November 31st,1999 in two Emergency Room Units. Three groups had been defined, each one with 30 participants: migraine without aura (MWOA), migraine with aura (MWA) and episodic tension-type headache (ETTH). Patients were participating of a randomized study to evaluate efficacy of 4 different drugs; those randomized to receive placebo were included. We evaluated pain and associated symptoms. After one hour of placebo administration, 50% of MWOA patients, 23.3% of MWA and 26.7% of ETTH had presented pain relief. The mean of this relief, evaluated by the numerical pain scale, was 41.6%, 23.1% and 36%, respectively. Use of placebo is essential in evaluating the therapeutic role of drugs used in the treatment of acute headache.


Assuntos
Efeito Placebo , Cefaleias Vasculares/tratamento farmacológico , Doença Aguda , Adolescente , Adulto , Feminino , Humanos , Masculino , Enxaqueca com Aura/tratamento farmacológico , Enxaqueca sem Aura/tratamento farmacológico , Medição da Dor/métodos , Cefaleia do Tipo Tensional/tratamento farmacológico , Resultado do Tratamento
14.
Headache ; 41(7): 710-9, 2001.
Artigo em Inglês | MEDLINE | ID: mdl-11554960

RESUMO

OBJECTIVE: To determine the prevalence of migraine and episodic tension-type headache (ETTH) among university students as well as its impact on academic performance and quality of life. BACKGROUND: Headache is a very common symptom in clinical practice. The reduced capacities due to migraine can be profound, and more studies are needed to evaluate, in particular, school performance. Few studies have been conducted to evaluate the impact of tension-type headache on work productivity, quality of life, and the impact of headache on school performance. METHODS: A total of 1022 students were interviewed. Two questionnaires were utilized, a standard one that permitted a diagnosis of migraine or ETTH according to the criteria of the International Headache Society and a second one consisting of a battery of tests on quality of life. RESULTS: A total of 256 students (25%) had migraine and 336 (32.9%) reported ETTH. When in pain, migraineurs demonstrated a 62.7% decrease in productivity while studying, compared with a 24.4% decrease in those with ETTH. Fifty percent of migraineurs tried to study despite the pain, compared with 53.2% of those with ETTH. With respect to all other items tested, there was a significantly higher impairment in the presence of migraine than in the presence of ETTH and in the presence of the latter compared with a control situation. CONCLUSIONS: The present study confirms the profound impact of headache on the performance of university students, with this impact much more evident among migraineurs but also important among students with ETTH.


Assuntos
Logro , Transtornos de Enxaqueca/fisiopatologia , Transtornos de Enxaqueca/psicologia , Qualidade de Vida , Estudantes , Cefaleia do Tipo Tensional/fisiopatologia , Cefaleia do Tipo Tensional/psicologia , Adulto , Feminino , Humanos , Masculino
15.
Cephalalgia ; 21(2): 90-5, 2001 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-11422089

RESUMO

Acute headache is a very frequent symptom, responsible for significant demand at primary care units and emergency rooms. In such sets in Brazil, metamizol is easily found but, on the other hand, neither ergotics nor triptans are available. The aim of this study is to compare intravenous metamizol with placebo in the acute treatment of migraine with aura, migraine without aura and episodic tension-type headache. Fifty-four migraine with aura patients, 95 migraine without aura patients and 30 tension-type headache patients were treated with metamizol. Ninety patients (30 migraine with aura, 30 migraine without aura and 30 tension-type headache patients) received placebo. Pain intensity, nausea, aura, photo- and phonophobia were investigated at 30 min and 60 min after the administration of the drug. Significant improvement of pain after 30 min and 60 min post-dosage was achieved from metamizol groups compared with placebo groups. Significant improvement of all other symptoms was achieved after 60 min post-dosage. Side-effects were mild and with small incidence. Metamizol is an effective, safe and low price drug. It may be regarded as a good alternative drug for the treatment of common acute primary headaches.


Assuntos
Dipirona/administração & dosagem , Transtornos de Enxaqueca/tratamento farmacológico , Cefaleia do Tipo Tensional/tratamento farmacológico , Doença Aguda , Adulto , Brasil , Dipirona/efeitos adversos , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Estudos Prospectivos , Método Simples-Cego , Resultado do Tratamento
16.
Headache ; 41(5): 503-8, 2001 May.
Artigo em Inglês | MEDLINE | ID: mdl-11380649

RESUMO

OBJECTIVES: To evaluate the indirect costs of migraine affecting employees of a public Brazilian hospital. BACKGROUND: Migraine is a common primary headache which has a negative influence on the well-being and quality of life, as well as the professional life, of affected individuals. METHODS: Our series consisted of 846 employees with migraine. The Lost Hours Equivalence Index, which considers both the hours lost due to the absence from work and reduction in productivity, was used to estimate the number of working hours lost due to migraine. RESULTS: Of the employees with migraine studied, 91% presented a mean 56.9% loss of productivity. The mean number of total lost working hours per month due to migraine was 6.5. The estimated total indirect cost of migraine was R $986 903.77 (US $815 622.54), implicating costs of R $241.30 (US $199.42) per employee per year. CONCLUSIONS: Based on its impact on life and the resulting costs, migraine should be considered a public health problem and thus measures should be adopted to reduce its impact on the individual and on society.


Assuntos
Custos Hospitalares/estatística & dados numéricos , Hospitais Públicos/economia , Transtornos de Enxaqueca/economia , Recursos Humanos em Hospital , Absenteísmo , Brasil , Custos de Saúde para o Empregador/estatística & dados numéricos , Feminino , Humanos , Masculino , Recursos Humanos
17.
Arq Neuropsiquiatr ; 58(3A): 664-70, 2000 Sep.
Artigo em Português | MEDLINE | ID: mdl-10973107

RESUMO

Headache is one of the most frequent complain in the medical practice and a very common cause of medical assistance searching in emergency rooms, leading to considerable high costs. The headache cases assisted during the year of 1996 of an emergency room unit (UE - USP) at Ribeirão Preto, SP, Brazil, had been retrospectively studied. During that year a number of 1254 patients searched the UE - USP with major complain of acute headache, among which 64 needed hospitalization. The estimated costs due to consultation, investigation and clinical treatment of the acute headaches was in the order of R$ 138 573.31 (US$ 76 985.17). The expenses related only to laboratorial exams were R$ 23 801.54 (US$ 13 223.07). The surgical expenses were R$ 5 817.90 (US$ 3 232.17). The total cost was R$ 144 391.21 (US$ 80 217.34) which corresponds to R$ 115.14 (US$ 63.97) per patient. This calculus instigates an additional discussion about the costs and effectiveness of the current public health policy, where the financial resources are less abundant than the State dependant population's needs.


Assuntos
Serviço Hospitalar de Emergência/economia , Cefaleia/economia , Custos Hospitalares/estatística & dados numéricos , Doença Aguda , Adulto , Fatores Etários , Brasil , Criança , Análise Custo-Benefício , Humanos , Estudos Retrospectivos
18.
Arq Neuropsiquiatr ; 58(2B): 431-6, 2000 Jun.
Artigo em Português | MEDLINE | ID: mdl-10920404

RESUMO

Headache is a common symptom in the population, with a life prevalence around 90%. It results in an important impact in the life quality of sufferers. The aim of this study is to evaluate the prevalence of migraine among employees of an university hospital (HC), as well as to measure the headache intensity, interference and impact in the daily activities. A total of 1890 employees had answered to a questionnaire which made possible to carry out diagnosis of migraine. Life prevalence of this headache type was 30. 4%. Pain was considered intense, most of the time, by 86% of the migraneurs. It was verified an important impact in the daily life aspects as much during as between the headache attacks. It can be concluded that migraine represents a public health problem among the HC employees. Because migraine brings about an important impact in the life quality of those workers, it is possible that a reduction of working capacity with considerable economic burden exists. This problem deserves, thus, special attention, through a better diagnostic and treatment.


Assuntos
Pessoal de Saúde/estatística & dados numéricos , Hospitais Universitários , Transtornos de Enxaqueca/epidemiologia , Qualidade de Vida , Brasil/epidemiologia , Feminino , Humanos , Masculino , Transtornos de Enxaqueca/fisiopatologia , Medição da Dor , Prevalência , Distribuição por Sexo
19.
Sao Paulo Med J ; 118(3): 58-62, 2000 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-10810329

RESUMO

CONTEXT: When experiencing a headache attack, Brazilian patients usually look for a primary care service, where they are seen by general clinicians. In the town of Ribeirão Preto, these clinicians routinely refer patients to the Emergency Room of the University Hospital. OBJECTIVE: The objective of this study was to evaluate the quality of primary care by analyzing retrospectively the medical records of patients with a complaint of headache seen in this emergency room during the year of 1996. DESIGN: retrospective study. SETTIING: Emergency Room of the Universital Hospital, Ribeirão Preto, São Paulo, reference unit. PARTICIPANTS: 1254 patients. The patients who sought the Emergency Room (ER) of the University Hospital of Ribeirão Preto, during the year of 1996 with a complaint of headache were studied retrospectively. MAIN MEASUREMENTS: Etiology, age, diagnosis, secondary cause, laboratory tests. RESULTS: Of the 1254 patients seen (61% women), 1190 (94.9%) were discharged after the administration of parenteral analgesics before they had spent 12 hours in the room. Only 64 (5.1%) patients remained for more than 12 hours. Of the patients who spent less than 12 hours in the room, 71.5% had migraine or tension type headache and did not require subsidiary exams for diagnosis. Of the patients who spent more than 12 hours in the room, 70.3% had secondary headaches. CONCLUSIONS: We conclude the primary care for headache is unsatisfactory in the Ribeirão Preto region. Many patients with primary headache are referred to tertiary care services, indicating the need for the dissemination of the diagnostic criteria of the International Headache Society to general practitioners.


Assuntos
Serviço Hospitalar de Emergência/normas , Cefaleia/terapia , Atenção Primária à Saúde/normas , Qualidade da Assistência à Saúde , Adolescente , Adulto , Distribuição por Idade , Brasil/epidemiologia , Criança , Pré-Escolar , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Cefaleia/diagnóstico , Cefaleia/epidemiologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/estatística & dados numéricos , Estudos Retrospectivos
20.
Headache ; 40(3): 241-7, 2000 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-10759928

RESUMO

OBJECTIVES: To determine (a) which patients seek primary care services with a complaint of headache, (b) the percentages of the various types of headache in this population, and (c) the impact of the care provided to these patients on the basic health care network. BACKGROUND: Headache is one of the most frequent symptoms reported in medical practice, resulting in significant medical services costs and loss of patient productivity, as well as reduced quality of life. METHODS: A prospective study was conducted in two towns (Ribeirão Preto and São Carlos) in the State of São Paulo, Brazil. The participants in the study consisted of 6006 patients (52.4% women) with highly varied acute symptoms. The patients ranged in age from 14 to 98 years. RESULTS: Headache as the main complaint was reported by 561 (9.3%) of the patients considered, with 312 (55.6%) of those patients presenting with primary headache, 221 (39.4%) with headaches secondary to systemic disorders, and 28 (5.0%) with headaches secondary to neurological disorders. Migraine, the most prevalent primary headache, accounted for 45.1% of patients reporting headache as the single symptom. The most frequent etiologies of headaches secondary to systemic disorders were fever, acute hypertension, and sinusitis. The most frequent headaches secondary to neurological disorders were posttraumatic headaches, headaches secondary to cervical disease, and expansive intracranial processes. Of the 26 cases of drug abuse, 20 were secondary to alcohol (hangover). Headaches secondary to systemic disorders were more frequent in the extreme age ranges. CONCLUSIONS: Headache is a very frequent symptom among patients seen at primary health care units and should be considered a public health problem. The dissemination of the diagnostic criteria of the International Headache Society among primary health care physicians is urgently needed in order to avoid the repeated return of patients or their referral to more differentiated emergency units, which overburden an already insufficient health care network.


Assuntos
Cefaleia/epidemiologia , Cefaleia/etiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Brasil , Feminino , Cefaleia/classificação , Transtornos da Cefaleia/epidemiologia , Humanos , Hipertensão/complicações , Incidência , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/complicações , Atenção Primária à Saúde , Distribuição por Sexo , Sinusite/complicações , Transtornos Relacionados ao Uso de Substâncias/complicações
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