The role of sleep in migraine attacks.

Migraine attacks may be precipitated by sleep deprivation or excessive sleep and sleep is also associated with relief of migraine attacks. In view of this variable relationship we studied the records of 159 consecutive outpatients of our Headache Unit. In 121 records there was reference to sleep involvement, in 55% by a single form and in 45% by more than one form. When only one form was related, relief was most common (70%). 30% of that group of patients had the migraine attack precipitated by sleep, 24% by deprivation and 6% by sleep excess. When the effects of sleep were multiple, these effects were as expected logically in 65%: "in accordance" group (e.g attack precipitated by sleep deprivation and relieved by sleep onset. In a second group, ("conflicting") where the involvement was not logical, there were three different combinations of sleep involvement, possibly due to more than one pathophysiological mechanism.

[Fibrous dysplasia of the temporal bone and cerebral occlusive vasculopathy: report of a case]. / Displasia fibrosa do osso temporal e vasculopatia oclusiva cerebral. Relato de caso.

Fibrous dysplasia is a benign disease with unknown etiology. Skull attempt may cause neurological disorders. The diagnostic can be made through radiological examination. A case of a patient with right temporal bone involvement with facial palsy, right parietal lobe infarctions and elevated anticardiolipin antibody titers is presented. Cerebral angiography showed occlusion of several cerebral arteries. Post mortem examination displayed recent myocardial infarction, ischemic cerebral softening, and generalized arteriosclerosis. The simultaneous occurrence of fibrous dysplasia and a probable anticardiolipin syndrome is commented.

[Use of substances for immediate management of pain in patients with headache. Study in an ambulatory population]. / Uso de substâncias para alívio imediato da dor (SAID) em pacientes com cefaléia. Estudo em uma população ambulatorial.

Data about the use of pain relieving drugs in 411 patients, collected during 24 months are presented. The patients were interviewed personally by one of the authors during a selection process. Demographic data were obtained as well as information about headaches and other pains, duration of the disease, previous headache treatment, clinical characteristics of the headache and a diagnostic hypothesis was formulated. Regarding the use of medication the following factors were considered: amount and quality of medication taken, duration of disease, person responsible for the prescription and awareness of side effects. The results showed that 82% of the patients used substances for immediate relief to headache. Eighty per cent of these patients used commercial products without ergot derivatives, 9% with ergot derivatives and 12%, both. At the same time, 27% of the patients used 3 or more commercial products. The most frequently used substance was dipyrone. Several patients used, as PRD, substances without these properties. Forty eight per cent of the patients used PRD daily or more than once a day and 63% used them for over 90 days. Thirty two per cent of the patients used 5 or more doses of PRD during one single crisis of pain. Seventy four per cent of the patients used self-medication and 81% were not aware of side effects. The present data indicate that the use of PRD is high and chronic. The main implications of this fact and preventive measures are discussed.

[Abuse of substances for immediate management of pain in patients with headache]. / Abuso de substâncias para alívio imediato da dor (SAID) em pacientes com cefaléia.

Data on the use of pain relieving drugs in 339 patients who used medication to relieve their headache are presented. One hundred sixty eight (49%) of them were considered as abusers based on Diamond and Dalessio's criteria modified by Saper. The most common form of abuse was the daily use of PRD, observed in 90 (54%) of the patients (criterion A) followed by: abuse by criterion A plus use of more than 100 doses of analgesic/month (criterion B) observed in 18 (11%) and finally criterion A plus daily use of compounds containing barbiturates or other tranquilizing drugs, in 18 (11%) of the patients. The abuse by psychotropic drugs was observed in 11 (7%) of the patients. The data suggest that the abuse of PRD is high and must be regarded as a public health problem.

[A unit for the care of acute headache attacks. A new experience in our milieu]. / Unidade de atendimento de agudos com cefaléia (UAAC). Uma experiência nova em nosso meio.

This paper presents the aims of the first unit for treatment of headache crisis in a Brazilian Medical School. The differences between this unit and a neurological emergency unit and the therapeutic schedules are discussed.

"Hemicrania continua": a case report.

The case of a 42-year-old woman with a 31-year history of continuous unilateral, pulsating headache with occasional exacerbations is described. Complete relief was obtained with 150 mg indomethacin daily.

[Confusional state and infantile migraine: report of a case]. / Estado confusional e enxaqueca infantil: relato de um caso.

The case of a male patient having had episodes of confusion and motor deficits at age 5, 9 and 11, admitted to the hospital on these three occasions is reported. All investigations showed negative results, except for the EEG. A clue for the clinical diagnosis of confusional state due to migraine was the past history of the patient, who suffered several migranous attacks from the age of 9. A review of the pathophysiology is made, based on the available literature.