Análisis de la efectividad de la técnica de punción seca en cefaleas: revisión sistemática / Effectiveness of dry needling for headache: A systematic review

Introducción: El uso de tratamientos no farmacológicos en pacientes con cefalea, como la punción seca (PS), está asociado a una baja morbimortalidad y a un bajo coste sanitario. Algunos han demostrado utilidad en la práctica clínica. El objetivo de esta revisión fue analizar el grado de evidencia de la efectividad de la PS en la cefalea.MétodosRevisión sistemática de ensayos clínicos aleatorizados sobre cefalea y PS en las bases de datos biomédicas PubMed, Web of Science, Scopus y PEDro. Se evaluó la calidad de los estudios incluidos mediante la escala PEDro por 2 evaluadores de forma independiente.ResultadosDe un total de 136 estudios, se seleccionaron 8 ensayos clínicos publicados entre 1994 y 2019, incluyendo en total 577 pacientes. Dos estudios evaluaron pacientes con cefalea cervicogénica, otros 2, pacientes con cefalea tensional, y otro, pacientes con migraña. Los otros 3 estudios evaluaron pacientes con cefalea de características mixtas (tensional/migraña). La calidad de los estudios incluidos osciló entre «baja» (3/10) y «alta» (8/10). La eficacia de la PS sobre los episodios de cefalea fue similar a la de los tratamientos con los que se comparó. No obstante, obtuvo mejoras significativas respecto a variables funcionales y de sensibilidad.ConclusionesLa punción seca es una técnica a considerar para el tratamiento de las cefaleas en la consulta, pudiendo utilizarse de forma rutinaria, bien de forma aislada, bien en combinación con terapias farmacológicas. (AU)

Introduction: Non-pharmacological treatment of patients with headache, such as dry needling (DN), is associated with less morbidity and mortality and lower costs than pharmacological treatment. Some of these techniques are useful in clinical practice. The aim of this study was to review the level of evidence for DN in patients with headache.MethodsWe performed a systematic review of randomised clinical trials on headache and DN on the PubMed, Web of Science, Scopus, and PEDro databases. Methodological quality was evaluated with the Spanish version of the PEDro scale by 2 independent reviewers.ResultsOf a total of 136 studies, we selected 8 randomised clinical trials published between 1994 and 2019, including a total of 577 patients. Two studies evaluated patients with cervicogenic headache, 2 evaluated patients with tension-type headache, one study assessed patients with migraine, and the remaining 3 evaluated patients with mixed-type headache (tension-type headache/migraine). Quality ratings ranged from low (3/10) to high (7/10). The effectiveness of DN was similar to that of the other interventions. DN was associated with significant improvements in functional and sensory outcomes.ConclusionsDry needling should be considered for the treatment of headache, and may be applied either alone or in combination with pharmacological treatments. (AU)

Effectiveness of dry needling for headache: A systematic review.

INTRODUCTION: Non-pharmacological treatment of patients with headache, such as dry needling (DN), is associated with less morbidity and mortality and lower costs than pharmacological treatment. Some of these techniques are useful in clinical practice. The aim of this study was to review the level of evidence for DN in patients with headache. METHODS: We performed a systematic review of randomised clinical trials on headache and DN on the PubMed, Web of Science, Scopus, and PEDro databases. Methodological quality was evaluated with the Spanish version of the PEDro scale by 2 independent reviewers. RESULTS: Of a total of 136 studies, we selected 8 randomised clinical trials published between 1994 and 2019, including a total of 577 patients. Two studies evaluated patients with cervicogenic headache, 2 evaluated patients with tension-type headache, one study assessed patients with migraine, and the remaining 3 evaluated patients with mixed-type headache (tension-type headache/migraine). Quality ratings ranged from low (3/10) to high (7/10). The effectiveness of DN was similar to that of the other interventions. DN was associated with significant improvements in functional and sensory outcomes. CONCLUSIONS: Dry needling should be considered for the treatment of headache, and may be applied either alone or in combination with pharmacological treatments.

Los costes indirectos de la cefalea tensional. Una revisión sistemática de la literatura / The indirect costs of tension type headache. A systematic literature review

Objetivo: El objetivo de este trabajo fue revisar sistemáticamente la literatura publicada con relación a los costes indirectos estimados asociados al TTH.DiseñoEsta revisión sistemática siguió la declaración de elementos de informes preferidos para revisiones sistemáticas y metaanálisis (PRISMA).Fuentes de datosLa revisión se realizó en dos bases de datos principales, PubMed y EconLit, y fue completada con la búsqueda de literatura gris.Selección de estudiosEl criterio básico para la inclusión de estudios fue que presentaran al menos una medida de costes indirectos específicos del TTH.Extracción de datosSe seleccionaron finalmente 12 estudios para la extracción de la información. De todos los artículos seleccionados se sintetizaron las características del diseño del estudio, los tipos de coste incluidos, así como el instrumento de medida, y los resultados principales.ResultadosLa búsqueda arrojó en total 568 estudios. Se encontró heterogeneidad en los diseños y muestras/poblaciones de los estudios incluidos. Sólo dos estudios estimaron costes directos e indirectos para el TTH. Entre los resultados más destacables, encontramos un impacto moderado estimado de la discapacidad por TTH (entre 0,037 y 0,15 por persona, 0,06-0,09% para la población). Las pérdidas de productividad y eficiencia se observaron y fueron muy heterogéneas. La disposición a pagar por un tratamiento efectivo oscilaría entre $1,32 y $9,20 mensuales. La calidad de vida es baja, entre 28,2 y 28,4 puntos sobre 100, y la calidad de vida relacionada con la salud, parece mejorar significativamente con un tratamiento.ConclusionesA pesar de la elevada heterogeneidad de los resultados, podemos concluir que la cefalea tensional se caracteriza por un impacto moderado en la discapacidad, en la productividad y eficiencia en el trabajo o la escuela, y en la calidad de vida de quien la sufre.

Objective: The objective of this work was to systematically review the published literature in relation to the estimated indirect costs associated with TTH.DesignThis systematic review followed the Preferred Reporting Items Statement for Systematic Reviews and Meta-analyzes (PRISMA).Data sourcesThe review was performed in two main databases, PubMed and EconLit, and was completed with the gray literature search.Study selectionThe basic criterion for the inclusion of studies was that they present at least one measure of indirect costs specific to TTH.Data extraction12 studies were finally selected for information extraction. Of all the selected articles, the characteristics of the study design, the types of costs included, as well as the measurement instrument, and the main results were synthesized.ResultsThe search yielded a total of 568 studies. Heterogeneity was found in the designs and samples/populations of the included studies. Only two studies estimated direct and indirect costs for TTH. Among the most notable results, we find an estimated moderate impact of disability due to TTH (between 0.037 and 0.15 per person, 0.06–0.09% for the population). Productivity and efficiency losses were observed and were very heterogeneous. The willingness to pay for effective treatment would range from $1.32 to $9.20 per month. Quality of life is low, between 28.2 and 28.4 points out of 100, and health-related quality of life seems to improve significantly with treatment.ConclusionsDespite the high heterogeneity of the results, we can conclude that tension headache is characterized by a moderate impact on disability, on productivity and efficiency at work or school, and on the quality of life of those who suffer it.

[The indirect costs of tension type headache. A systematic literature review]. / Los costes indirectos de la cefalea tensional. Una revisión sistemática de la literatura.

OBJECTIVE: The objective of this work was to systematically review the published literature in relation to the estimated indirect costs associated with TTH. DESIGN: This systematic review followed the Preferred Reporting Items Statement for Systematic Reviews and Meta-analyzes (PRISMA). DATA SOURCES: The review was performed in two main databases, PubMed and EconLit, and was completed with the gray literature search. STUDY SELECTION: The basic criterion for the inclusion of studies was that they present at least one measure of indirect costs specific to TTH. DATA EXTRACTION: 12 studies were finally selected for information extraction. Of all the selected articles, the characteristics of the study design, the types of costs included, as well as the measurement instrument, and the main results were synthesized. RESULTS: The search yielded a total of 568 studies. Heterogeneity was found in the designs and samples/populations of the included studies. Only two studies estimated direct and indirect costs for TTH. Among the most notable results, we find an estimated moderate impact of disability due to TTH (between 0.037 and 0.15 per person, 0.06-0.09% for the population). Productivity and efficiency losses were observed and were very heterogeneous. The willingness to pay for effective treatment would range from $1.32 to $9.20 per month. Quality of life is low, between 28.2 and 28.4 points out of 100, and health-related quality of life seems to improve significantly with treatment. CONCLUSIONS: Despite the high heterogeneity of the results, we can conclude that tension headache is characterized by a moderate impact on disability, on productivity and efficiency at work or school, and on the quality of life of those who suffer it.

Tratamiento del síndrome de dolor miofascial en una paciente diagnosticada de cefalea tensional: a propósito de un caso / Myofascial pain syndrome treatment in a patient diagnosed with tension headache: A case report

Introducción La cefalea tensional tiene una prevalencia importante y un fuerte impacto socioeconómico. Se considera un síndrome de dolor miofascial. El tratamiento del síndrome de dolor miofascial en la musculatura cervical posterior y craneal puede ser una alternativa al tratamiento farmacológico en el abordaje de la cefalea tensional. Objetivo Describir la presencia del síndrome de dolor miofascial en una paciente diagnosticada de cefalea tensional y determinar la efectividad de un tratamiento fisioterapéutico. Materiales y métodos Mujer de 60 años diagnosticada de cefalea tensional. Presentaba un cuadro de dolor opresivo de localización bilateral en cabeza, así como dolor y rigidez cervical. Se exploraron 23 músculos de la zona craneocervical y escapular para diagnosticar el síndrome del dolor miofascial y tratar los puntos gatillo mediante punción seca y el abordaje de Dejung. Se midió el rango articular cervical mediante goniometría y se evaluó el dolor de cabeza con la escala analógica visual del dolor. Resultados El diagnóstico del síndrome del dolor miofascial se confirmó por la presencia de 8 puntos gatillo miofasciales activos. Los resultados mostraron una mejoría clínica relevante en la variable intensidad del dolor, con una reducción superior al 25% en todas las mediciones excepto la tercera. Esta mejora se mantuvo 2 semanas después del tratamiento. Al final de la intervención el dolor remitió, desaparecieron todos los puntos gatillo iniciales activos y latentes, y se recuperaron los últimos grados de ROM para la rotación e inclinación cervical izquierda. Conclusiones El diagnóstico y abordaje del síndrome del dolor miofascial debe ser considerado en pacientes con cefalea tensional (AU)

Introduction Tension headache has an important prevalence and a strong socioeconomic impact. It is considered a myofascial pain syndrome. The treatment of myofascial pain syndrome in the posterior cervical and cranial muscles can be an alternative to pharmacological treatment in the management of tension headache. Objective To describe the presence of myofascial pain syndrome in a patient diagnosed with tension headache, as well as determine the effectiveness of a physiotherapeutic treatment. Materials and methods A 60-year-old woman diagnosed with tension headache. The patient presented a condition of oppressive bilateral headache, as well as neck pain and stiffness. Twenty-three muscles were scanned from the cranio-cervical and scapular area to diagnose myofascial pain syndrome and to treat the trigger points through dry needling and Dejung's technique. Cervical joint range of motion was measured by goniometry and headache was assessed with the visual analogue scale for pain. Results The diagnosis of myofascial pain syndrome was confirmed by the presence of 8 active myofascial trigger points. The results showed a relevant clinical improvement in the pain intensity variable, with a reduction of more than 25% in all measurements except in the third one. This improvement was maintained 2 weeks after the treatment. At the end of the intervention, the pain remitted, all the active and latent initial trigger points disappeared, and the last degrees of ROM were recovered for left cervical rotation and tilt. Conclusions The diagnosis and approach of myofascial pain syndrome should be considered in patients with tension headache (AU)

Manual therapy in adults with tension-type headache: A systematic review.

INTRODUCTION: Tension-type headache is the most common primary headache, with a high prevalence and a considerable socioeconomic impact. Manual physical therapy techniques are widely used in the clinical field to treat the symptoms associated with tension-type headache. This systematic review aims to determine the effectiveness of manual and non-invasive therapies in the treatment of patients with tension-type headache. DEVELOPMENT: We conducted a systematic review of randomised controlled trials in the following databases: Brain, PubMed, Web of Science, PEDro, Scopus, CINAHL, and Science Direct. Ten randomised controlled trials were included for analysis. According to these studies, manual therapy improves symptoms, increasing patients' well-being and improving the outcome measures analysed. CONCLUSIONS: Manual therapy has positive effects on pain intensity, pain frequency, disability, overall impact, quality of life, and craniocervical range of motion in adults with tension-type headache. None of the techniques was found to be superior to the others; combining different techniques seems to be the most effective approach.

Terapia manual en adultos con cefalea tensional: revisión sistemática / Manual therapy in adults with tension-type headache: A systematic review

Introducción: La cefalea tensional es la cefalea primaria más usual, con una prevalencia elevada y unas consecuencias socioeconómicas de gran impacto. Las técnicas de terapia manual, desde la fisioterapia, son muy utilizadas en el abordaje del conjunto de síntomas que puede provocar. El propósito fue realizar una revisión sistemática sobre la efectividad de las terapias manuales y no invasivas en el tratamiento de pacientes que presentan cefalea tensional en sus actuales formas.DesarrolloSe llevó a cabo una revisión sistemática de la literatura en busca de ensayos controlados y aleatorizados. Se emplearon las siguientes bases de datos: Brain, PubMed, Web of Science, PEDro, Scopus, CINHAL y Science Direct. Se analizaron 10 estudios, todos ellos ensayos controlados y aleatorizados. Según los estudios individuales, la intervención logra mejorar la clínica, aportando bienestar al paciente y mejorando las distintas medidas de resultado analizadas.ConclusionesLa terapia manual logra efectos positivos sobre la intensidad y la frecuencia del dolor, la discapacidad, el impacto, la calidad de vida y el rango de movimiento craneocervical en adultos con cefalea tensional. No se encuentra superioridad entre una técnica con respecto a otra, siendo más efectivo el tratamiento combinado de estas. (AU)

Introduction: Tension-type headache is the most common primary headache, with a high prevalence and a considerable socioeconomic impact. Manual physical therapy techniques are widely used in the clinical field to treat the symptoms associated with tension-type headache. This systematic review aims to determine the effectiveness of manual and non-invasive therapies in the treatment of patients with tension-type headache.DevelopmentWe conducted a systematic review of randomised controlled trials in the following databases: Brain, PubMed, Web of Science, PEDro, Scopus, CINAHL, and Science Direct. Ten randomised controlled trials were included for analysis. According to these studies, manual therapy improves symptoms, increasing patients’ well-being and improving the outcome measures analysed.ConclusionsManual therapy has positive effects on pain intensity, pain frequency, disability, overall impact, quality of life, and craniocervical range of motion in adults with tension-type headache. None of the techniques was found to be superior to the others; combining different techniques seems to be the most effective approach. (AU)

Effectiveness of dry needling for headache: A systematic review. / Análisis de la efectividad de la técnica de punción seca en cefaleas: revisión sistemática.

INTRODUCTION: Non-pharmacological treatment of patients with headache, such as dry needling (DN), is associated with less morbidity and mortality and lower costs than pharmacological treatment. Some of these techniques are useful in clinical practice. The aim of this study was to review the level of evidence for DN in patients with headache. METHODS: We performed a systematic review of randomised clinical trials on headache and DN on the PubMed, Web of Science, Scopus, and PEDro databases. Methodological quality was evaluated with the Spanish version of the PEDro scale by 2 independent reviewers. RESULTS: Of a total of 136 studies, we selected 8 randomised clinical trials published between 1994 and 2019, including a total of 577 patients. Two studies evaluated patients with cervicogenic headache, 2 evaluated patients with tension-type headache, one study assessed patients with migraine, and the remaining 3 evaluated patients with mixed-type headache (tension-type headache/migraine). Quality ratings ranged from low (3/10) to high (7/10). The effectiveness of DN was similar to that of the other interventions. DN was associated with significant improvements in functional and sensory outcomes. CONCLUSIONS: Dry needling should be considered for the treatment of headache, and may be applied either alone or in combination with pharmacological treatments.

Effects of physical therapy and relaxation techniques on the parameters of pain in university students with tension-type headache: A randomised controlled clinical trial. / Efectos de entrenamiento físico específico y técnicas de relajación sobre los parámetros dolorosos de la cefalea tensional en estudiantes universitarios: un ensayo clínico controlado y aleatorizado.

INTRODUCTION: Non-pharmacological treatments help control tension-type headache; however, evidence about their effectiveness is still limited. This study evaluates the effectiveness of physical therapy based on cervical spine kinesiotherapy and posture correction exercises compared to a programme of relaxation techniques only (Schultz's Autogenic Training, AT). METHODS: Tension-type headache is very common among university students. We randomly selected 152 university students with a diagnosis of tension-type headache according to the criteria of the International Headache Society. Eighty-four were women (55.3%) and 68 were men (44.7%). Mean age was 20.42±2.36 years. The study design is a randomised controlled trial of a non-pharmacological intervention with a blinded evaluation of response variables. We compared the results of two independent samples: AT was used in one of the groups while the other group received AT plus cervical spine kinesiotherapy and posture correction training. Patients recorded any changes in the parameters of pain (frequency, intensity, and duration) and drug consumption in a headache diary before treatment, at 4 weeks, and at 3 months. RESULTS: Both interventions achieved a decrease in all the parameters of pain; however, decreases in frequency and intensity were more significant in the combined treatment group (P<0.01) (d=0.4). CONCLUSIONS: Such active, non-invasive therapies as AT and cervical spine kinesiotherapy, and especially the combination of both, effectively reduce tension-type headache by preventing and managing the potential psychophysical causes of this disorder. Future research should aim to assess the long-term effects of these interventions.

Angiomas venosos y cefalea en pediatría: un caso clínico / Venous angiomas and headache in children: A case report

Introducción: Los angiomas venosos (AV) son entidades benignas que infrecuentemente presentan síntomas. Objetivo: Reporte de un caso y revisión del tema. Caso clínico: Escolar, de sexo femenino, 6 años, que inicia cefaleas bifrontales frecuentes 3-4 veces por semana, en relación con trabajo académico, de carácter opresivo, no pulsátil, sin náuseas ni vómitos, rango de intensidad entre 4-6/10. Se inició manejo con calendario de cefaleas, apoyo escolar y evaluación psicológica. La tomografía computarizada cerebral solicitada informó de angioma venoso de núcleo caudado izquierdo, razón por la cual se realizó una resonancia magnética cerebral más angiorresonancia que confirmó angioma venoso y excluyó complicación o asociación a otra malformación vascular. La cefalea respondió bien a terapia psicopedagógica y psicológica. La frecuencia de cefaleas disminuyó a 10-12 al año, agrupadas en periodos de mayores demandas académicas. La paciente es controlada durante 12 años, hasta el egreso de la enseñanza media, sin complicaciones y con un buen manejo de la cefalea tensional. Conclusión: En el estudio de una cefalea el hallazgo de un AV puede ser incidental; una vez reunidos los criterios internacionales de cefalea tensional e iniciado el tratamiento para ello, la monitorización de los AV debe ser clínica. Las complicaciones del AV son infrecuentes y el tratamiento quirúrgico es excepcional.

Introduction: Venous angiomas (VA) are benign entities; however infrequent symptomatic cases may occur. Objective: Case report and literature review. Case report: A 6 year old girl was referred with a history of bi-frontal, non-pulsatile, headache with no nausea or vomiting. Headache intensity was 4-6/10. The episodes were frequent, 3-4 times per week. Triggers include academic work. Computed tomography showed a small VA in left caudate nucleus, which was confirmed by a brain MRI, with no evidence of inflammatory or ischaemic changes, or another vascular malformation. Psychological and psycho-pedagogic techniques were used, combined with relaxation and cognitive-behavioural techniques to reduce the intensity and frequency. There was a good outcome, and the headache decreased to 10 episodes per year. The patient was monitored for 12 years until graduation from high school. The VA remained without complications. Conclusions: In the study of a headache, a VA usually is an incidental finding. The International Classification of Headache Disorders III provides specific criteria of frequent episodic tension-type headache, and allows us begin specific therapy for it. Monitoring of non-symptomatic VA cases should be clinical. The surgical management of these entities is exceptional.

[Venous angiomas and headache in children. A case report]. / Angiomas venosos y cefalea en pediatría: un caso clínico.

INTRODUCTION: Venous angiomas (VA) are benign entities; however infrequent symptomatic cases may occur. OBJECTIVE: Case report and literature review. CASE REPORT: A 6 year old girl was referred with a history of bi-frontal, non-pulsatile, headache with no nausea or vomiting. Headache intensity was 4-6/10. The episodes were frequent, 3-4 times per week. Triggers include academic work. Computed tomography showed a small VA in left caudate nucleus, which was confirmed by a brain MRI, with no evidence of inflammatory or ischaemic changes, or another vascular malformation. Psychological and psycho-pedagogic techniques were used, combined with relaxation and cognitive-behavioural techniques to reduce the intensity and frequency. There was a good outcome, and the headache decreased to 10 episodes per year. The patient was monitored for 12 years until graduation from high school. The VA remained without complications. CONCLUSIONS: In the study of a headache, a VA usually is an incidental finding. The International Classification of Headache Disorders III provides specific criteria of frequent episodic tension-type headache, and allows us begin specific therapy for it. Monitoring of non-symptomatic VA cases should be clinical. The surgical management of these entities is exceptional.

Efficacy of manual therapy in the treatment of tension-type headache. A systematic review from 2000-2013. / Eficacia de la terapia manual en el tratamiento de la cefalea tensional. Una revisión sistemática desde el año 2000 hasta el 2013.

OBJECTIVES: To study the efficacy of manual therapy in the treatment of tension-type headache (TTH) by assessing the quality of randomized control trials (RCTs) published from the year 2000 to April 2013. METHODS: A search was performed in the following databases: MEDLINE, EBSCO, CINAHL, SCOPUS, PEDRO and OVID. An analysis was made of RCT including patients with TTH receiving any manual therapy, and assessing outcome measures including the intensity, and frequency or duration of the headache. Two independent referees reviewed the methodological quality of RCTs using the Jadad scale. Data from the studies were extracted by two different reviewers. RESULTS: A total of fourteen RCTs were selected. Twelve studies showed acceptable quality (Jadad scale ≥3), and the remaining 2 had low quality (Jadad=2). The studies showed positive results, including reduction in headache intensity and/or frequency, reduction of medication consumption, and improvement in quality of life. CONCLUSIONS: The effectiveness of manual therapy for TTH cannot be completely assessed due to the heterogeneity in study design, outcome measures, and different treatments. Nevertheless, the results suggest patients with TTH receiving manual therapies showed better progress than those receiving conventional treatment or placebo. Further studies of high quality using manual therapy protocols, and also including standardized outcome measures, are now needed to clarify the efficacy of manual therapy in the management of TTH.

Cefalea primaria y cervicalgia en el Hospital San Francisco de Quito / Primary headaches and neck pain in the San Francisco de Quito Hospital

Introducción: las cefaleas en conjunto son la primera causa de consulta ambulatoria neurológica. De todos los tipos de cefalea, tanto primarias como secundarias a otro proceso, el 90% de los pacientes que presentan este trastorno, padecen migraña y/o cefalea tensional. Muchos pacientes con cefalea primaria manifiestan presentar dolor en la región cervical. El objetivo del presente trabajo es conocer la epidemiología de cefalea primaria en pacientes atendidos en el Hospital San Francisco de Quito (HSFQ) y valorar la prevalencia de cervicalgia en este grupo de pacientes y la relación de este síntoma con rectificación de la lordosis fisiológica. Materiales y métodos: se realizó un estudio observacional en donde se analizaron los expedientes clínicos de 356 pacientes con cefalea tensional o migraña según los criterios de la "International Headache Society" valorados en la consulta externa de Neurología entre el 01 de marzo y el 31 de diciembre de 2013. Resultados: en la muestra se observó que un 71% y 29% de pacientes padecen cefalea tensional y migraña respectivamente, con un predominio de mujeres en relación a los hombres en ambos casos. La migraña es más prevalente que la cefalea tensional en la pubertad y afecta principalmente al grupo de edad comprendido entre los 25 y los 40 años. La cefalea tensional presenta un pico de prevalencia entre los 35 y 59 años de edad. 269 pacientes equivalente al 76% de los casos presentaron cervicalgia concomitantemente, con la cefalea sin encontrarse una diferencia significativa entre la presencia de este síntoma y cefalea tensional o migraña. Los pacientes que presentaban un dolor cervical entre moderado y grave medido por escala análoga visual, tenían en su mayoría una rectificación de la lordosis cervical valorada mediante el método de Gore. Conclusiones: la prevalencia de cervicalgia en pacientes con cefalea primaria en el presente estudio está en torno al 76%. No existe una diferencia estadísticamente significativa en relación a la presencia de cervicalgia entre personas con cefalea tensional o migraña. El presente estudio nos permite conocer cuál es la epidemiología de las cefaleas primarias en una muestra de población ecuatoriana y es un punto de partida para futuros estudios con el fin de demostrar una asociación entre cervicalgia y cefaleas primarias.

Introduction: headaches are the leading cause of neurological consultations. From all types of both primary and secondary, 90 % of patients with this disorder showed migraine and / or tension headache. Many patients with primary headache complained about pain in the cervical region. The objective of this study is to determine the epidemiology of primary headache in patients seen at the San Francisco of Quito Hospital and assess the prevalence of neck pain in this group of patients and the relationship of this symptom with rectifcation of physiological lordosis. Materials and methods: an observational study was performed, where medical records of 356 patients with tension headache or migraine according to the criteria of the International Society Headache seen at the outpatient Neurology between march 1 and december 31, 2013 was conducted. Results: it was observed that 71 % and 29% of patients suffer from tension headache and migraine respectively, with a predominance of women in relation to men in both cases. Migraine is more prevalent than tension headache at puberty and affects mainly the group aged between 25 and 40 years. Tension headache has peak prevalence between 35 and 59 years old. 269 patients equivalent to 76% of cases had neck pain along with tension headache without fnding a signifcant difference between the presence of this symptom and tension headaches or migraine. Most of the patients, who had a cervical pain from moderate to severe measured by visual analog scale had also a correction of cervical lordosis assessed by the method of Gore. Conclusions: the prevalence of neck pain in patients with primary headache in the present study is around 76%. There is no statistically signifcant difference in relation to the presence of neck pain among people with tension headache or migraine. This study allows us to know the epidemiology of primary headache disorders in a sample of Ecuadorian population and it is a starting point for future studies to demonstrate a connection between cervical pain and primary headaches.

Characteristics of the first 2,000 patients registered in a specialist headache clinic.

OBJECTIVES: Headache is a common cause of medical consultations. We aim to analyze demographic characteristics of first two thousand patients in our register, and the incidence of their different headaches coded according to the International Classification of Headache Disorders, ii edition (ICHD-II). PATIENTS AND METHODS: On January 2008 a headache outpatient clinic was established in a tertiary hospital. Patients could be referred by general practitioners according to previously consensused criteria, as well as by general neurology or other specialities clinics. The following variables were prospectively collected on all patients; age, sex, referral source, complementary tests required, and the previously prescribed symptomatic or prophylactic therapies. All headaches were classified accordingly to ICHD-II. When a patient fulfilled criteria for more than one type of headache, all of them were diagnosed and classified. RESULTS: In October 2012, 2000 patients (ratio women/men 2.59/1) had been seen in our headache clinic. The median age was 42 years (range: 11-94), 55.3% were referred from primary care, and 68.1% did not require complementary tests. A total of 3095 headaches were recorded in these 2000 patients, of which 2222 (71.8%) were considered primary headaches, 382 (12.3%) secondary headaches, with 117 (3.8%) corresponding to cranial neuralgias, 136 (4.3%) were unclassified headaches, and 238 (7.7%) were included in the research Appendix of the ICHD-II. The most represented group was 1 (migraine) with 53% of all headaches. CONCLUSIONS: The characteristics of first 2000 patients in our register were comparable to those previously described in other types of headache outpatient clinics. Migraine was the most frequent diagnosis, and secondary headaches were not as frequent in our series. Most headaches could be coded according to ICHD-II criteria.

Headache in the elderly: characteristics in a series of 262 patients.

INTRODUCTION: Although headache prevalence decreases in patients older than 65, headaches are a common complaint and their different clinical and therapeutic features must be understood. This article analyses the clinical characteristics of elderly patients treated in an outpatient headache unit. METHODS: We collected demographic and clinical data from patients treated in a tertiary hospital headache unit between January 2008 and May 2013. Headaches were codified according to the International Classification of Headache Disorders, 2nd edition (ICHD-2). RESULTS: Of a total of 1868 patients treated, 262 patients (14%, 189 women and 73 men) were older than 65 years. Ninety-nine (68 women, 31 men, 5.3% of the total) were over 75. Headaches began after the age of 65 in only 136 patients (51.9%). The 362 headaches were codified as follows: 23.8% as Group 1 (Migraine) and 28.7% as Group 2 (Tension-type headache). We diagnosed 58 (16%) secondary headaches; 26 (7.2%) were classified as Group 13 (Cranial neuralgias) and 23 (6.4%) in Group 14 (Other headaches). Symptomatic medication overuse was detected in 38 patients (14.5%). We also identified headaches considered typical in the elderly, including chronic migraine (41 cases), hypnic headache (6), occipital neuralgia (4), SUNCT (2), cervicogenic headache (1), primary cough headache (1), and giant cell arteritis (2). CONCLUSIONS: Elderly patients were frequently treated in our outpatient headache unit. Tension-type headache was the most common diagnosis in this population. Geriatric headache syndromes such as hypnic headache or occipital neuralgia were also represented in our series.

Asimetrías faciales como factor etiopatogénico de cefaleas y dolor facial / Facial asymmetries as etiopathogenic factors of headache and facial pain

El objetivo de este estudio fue demostrar la hipótesis sobre la coexistencia de asimetría morfológica con actividad muscular asimétrica, y deesta última con disfunción cráneomandibular y cefalea tensional y dolor facial, para incorporar datos semiológicos al diagnóstico tempranoy tratamiento precoz de las disfunciones cráneo-cérvico mandibulares. Participaron del estudio 66 alumnos de la F.O.U.B.A. con signos y/o síntomas de disfunción cráneomandibular. El diagnóstico de dolor se realizó mediante cuestionarios siguiendo los criterios diagnósticos de la Internacional Headache Society. La determinación de asimetría se realizó midiendo segmentos y ángulos trazados en telerradiografíade frente para tejidos duros y fotografía de cara de frente para tejidos blandos. Se evaluó la función muscular mediante electromiografía de superficie (EMGS); y la dinámica del sistema estomatognático mediante el método magnetométrico. El análisis de regresión logística múltiple resultó significativo al nivel p=0.01. En el análisis de las variables individuales y el dolor se encontró correlación estadísticamente significativa entre la asimetría de tejidos duros y la presencia de cefalea tensional y/o dolor facial. El organismo intenta equilibrar las diferencias morfológicas, esto explicaría las asimetrías cruzadas entre tejidos duros, blandos y actividad muscular comocompensaciones funcionales. Concluimos diciendo que ante la presencia de cefalea tensional y/o dolor facial debemos considerar la asimetríafacial de tejidos duros como posible factor etiológico predisponente aunque no se observe asimetría en tejidos blandos por acción compensatoria de la dinámica muscular. La etiología mixta, oclusal y postural, de las asimetrías faciales requiere del trabajo interdisciplinario odontólogo-médico-kinesiólogo-psicólogo-fonoaudiólogo para un óptimo diagnóstico y tratamiento

The aim of this study was to test the hypothesis on the coexistence of morphological asymmetry with asymmetric muscle activity, and this one with craniomandibular dysfunction and tension headache and facial pain, to incorporate semiological data to early diagnosis and treatment for TMJD (temporo mandibular jaw dysfunction). Study participants were 66 students from the Faculty of Dentistry of the University of Buenos Aires with TMJD signs and / or symptoms. The diagnosis of pain was conducted by questionnaires following the diagnostic criteria of the International Headache Society. The asymmetry determination was performed by measuring segments and angles in cephalometric frontal tracings for hard tissues and frontal picture for soft tissues. Muscle function was evaluated by surface electromyography (SEMG) and stomatognathic system dynamics by magnetometric method. The multiple logistic regression analysis was significant at p = 0.01. In the analysis of individual variables and pain we found statistical correlation between the asymmetry of hard tissues and the presence of tension headache and / or facial pain. The body tries to balance the morphological differences; this would explain the asymmetries cross between hard tissues, soft and functional muscle activity as offsets. We conclude saying that in the presence of tension headache and/or facial pain, the hard tissue facial asymmetry should be considered as a possible etiologic factor predisposing even asymmetry is not observed in soft tissue because of compensatory action of muscle dynamics. The mixed etiology, occlusal and postural of the facial asymmetries, requires interdisciplinary work dentist-doctor-physiotherapist,-psychologist-speech therapist, for optimal diagnosis and treatment.

Tratamiento acupuntural en pacientes con cefalea tensional crónica: Las Tunas 2009 / Acupunctural treatment in patient with migraine chronic tensional: Las Tunas 2009

Se realizó un estudio experimental no controlado, con el objetivo de determinar la efectividad del tratamiento con acupuntura en los pacientes con diagnóstico de cefalea tensional crónica; la muestra quedó constituida por 56 pacientes del policlínico docente Guillermo Tejas Silva de la ciudad de Las Tunas, que acudieron a consulta con diagnóstico de CTC y cumplían los criterios de inclusión, en el período comprendido desde el 1ro de septiembre del 2008 hasta el 31 de agosto del 2009. El tratamiento acupuntural fue aplicado durante un mes, en días alternos. En cuanto a los resultados, el mayor número de pacientes quedó en la categoría de asintomáticos, que representan el 71,4 por ciento. De los pacientes atendidos con menos de un año de evolución de la cefalea, el 77,2 por ciento terminaron el tratamiento asintomáticos y el 20 por ciento mejorados, solo un paciente no refirió mejoría. A medida que aumentó el número de sesiones, fueron mejores los resultados y los pacientes no tuvieron recaídas en un periodo mínimo de 30 días después de haber aplicado el tratamiento. El número de reacciones adversas fue escaso, demostrándose la baja incidencia de complicaciones con el uso de la acupuntura, su fácil uso y beneficio económico(AU)

Was carried out an not controlled experimental study with the objective of determinate the effectiveness of the treatment with acupuncture in the patients with diagnosis of Migraine chronic tensional; the sample was constituted by 56 patients that went to consultation with diagnosis of (MCT) and they completed the inclusion approaches, in the period understood from September 1ro of 2008 up to August 31 of 2009, corresponding to the educational health center Guillermo Tejas Silva of the city of Las Tunas. The acupunctural treatment was applied during one month in alternating days. Key words: Acupuncture, migraine tensional, epidemiology. In relation with the results, the biggest number of patients was in without symptoms category that, it represent the 71,4 por cent. The patients assisted with less than a year of evolution of the migraine, the 77,2 por cent finished the treatment without symptoms and 20 improved por center, alone a patient didn't refer improvement, as the number of sessions increased they were better the results and the patients didn't have relapses in a minimum period of 30 days after having applied the treatment. The number of adverse reactions was scarce being demonstrated the drop incidence of complications with the use of the acupuncture, its easy use and economic Benedit(AU)

Características psicopatológicas en un grupo de pacientes con cefalea / Psychopathologic characteristics in a groups of patients with headache

La cefalea es una de las causas más frecuentes de consulta en el adulto. El objetivo de este estudio es conocer las características de personalidad y el índice de depresión en un grupo de 100 pacientes adultos con cefalea primaria, de la consulta que se da en el Departamento de Tratamientos Especializados (Neurología) de la Habana. Se clasificaron los pacientes según el tipo de dolor referido en: cefalea tensional; migraña común; migraña clásica y cefalea histamínica: se aplicó a los 100 pacientes un cuestionario de preguntas diseñado para consultas de cefalea, el test de Eysenck para el estudio de personalidad, el test CRS mide depresión. Se realizaron análisis estadísticos de los resultados.La cefalea más frecuente fue la tensional (n=36) , seguida por la migraña común (n= 29), la migraña clásica (n=20), la cefalea tensional asociada a migraña común (n=13), con y con cefalea en racimos (n=2).Los pacientes en total referían más de 10.6 años de dolor con una desviación estándar de 10 añosCon personalidad inestable 68 casos. Con personalidad introvertida 64 y equilibrada 27. Con signos moderados y severos de depresión 49 pacientes. Según los resultados encontrados, más de la tercera parte de los pacientes estudiados tienen cefalea tensional seguida de la migraña común y de la clásica. Mientras que en más de la mitad del total de los pacientes con cefalea vistos predomina una personalidad inestable con signos de neurosis y depresión que obliga a un proceder psicoterapéutico correspondiente(AU)

Headache is one of the most frequent causes of medical consultation in adults. The objective of this study is to know the personality traits and the depression index in a group of 100 mature patients with primary migraine that go to a doctors office in the Department of Specialized Treatments (Neurology) of the Havana.The patients were classified according to the pain type referred: tensional headache; common migraine; classic migraine and clusters migraine.A questionnaire designed for migraine was applied to the 100 patients that came to see the physician; also the Eysenck test for personality type and the CRS test for depression were used. Statistical analyses were applied to the results of theses questionnaires. Tensional Migraine was the most frequent type of headache (n=36), followed by Common Migraine (n = 29) and Classic Migraine (n=20).The average time of suffering the disease was 10.6 years with a standard deviation between 10 years According to the psychological test we use, 68 cases present an unstable personality and 64 patients showed an introverted personality. Forty-nine patients showed moderate or severe signs of depression. According to the results, more than one third of the studied patients suffer from tensional headache followed in order of frequency by common and classic migraine. More than half of the studied patients showed an unstable personality with signs of neurosis and depression, a fact that forces to proceed with the corresponding psychotherapeutic assessment(AU)

Migraña y cefalea tipo tensión: teoría de la convergencia / Migraine and tension: type headache: convergence theory

La migraña y la cefalea tensional comparten muchos de los síntomas, factores precipitantes, aspectos epidemiológicos, y ambas presentan una buena respuesta a los triptanes, lo cual dificulta hacer una distinción entre ambos tipos de cefalea y en ocasiones no se puede establecer un diagnóstico preciso, ya que hay una superposición de los síntomas. Debido a esto, se cree que estos dos tipos de cefalea comparten mecanismos fisiopatológicos similares, tales como la inflamación neurogénica, el compromiso neuronal central y la sensibilización al dolor; lo cual se podría explicar por la convergencia entre fibras del trigémino y cervicales.

Migraine and tension-type headache share many of the symptoms, precipitating factors, epidemiologycal aspects, and both have good response to triptans; all of that makes difficult to distinguish between these two types of headaches, and sometimes an accurate diagnosis cannot be established, since there is a overlap of symptoms. Because of this, it is considered that these two types of headaches share similar phatophysiological mechanisms, such as neurogenic inflammation, central neuronal copromise and sensibilization to pain; which could be explained by the convergence between trigeminal and cervical fibers.

Cefalea tipo tensional: diagnóstico, fisiopatología y tratamiento / Tension-type cephalea: diagnosis, pathophysiology and treatment

La cefalea de tipo tensional (CTT) es una patología frecuente, con características clínicas y esquemas terapéuticos poco específicos. La CTT es una cefalea primaria con una relación hombres:mujeres de 4:5, y una mayor prevalencia entre los 30 y 39 años. Afecta al 78 por ciento de la población y su tratamiento genera altos costos. El diagnóstico se basa en la presencia de dolor en ausencia de otros hallazgos que se observan en otras cefaleas primarias. La cefalea generalmente es bilateral, opresiva o de tipo pesadez y nunca se relaciona con síntomas migrañosos. La CTT se debe diferenciar de otras cefaleas como migraña, cefalea crónica diaria de novo, cefalea cervicogénica y cefalea secundaria a sobreuso de analgésicos. La fisiopatología de la CTT es multifactorial, involucra mecanismos periféricos y centrales (sensibilización). Los hallazgos clínicos más importantes en la CTT son el aumento de la sensibilidad miofascial pericraneal y el aumento de la contracción muscular a la palpación. También participan factores emocionales por modificación del sistema límbico, incremento del tono vascular por hiperactividad del sistema simpático, cambios en la presión intracraneana del líquido cefalorraquídeo o del sistema venoso intracraneano, y fallas en la inhibición supraespinal por disfunción del sistema serotoninérgico. El tratamiento de la CTT se basa en la instauración de terapias farmacológicas abortivas y profilácticas, y en las terapias no farmacológicas.

Tension-type headache (TTH) is a common disorder, with inespecific clinical characteristics and terapheutic schemes. TTH is a primary headache with a 4:5 male: female proportion, and is most prevalent between 30 and 39 years. It affects 78 per cent of the population and its treatment represents high costs. The diagnosis is based on the presence of pain without other findings observed in other primary headaches. The pain is usually bilateral, opressive or as a sensation of heaviness and it is not related to migraine symptoms. TTH should be distinguished from other headaches such as migraine, new daily chronic headache, cervicogenic headache, and headache secondary to analgesics overuse. The pathophysiology of TTH is multifactorial, involving central and peripheral mechanisms (sensibilization). The most important clinical findings in TTH are an increase of pericraneal myofascial sensitivity and an increase of muscular contraction on palpation. There are also involved emotional factors due to modifications of the lymbic system, increase in vascular tone caused by the hyperactivity of the sympathetic system, changes in intracraneal pressure of cerebrospinal fluid or intracraneal venous system, and failures in supraspinal inhibition due to serotoninergic system dysfuction. The treatment of TTH is based on pharmacological abortive and prophylactic measures, and non-pharmacologycal therapies.