bluuebunny/crossref_metadata_2025 huggingface dataset:
Full Head Block for headache treatment: technical description, indications and mechanisms
Authors: Dias Bruna de Freitas , Frederico Thiago Nouer , Dangoni Filho Iron , Peres Mario Fernando Prieto
Published: May 2021

Headache is a most prevalent neurological condition in the world and has a major impact on quality of life. The causes are usually multifactorial and may have a chronic character. Headache management involves pharmacological and non-pharmacological approach; invasive and noninvasive. Peripheral nerve block is already a viable, safe, and effective treatment option, such as major occipital nerve block. Full head block is a minimally invasive proposal of peripheral pain neuromodulation for the treatment of refractory or severe headache, mainly. The aim of this paper is to describe a technique and discuss the role of full head block in the headache management. The proposal is bilaterally anesthetizing the following nerves: major and minor occipital, supraorbital, supratrochlear, zygomatic-temporal and auriculo-temporal with local anesthetic and a corticosteroid. Many aspects should be studied: efficacy and safety of the technique, clinical indications, professional training, need for USG guidance, adequate dose of anesthetic and corticosteroids. In order to further evaluate the role of peripheral blocks in headaches randomized controlled trials are required.
“No Pain, More Gain”? Affect and Adherence to Exercise in Migraine Patients: A Prospective Cohort Study
Authors: Oliveira Arão Belitardo , Gringõn Dhiego Luigi , Peres Mario Fernando Prieto
Published: May 2021

Objectives: To compare the affective and perceptual responses to a standardized exercise session between episodic migraine patients and nonheadache persons, and its influence on adherence to an 12-week exercise training program. Methods: In a secondary analyses of a prospective cohort enrolled in a clinical trial, we assessed the affective response at rest, at 15th minof exercise, and immediately after an acute 40-min exercise session previously the training program. All measurements were undertaken in headache-free days. Participants were subsequently randomly assigned to a 12-week aerobic exercise-training program, or to a waitlist. In a multiple linear regression model, variables tested as possible predictors of adherence were body massindex, cardiorespiratory fitness, and the perceived exertion and affect scores elicited in the previous exercise session. Results: Fifty-four participants were analyzed for acute exercise session data (mean±SD age: 37.37±11.5; mean±SD BMI: 26.7±4.5). Patients (N=28) and controls (N=26) showed no differences in anthropometric characteristics and cardiorespiratory fitness. Compared to controls, migraine patients showed reduced affective response during and after exercise, but showed no differences in perceived exertion. Twentyfive participants (patients: N=13; controls: N=13) concluded the 12-week exercise-training program. Adherence was lower in migraine group (p = 0.1, d = 0.641). Multiple linear regression analysis showed post-exercise affect score as the only predictor variable of adherence to the exercise-training program (β =0.405, p = 0.040). Conclusions: This study indicates that migraine patientshave lower affective response to exercise, which was associated with adherence to the training program.
Motion Sickness in Headache Patients
Authors: Olivier Marina , Cavanagh Sol , Bonamico Lucas , Gualtieri Francisco , Goicochea María Teresa
Published: May 2021

Introduction: Headache is one of the most frequent consultations in neurology. Some patients with headache report intolerance to passive mobilization, associated with dizziness, nausea, vomiting, known as motion sickness. These symptoms are caused by a conflict between the systems: visual, vestibular and somatosensitive. Objective: To determine the prevalence of motion sickness inpatients who consult due to headache. Method: Cross-sectional, retrospective and descriptive study. It included patients over 18 years of age, who consulted for headache at the Headache Clinic, during the period from January 2 to June 30, 2017, through a structured interview. Results: Of a total of 266 patients: 62 (23.30%) presented motion sickness (mean age 41.5 years; 80.6% werewomen). 14 described motion sickness only in childhood and 48 persisted with symptoms until the time of consultation. Among the patients with headache and motion sickness 52 (83.87%) presented migraine; 7 patients presented tension headaches; 2 in salvos; 1 undetermined The prevalence of migraine was higher in those who reported motion sickness only in childhood compared tothose who continued with motion sickness (85.7 vs. 56.25%, p = 0.045), 12.5% of patients with current motion sickness reported it as a migraine trigger, 204 patients did not have motion sickness (76.7%). Conclusion: We consider that in patients with headache it is important to identify motion sickness as it can be limiting and also be a migraine trigger. Its diagnosis and treatment wouldimprove the quality of life of our patients.
ID-Migraine is a sensitive tool for screening migraine among patients with multiple sclerosis
Authors: Queiroz Marcos Vinícius de , Medeiros Jr Washington Luiz G. , Eboni Audred C. Biondo , Nogueira Eduardo A. Guimaraes , Gonçalves Marcus Vinicius M. , Sousa Nise Alessandra C. , Fragoso Yara Dadalti
Published: May 2021

Introduction: Migraine and multiple sclerosis (MS) have been described as comorbidities. While other types of headaches can be seen in patients with MS, it is migraine that usually adds to the burden of patients suffering from an already disabling and chronic neurological disease. Migraine is more prevalent in patients with MS than in the general population, and can be worsened by certain treatments that are used to control MS. ID-migraine is a tool to screen migraine in a population. It consists of only three self-reported questions, and shows good sensitivity, specificity and reliability. The aim of the present study was to assess the role of ID-migraine as a potential tool for screening migraine in patients with MS. Method: Patients diagnosed with MS for at least one year were invited to answer ID-migraine. Demographic data and information on MS therapy were obtained at the same time. Results: Sixty-two patients participated in the study. There were 16 men and 46 women, of average age 35 years. Migraine was identified in 51.5% of them and 18% reported having the characteristics of chronic migraine. ID-migraine showed 93% sensitivity and specificity for migraine in this population. The medication most frequently associated with worsening of previous migraine was interferon beta 1-a (27.4% of the cases). Conclusion: ID-migraine was shown to be a potential tool for identifying migraine in patients with MS. However, the high prevalence of migraine in this population may have constituted a selection bias, since mostpatients without headache may not have felt inclined to participate in this voluntary investigation. The results from this pilot study will be expanded and investigated in more detail in a large national study.
Feasibility of intravenous ketamine infusion for refractory headache
Authors: Dangoni Filho Iron , Arantes Hálisson Flamini , D´Orto Ulisses Cardoso , Marques Luis Sergio Fernandes , Arantes Bruno Schuind , Peres Mario Fernando Prieto
Published: May 2021

Background: Ketamine intravenous infusion has been used safely to several chronic pains and it is a good option to refractory chronic headaches. It is a noncompetitive NMDA receptor antagonist that blocks glutamate, responsible for the dissociation between thalamus-neocortical and limbic systems, leading to changes in patients’ pain perception. Due to this theorical mechanism and results in reducing cortical spreading depression, Ketamine has been proposed as a treatment for migraine. Methods: We conducted a retrospective medical chart review study at Hospital Israelita Albert Einstein including three patients. All of them were diagnosed previosly with refractory chronic headache. Results: Of participants included (n = 3), two were woman. The median duration of the disease was 21 years and 12 previous treatment’s failures. All the patients were currently in use of more than 4 preventive drugs. Treatment-emergent response was seen in all patients, requiring 1, 3 and 4 sessions to complete plain remission. They presented good tolerability to the treatment. One patient complained of tinnitus and mild dizziness at the end of the last session, which lasted less than 30 minutes. Conclusion: Ketamine is well tolerated and an effective treatment for patients with refractory chronic headache.
Do we know all the triggers of migraine?
Authors: Silva-Néto Raimundo Pereira
Published: May 2021

Editorial
The impact of anxiety and depression on migraine patients’ journey to a tertiary headache center
Authors: Érica C  Santos  , Juliane P P  Mercante  , André M S  Silva  , Rosana T  Miyazaki  , Pamella F  Daud  , Arao B  Oliveira  , Mario F P  Peres
Published: May 2021

Objective: To evaluate the role of psychiatric comorbidity in the number of diagnostic procedures, acute and preventive pharmacological treatments, and non-pharmacological interventions in migraine patients experienced before visiting a tertiary headache center in São Paulo, Brazil. Methods: We conducted a retrospective, observational study of 465 consecutive patients diagnosed with migraines and evaluated in a specialized tertiary headache center in São Paulo, Brazil. We collected the data based on medical chart reviews and a self-administered questionnaire routinely performed during the first medical visit. Two standardized instruments were used for the diagnosis of depression and anxiety, respectively: the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder (GAD-7). Results: We studied 465 patients diagnosed with migraines. The patients’ mean age was 37.3 years (±13.1), and 72.7% of patients were women. The average age of headache onset was 17.1 years (±11.4) before the first appointment at our tertiary headache center, and 51.7% of patients had chronic migraines. Most patients (65.8%) had a PHQ-9 ≥ 5, indicating at least some depressive symptoms, whereas 152 patients (34.2%) were considered depressed (PHQ-9 ≥ 9). Anxiety symptoms were observed in 68.2% of patients based on the GAD-7 instrument, and 209 patients (47.0%) were diagnosed with anxiety (GAD-7 ≥ 8). Chronic migraines were more common than episodic migraines among patients with psychiatric comorbidity: 63.2% of depressive patients, 61.2% of anxious patients, and 43.5% of patients without any psychiatric disorder. Most patients underwent laboratory tests and brain imaging (62.4% and 70.5%, respectively) in a similar proportion among subgroups with and without anxiety or depression. Nonpharmacological treatment was frequent in all subgroups, and 342 patients (73.5%) performed at least one modality. Overall, acupuncture was the most common non-pharmacological treatment (55.2% of patients), and we found no difference between the subgroups. Depressive and anxious patients more frequently underwent psychotherapy (54.2% and 50.8%, respectively) when compared to patients with neither depression nor anxiety (34.7%). Depression was associated with a reduced likelihood of previous physiotherapy (OR 0.39, CI 0.16 – 0.99). Patients with severe anxiety used 10.7 times more medicines than non-severe patients. Conclusion: Depressed patients underwent more psychotherapy than non-depressed patients, although they had a reduced chance of previous physiotherapy. Anxiety was also associated with previous psychotherapy and a risk of 10.7 times of using acute pharmacological treatment, which may lead to issues related to analgesic abuse. Anxiety and depression affect the journey of patients with migraines before arriving at a tertiary headache center.
Telemedicine in the Management of Primary Headaches: A Critical Review
Authors: Domingues Renan Barros , Lacerda Cassio Batista , Silva Paulo Diego Santos
Published: May 2021

Telemedicine is a modality of health care services delivery with the use of communication technologies. Its use has grown in several medicine areas. Several studies evaluated the feasibility, acceptance, efficacy, cost-effectiveness, and safety of telemedicine in the diagnosis and management of primary headache disorders. Videoconsultations were shown to be effective, convenient, and safe for primary headache disorders and migraine follow up. Some mobile health devices were show to improve adherence favoring better outcomes. Handling health data is a major concern so that international compliance standards must be adopted in all telemedicine procedures. The impact in the health system and increased access to appropriate primary headache treatments with the use of these technologies has yet to be elucidated.
Cerebral energetic metabolism of individuals with migraine through 31P-MRS: A systematic review
Authors: David Mírian Celly Medeiros Miranda , Neves Letycia dos Santos , Franco Carlúcia Ithamar Fernandes , Matos Rhowena Jane Barbosa de
Published: May 2021

Introduction: Migraine has a neurological origin and is characterized by failure of central modulation leading to neuronal hyperexcitability. Among the factors related to such excitability is the mitochondrial dysfunction that has been considered since the 1980s. Objective: To investigate changes in the cerebral energetic metabolism of individuals with migraine through phosphorus magnetic resonance spectroscopy (31P-MRS). Methods: It was searched articles on Pubmed, Web of Science and Science Direct betweenof June, 2018 and February, 2019. There was no restriction regarding the year of publication and language. The combination of the descriptors used for this systematic review was: Migraine AND Magnetic resonance spectroscopy [MESH]. The inclusion criteria chosen were: original articles using 31P-MRS in individuals diagnosed with migraine (with and/or without aura); studies with adults between 18 and 60 years of age diagnosed with episodic or chronic migraine; with control group of individuals without migraine and without pathologies or conditions that would interfere in the results. Excluded were articles: incomplete or unpublished; animal studies; and research protocol articles. Results: Of the 319 articles found, nine were selected. The sample totaled 216 individuals with migraine (53.7% without aura) and 233 healthy individuals in the control group. It was verified a reduction of phosphocreatine, phosphorylation potential, Mg2+ and ATP, whereas it was observed increase of inorganic phosphate and ADP. Conclusion: There are alterations in cerebral energetic metabolism in individuals with migraine, revealing mitochondrial dysfunction. However, it is needed more studies with higher quality and analysis of the relationships with the socio-demographic and clinical variables.
Melatonin reverts CGRP expression induced by capsaicin
Authors: Tanuri Fabiano da Cunha , Amado Debora , Lima Eliangela de , Dangoni Filho Iron , Peres Mario Fernando Prieto
Published: May 2021

Introduction: CGRP, a neuropeptide synthetized and released in the central nervous system and potent vasodilator, has been implicated in migraine physiopathology. Because of that, there are CGRP targeted therapies that decrease CGRP levels. Melatonin, a pineal gland secretion, has already proved its analgesic effect. We aimed to study CGRP expression in an animal model comparing capsaicin, CGRP and melatonin. Methods: We used in our study male animal rats and separated them into groups based in the kind of received solution (control group, capsaicin only and melatonin plus capsaicin). It was prepared brain stem slices and measured the CGRP levels in the trigemino nucleus caudalis (TNC). Results: Capsaicin group (N = 5) presented low intensity of GCRP expression and animals that received capsaicin plus melatonin (N = 5) showed high intensity of CGRP expression compared to capsaicin group. Conclusion: Melatonin decreases CGRP in an experimental model in rats induced by capsaicin, reducing its inflammatory action in cerebral vessels.
Of the available triptans, which should be chosen and how should they be used?
Authors: Valença Marcelo Moraes , Rosas Emanuela Paz , Costa Raisa Ferreira , Silva Amanda Araújo da , Ferreira Maria Rosana de Souza , Reis Rita Santana dos , Valença Marcelo Andrade , Andrade- Valença Luciana Patrízia Alves de
Published: May 2021

There is a plethora of articles dealing with the use of triptans to treat migraine, but so far no unanimity exists regarding the optimal form of using this group of drugs in a patient with recurrent attacks of migraine. Although all of them may exert their pharmacological effects through a known specific mechanism of action, i.e. agonist effects on serotonin 5-HT (1B/1D) receptors, distinct differences exist. The author comment a few facts on the prescription of triptans and possible adverse effects, depending on the clinical scenario. Thus, even though an enormous amount of information has accumulated over the last few decades on triptans, several questions remain to be answered, and research priorities need to be addressed.
Vessel wall imaging for diagnosis and follow-up of basilar artery reversible cerebral vasoconstriction syndrome (RCVS)
Authors: Pedro Matheus Kahakura Franco , Santos Paulo Sérgio Faro , Telles Bruno Augusto
Published: May 2021

Reversible Cerebral Vasoconstriction Syndrome (RCVS) is a clinical and radiological syndrome that is primarily defined by thunderclap headache, with or without further neurological deficits, and segmental intracranial vasoconstriction that resolves within three months. The current nomenclature was only established in 2007, but it has been known with diferent names for over fifty years. The pathophysiology, while still not completely understood, seems to point towards a disease based on abnormalities of vascular tonus without structural inflammation. It is clear, however, that patients with RCVS often have triggers, especially drugs or other vasoactive substances. Distinguishing this entity from others, especially subarachnoid hemorrhage and arterialdissection, is extremely important, given the particular prognosis and need of immediate treatment of each disease. The preferred imaging method has long been the angiography; however, new magnetic resonance imaging (MRI) such as vessel wall imaging have allowed for non-invasivediagnosis and follow-up. The authors report a case in which MRI was used in a patient with basilar artery RCVS and present a literature review.
Headache in patients infected with the novel coronavirus (Covid-19): An integrative literature review
Authors: Bastos Sarah Nilkece Mesquita Araújo Nogueira , Sousa Diego Afonso Cardoso Macedo de , Melo Simone Santos e Silva , Barbosa Bárbara Louise Freire , Cruz Larisse Giselle Barbosa , Silva-Néto Raimundo Pereira
Published: May 2021

Introduction: The disease caused by the new coronavirus was named by the acronym COVID- 19 which means “COrona VIrus Disease”, while “19” refers to the year 2019, when the first cases in Wuhan, China, were identified. Objective: Our objective was to identify the prevalence of headache and to know its clinical characteristics in COVID-19 patients, available in the literature. Methods: Based on a literature search in the major medical databases and using the descriptors “headache and coronavirus”, “headache and 2019-nCoV”, “headache and SARS- CoV-2”, “headache and coronavirus and 2019-nCoV” and “headache and coronavirus and SARS-CoV-2” we include articles published between January 2019 and April 2020. We found 94 articles, but only 13 met the inclusion criteria. Results: In 13 articles analyzed in this review, a total of 3,105 Chinese patients (51.6% men and 48.4% women) had laboratory diagnoses of COVID-19. In 240 (7.7%) patients, headache was an associated symptom of COVID-19, but in only 52 (21.7%) of them there was some information about the characteristics of this headache. Conclusions: COVID-19 patients have several clinical manifestations, including headache that is nonspecific with a prevalence of 7.7%.
The Migraine Tree: a shared tool for migraine information
Authors: Leroux Elizabeth
Published: May 2021

Migraine awareness is a critical step in minimizing the disease burden. The Migraine Tree is a web structure designed by a Canadian team to inform people living with migraine and give them the knowledge they need to understand their disease and make daily decisions. This article summarizes the reasons for the creation of the Migraine Tree, its design and underlying principles and proposes future collaborations for translation in other languages.
Migraine aura: results from an art contest
Authors: Dias Bruna de Freitas , Oliveira Arao Belitardo de , Mercante Juliane Prieto Peres , Viana Michele , Queiroz Luiz Paulo de , Peres Mario Fernando Prieto
Published: May 2021

Introduction: Migraine is a common primary headache and a major cause of disability. In at least a third of migraine attacks, the headache is preceded and/or accompanied by aura and the visual manifestation is the most frequent phenotype. Migraine with aura, a subtype of migraine disorder, are underdiagnosed and undertreated. So, a detailed aura iconography is important for better recognition, prevention and treatment of migraine with aura. Objective: A visual aura art contest was performed by ABRACES (Brazilian Association of Cluster Headaches and Migraines), in order to provide new images for raising awareness among population and professionals and decreasing the gap between diagnosis and treatment. Methods: The contest involved free subscription of drawings, paintings and digital art that expressed realistic results of a visual aura of migraine and answering of a questionnaire. The awards were separated in two categories (painting/drawing and digital art/photography) and amounted up to R$ 5,000. Results: There were 139 participants, 24% men and 76% women. The most common visual aura’s characteristic was the presence of colorful points, and the less frequently was golden. The mean duration of visual aura was 110.6 minutes (450.5 of standard deviation), median of 20 minutes, minimum of 1 minute and maximum of 3600 minutes. 36.7% of the subscribers have only one kind of visual aura and 33.8% answered that have more than one kind. 46,5% said that their visual aura almost never occurs without pain after or while aura and 19% reported that their visual aura always occurs without a headache. Conclusion: Art contests are useful tools for disease awareness. Further actions in disseminating aura images may help migraine aura underdiagnosis and undertreatment.
Management of chronic orofacial pain in pandemic of COVID-19
Authors: Hummig Wagner , Cavalcante-Leão Bianca Lopes , Stechman-Neto José
Published: May 2021

Clinical Correspondence
Headache in medical residents: association with residency program and neuropsychiatric aspects
Authors: Silva Jr Mário , Melo Thayanara , Valença Marcelo , Rocha-Filho Pedro
Published: May 2021

BackgroundAlthough a common complaint and related to factors frequently present in medical residency as psychological distress, depression and anxiety, headache is an issue poorly explored amongst medical residents.MethodsThis was a cross-sectional study enrolling medical residents from all geographic regions of Brazil. We applied an online structured survey with demographic and residency program- related questions, as well as validated tools to assess burnout, diurnal somnolence, anxiety, depression and migraine. Data was analyzed with multivariate logistic regression models.ResultsThe link to the survey received 1,989 individual clicks, of which 1,421 individuals completed the questionnaire (71.4%). Residents from 50 of the 55 (90.9%) available medical specialties responded this survey. Sixty-one percent were women, median age was 28yo (IQR=27-30), and the median post-graduation year was 2 (IQR=1- 3). Prevalence of at least one headache attack in last three months was 1,236/1,419 (87.1%); migraine occurred in 400/1,419 (28.2%). Frequent headache attacks (headaches occurring daily or often) occurred in 508/1,419 (35.8%) of respondents and were associated with female sex (OR=1.80 [95%CI=1.36- 2.37]), substantial weightgain (1.93 [1.38-2.70]), migraine (5.49 [4.16-7.24]), anxiety (1.45 [1.06-1.98]), depression (1.98 [1.47-2.67]), emotional exhaustion domain of burnout (1.49 [1.09-2.04]), and diurnal somnolence symptoms (1.32 [1.00-1.76]). At least one headache with functional impact in the last three months occurred in 634/1,419 (44.7%) and were associated with female sex (1.39 [1.10-1.74]), clinical training areas (1.32 [1.06-1.65]), anxiety (1.74 [1.38-2.21]), a unsatisfactory work-life balance (1.57 [1.17-2.09]), emotional exhaustion component of burnout (1.49 [1.14-1.94]), and an unsatisfactory subjective learning curve (1.30 [1.02-1.67]). Migraine was associated with female sex (3.10 [2.34-4.13]), anxiety (2.53 [1.94-3.31]), more than 60h dutyhours in residency (1.66 [1.29-2.15]), moral abuse from patients (1.42 [1.06-1.90]) and a clinical training area (1.34 [1.04-1.73]).ConclusionHeadaches amongst medical residents are frequent and related to depression, anxiety, burnout and diurnal somnolence, but also to aspects closely related to residency training such as the occurrence of mistreatment, longer duty- hour, poor work-life balance, and unsatisfactory learning curve.
Galcanezumab como opção terapêutica e profilática da migrânea: uma revisão sistemática da literatura
Authors: Lellis Caio , Silva Junior Weldes , Oliveira Maria de , Silva Sara , Oliveira Giovanna de , Lemos Luísa , Silva Ledismar
Published: May 2021

Introdução migrânea trata-se de uma doença neurológica que acarreta diminuição da qualidade de vida relacionada à saúde (QVRS) e está entre as dez principais causas de incapacidade relacionada à doença no mundo. O galcanezumab trata-se de um anticorpo monoclonal que se liga seletivamente ao peptídeo relacionado ao gene da calcitonina (CGRP) e impede sua atividade biológica. O objetivo deste estudo é revisar a literatura dos últimos dois anos acerca da eficácia do anticorpo monoclonal galcanezumab no manejo e na prevenção da migrânea.
Pacientes com migrânea crônica apresentam sintomas depressivos e má qualidade de vida relacionada à saúde: estudo observacional caso-controle
Authors: Ferreira Fernanda Mylla , Dantas Maria Ivone , Pereira Thaís , Feitosa Amanda , Santos Itanara dos , Rodrigues Ingrid Kyelli , DeSantana Josimari
Published: May 2021

IntroduçãoEnxaqueca é uma condição clínica crônica, geralmente associada a comorbidades, como ansiedade, depressão e síndrome do pânico, além de possuir um fardo considerável na qualidade de vida. Os objetivos deste estudo foram mensurar a presença de sintomas de ansiedade e depressão e avaliar os aspectos relacionados à qualidade de vida e qualidade do sono entre migranosos crônicos e indivíduos saudáveis.Material e MétodosTrata-se de um estudo observacional do tipo caso-controle, realizado com migranosos crônicos e indivíduos saudáveis com idade entre 18 e 50 anos. Foram seguidas as recomendações para comunicação de estudos observacionais (STROBE). O estudo foi aprovado pelo Comitê de Ética e Pesquisa da Universidade Federal de Sergipe (CAEE: 08310319.1.0000.5546). A amostragem foi por conveniência, no período entre janeiro de 2019 e fevereiro de 2020. Foram mensuradas as seguintes variáveis: ansiedade (Escala Hospitalar de Ansiedade e Depressão -HAD), qualidade ede vida (Medical Outcomes Study 36 – Item Short Form Health Survey SF-36) e qualidade de sono (Índice de Qualidade do Sono de Pittsburgh - PSQI). O software utilizado para análises estatísticas foi o GraphPad Prism versão 6.0 (San Diego, CA, USA). O teste de Shapiro-Wilk foi utilizado para analisar a normalidade (dados paramétricos - teste t para medidas independentes e dados não paramétricos - teste Mann-Whitney), com p significativo <0,05).ResultadosA amostra foi constituída por 32 pacientes com enxaqueca (GE) e 22 voluntários no grupo controle saudável (GC). Os sintomas de ansiedade mensurados através da HAD não apresentaram diferença entre GE e GC (p=0,418). Porém, o grupo GE apresentou maior presença de sintomas depressivos que GC (p=0,016). Os aspectos gerais relacionados à qualidade de vida foram significativamente piores no GE (52,43±2,65, de 0-100) que no GC (75,91±2,68, de 0-100) (p<0,001) no escore total. Ao realizar uma análise por domínios, os migranosos apresentaram escores significativamente piores nos oito domínios do que indivíduos controle. A qualidade dosono avaliada por meio dos escores do PSQI não diferiu entre GE (10,44±0,63, de 0-21) e GC (8,95±0,84, de 0-21) (p=0,161).ConclusãoPacientes com migrânea crônica apresentam sintomas de de- pressão e má qualidade de vida relacionada a saúde.
Uso dos anticorpos monoclonais para migrânea no Brasil: experiência de um Centro Terciário de Cefaleia em Brasília
Authors: Siega Marcio , Souza Bernardo , Teles Laís , Binder Laura , Tokarski Lucca
Published: May 2021

IntroduçãoA migrânea, ou enxaqueca, está incluída no ranking da Organização Mundial de Saúde (OMS) como uma das doenças mais incapacitantes do mundo e acomete cerca de 15% da população brasileira. Apesar disso segue sendo subdiagnosticada e subtratada. E quando tratada, existe uma grande taxa de abandono por efeitos adversos. Faz-se imprescindível a inclusão de terapêuticas que melhorem efetivamente a qualidade de vida desses indivíduos; e a utilização de anticorpos monoclonais toma lugar de destaque.Material e MétodosForam entrevistados 86 pacientes que receberam a injeção subcutânea indicado para migrânea com erenumabe, galcanezumabe ou fremanezumabe na primeira metade de 2020. Foi avaliado a quantidade de dias de dor forte a moderada, dias de analgésicos prétratamento e nos últimos 30 dias. Também foi avaliado a quantidade de meses que recebeu aplicação, continuidade ou interrupção ou troca de medicação e o motivo.ResultadosDos 86 indivíduos que aplicaram, 67 responderam o questionário. Média na idade de 40,6 anos, 17 dias de dor moderada ou forte e 18 dias de analgésicos. A porcentagem de melhora de 100% nos dias de dor moderada ou forte ocorreu em 7 pacientes (10%). As 3 substâncias estudadas estão contidas nesse grupo. Indivíduos com melhora maior ou igual a 50 % correspondem a 48%. Melhora discreta (10 a 49%) ocorreu em 10% dos casos e menor que 10% ou piora ocorreu em 42%. As 3 substâncias também estão contidas no grupo dos não respondedores. Os resultados do consumo de analgésicos têm resultados semelhantes: melhora total 13%, metade oumais 37%, melhora discreta 16% e mantido ou piora 46%. Dez pacientes (15%) realizaram troca de medicação, e o principal motivo foi falta de eficácia em 7 e questões financeiras em 3. A maioria dos pacientes que experimentaram o tratamento interrompeu o tratamento (63%), sendo o principal motivo a ineficácia (64%), com média de uso de 2,2 meses, seguido pelo preço da medicação (17%). Interrupção por efeitos adversos ocorreu em 2 pacientes (alergia cutânea). Os pacientes que continuam usando o estão há 3,2 meses.ConclusãoO tratamento com os anticorpos monoclonais apresentou resultados satisfatórios em elevada parcela dos indivíduos. No entanto a maioria dos pacientes abandonou seu uso sendo a ineficácia o principal motivo, mesmo usando em média mais que 2 meses. Taxa de abandono pelo custo foi discreta e taxa de efeitos colaterais muito discreta.
Desenvolvimento de e-book para auto-manejo da migrânea
Authors: Silveira Diogo Nabhan , Sakurai Gabriel Sussumu , Soares Renato Rodrigues de Freitas , Silva João de Oliveira , Silva Aline Vitali da , Poli-Frederico Regina Célia , Bello Valéria Aparecida
Published: May 2021

IntroduçãoA Migrânea é um tipo de cefaleia primária que afeta muito a qualidade de vida dos pacientes. Com uma fisiopatologia complexae forte influência genética, possui tratamento agudo e profilático com diversas opções disponíveis – e um futuro promissor de novasdrogas, bem como forte influência de hábitos de vida, que incluem atividades físicas e qualidade de sono. A educação dos pacientestem sido cada dia mais valorizada e é muito importante porque proporciona maiores conhecimentos sobre a condição e estimula oacompanhamento médico adequado, já que se trata de uma doença de alta prevalência e notório impacto pessoal, econômico e social.ObjetivosDesenvolver ferramenta que promova a compreensão da enxaqueca e a auto- gestão do tratamento pelo paciente através da educação acerca de sua doença.Material e MétodosFoi desenvolvido um e-book voltado para pacientes com Migrânea, disponibilizado gratuitamente no site www.naoedrama.com.br.As informações obtidas para a elaboração do mesmo foram trabalhadas para serem abordadas de forma simplificada, para acompreensão por leigos. Após a leitura, os indivíduos foram convidados a responder avaliação sobre o conteúdo, por meio daferramenta Google Forms, com ciência e aceite do TCLE.ResultadosDentre mais de 1000 indivíduos que fizeram o download do arquivo, 66 responderam ao questionário, dos quais 55 afirmaramapresentar cefaleia frequentemente. Desse total, 89,1% pretendem mudar algumas atitudes ou tratamentos após a leitura do conteúdo, principalmente hábitos de vida, que são muito ligados à prevenção da doença. A média de idade foi de 33 anos, com níveis de escolaridade altos: 95,5% dos participantes têm ensino médio completo. Os conteúdos foram considerados de fácil compreensão por 100% dos participantes e com informações novas por 89,4% deles.ConclusõesA utilização de novas ferramentas tecnológicas, como o e-book, se provou como uma opção extremamente viável para a educaçãodo paciente, já que houve considerável número de downloads do arquivo, ampla aprovação dos participantes da pesquisa e altosníveis de compreensão das informações. A principal vantagem desse método foi a capacidade de influenciar os pacientes a buscarem melhorias em seu estilo de vida. De acordo com os resultados obtidos, o e-book gerou um impacto muito positivo para o auto-manejo da Migrânea: cerca de 9 em cada 10 pacientes com cefaleia afirmaram que pretendem mudar algumas atitudes após a leitura do mesmo.
Cefaleia atribuída ao acidente isquêmico transitório: frequência e características
Authors: Rocha Filho Pedro Augusto Sampaio , Oliveira Felipe Araújo Andrade de
Published: May 2021

IntroduçãoOs poucos trabalhos que avaliaram a cefaleia atribuída ao acidente isquêmico transitório estimam sua frequência entre 7,4 e 34% dos casos. Pouco se sabe sobre as características dessa cefaleia. Temos como objetivos avaliar a frequência da cefaleia atribuída ao acidente isquêmico transitório e suas características.MétodoTrata-se de um estudo transversal. Foram incluídos pacientes consecutivos internados no Real Hospital Português de março de 2017 a maio de 2020 com diagnóstico de acidente isquêmico transitório (AIT). Os pacientes foram avaliados por neurologista com experiência no diagnóstico e tratamento de cefaleias. Para a coleta de dados, utilizou-se questionário semi-estruturado. Todos os pacientes fizeram exame físico e neurológico. Todos os pacientes fizeram ressonância magnética de encéfalo. O projeto foi aprovado pelo comitê de ética do hospitalResultadosForam incluídos 44 pacientes, 24/44 (55%) eram homens, idade mediana: 66 (59; 77,5) anos. O tempo mediano entre o início dos sintomas e a chegada ao hospital foi de 2,8 horas (1,5; 5); a mediana da pontuação da escala de AVC do NIH à admissão foi de 0 (0 ; 0). Em relação à etiologia do AIT: doenças de grandes vasos (n=7), cardioembólico (n=6), outras causas (n= 3); indeterminado (n= 28). Quinze (34,1%) pacientes tiveram cefaleia atribuída ao AIT, em 10/15 (67%) esta teve inicio insidioso; em 9/15 (60%) foi bilateral, a mediana de duração foi de 3 horas (0,8; 15); intensidade mediana: 5 (3; 6). Em 6/15 (40%) a cefaleia iniciou-se antes do AIT (mediana de 12 h antes; 10; 15); em 2, ao mesmo tempo, e em 7/15 (47%), depois (mediana de 4 h depois; 1; 27). Em relação aos sintomas associados, um teve fonofobia, um teve fotofobia, 3 tiveram náuseas e um teve vômitos. A cefaleia possuía padrão de migrânea em um paciente (6,6%), possuía padrão de cefaleia tipo tensional em 10 pacientes (66,6%) e em 04 pacientes (26,6%), esta era inclassificável. A ocorrência de cefaleia atribuída ao AIT não teve associação com o sexo (qui-quadrado; p=0,60), idade (Mann-Whitney; p: 0,804), com a pressão arterial sistêmica sistólica (Mann-Whitney; p: 0,81) ou com a pressão arterial sistêmica diastólica à admissão (Mann-Whitney; p: 0,36).ConclusãoA cefaleia atribuída ao AIT tem frequência alta, mais frequentemente tem inicio insidioso, é bilateral, inicia-se após os déficits focais e tem fenótipo de cefaleia tipo tensão.
Termocoagulação por radiofrequência no tratamento da neuralgia do trigêmeo: uma revisão sistemática da literatura
Authors: Lellis Caio , Campos Luiza , Siqueira Laura , Braga Aline , Diniz Paulo , Silva Ledismar da
Published: May 2021

IntroduçãoA neuralgia do trigêmeo consiste em uma neuropatia que acomete uma ou todas as porções do V nervo craniano, resultando em uma intensa dor facial. Nesse contexto, a termocoagulação por radiofrequência (TRF) consiste em uma técnica que visa destruir, de forma seletiva, as fibras nervosas do grupo C por meio do calor gerado pela radiofrequência. O objetivo desta revisão é analisar a eficácia da termocoagulação como opção terapêutica da NT.Material e MétodosRealizou-se uma revisão sistemática da literatura no banco de dados do PubMed, com dos descritores: “Trigeminal neuralgia AND Radiofrequency thermocoagulation”. Foram selecionados apenas os ensaios clínicos e os relatos de caso publicados em inglês nos últimos 10 anos. Excluiu-se os estudos que não se enquadravam nos objetivos, restando 13 estudos para compor a revisão.ResultadosUm ensaio clínico prospectivo apresentou o desenvolvimento de uma nova técnica de TRF para bloqueio seletivo do nervo trigêmeo V2 em forame rotundo (FR), alternativamente à abordagem clássica do forame oval (FO), concluindo que a nova terapêutica apresenta bom alívio imediato e sustentado da dor. Acerca da abordagem clássica, outro estudo constatou que o RFT está associado a uma elevada taxa de recorrência em pacientes com variações anatômicas do FO, propondo uma técnica acessando o gânglio de Gasser a partir de um ângulo mandibular sob tomografia computadorizada (TC) e orientação de neuronavegação, que pode complementar a TRF. Também, concluiu-se que a TRF se mostrou mais eficaz que a termocoagulação por rizólise percutânea de glicerol anidrido (PRGR) no fornecimento de alívio completo e imediato da dor, sendo que 41% dos pacientes do grupo TRF não exigiram quaisquer medicamentos adicionais durante o período de estudo e 82% relataram alívio significativo da dor, enquanto o grupo do PRGR apresentou apenas 35% e 50%, respectivamente. Ademais, dois estudos apresentaram que a TRF é mais eficaz quando utilizada juntamente com a radiofrequência pulsada (PRF), reduzindo as complicações pós-operatórias e elevando a velocidade de recuperação.ConclusãoA TRF se mostrou uma opção terapêutica segura e eficaz no manejo da neuralgia trigeminal, sendo que a TC e as técnicas de neuronavegação são recomendadas por conta das variações anatômicas. Além disso, foi proposta uma nova abordagem pelo FR que mostrou resultados significativos na redução da dor quando comparada com a abordagem tradicional pela FO.
Case report: migraine with aura in patient with cadasil
Authors: Costa Bárbara , Carvalho Felipe , Kubota Gabriel , Andrade Daniel , Fortini Ida
Published: May 2021

IntroductionCerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most frequent hereditary cause of brain ischemic small vessel disease (1). Migraine with aura (MA) is typically the presenting and most common clinical feature of CADASIL. The estimated prevalence of MA in CADASIL ranges from 20 to 40% (2).Case Report43-year-old woman, with previous history of hypertension, diabetes, and episodic migraine with visual aura, suffered three episodes of hemihyposthesia in 2016, 2017 and 2018 (one on her right and the other two on her left). In the last of these episodes, she reported worsening of the visual acuity of her right eye, and developed chronic migraine. Brain MRI showed extensive areas of confluent T2 hyperintensity in the white matter, as well as in the nucleocapsular and bilateral thalamic regions. In all three episodes the patient was treated with IV or oral corticosteroids and had partial improvement of the symptoms. The patient had familiar history of relatives who had suffered multiple strokes.DiscussionThe diagnosis of multiple sclerosis was firstly considered due to the evolution in clinical attacks and the response to corticotherapy. However, the patient’s family history, MRI findings and previous diagnosis of migraine with visual aurea lead to the suspicion of CADASIL. This diagnosis was ultimately confirmed through genetic testing that showed C> T variation in NOTCH3 gene. Migraine was successfully treated with greater occipital nerve blocks and topiramate.Final CommentCADASIL stroke-like attacks remain a therapeutic challenge. It is possible that corticosteroid treatment may benefit these patients by reducing the inflammatory process that results from blood-brain barrier breakdown. More studies are needed to evaluate the efficacy and safety of corticotherapy in this population.
Variante polimórfica -308 g/a do gene tnf-a em pacientes com migrânea
Authors: Nascimento Caio , Silveira Diogo , Sakurai Gabriel , Soares Renato , Bello Valeria , Silva Aline , Poli-Frederico Regina
Published: May 2021

IntroduçãoA migrânea é uma doença neurológica que afeta os indivíduos, suas famílias e a sociedade, sendo a sétima patologia mais incapacitante com prevalência mundial de 15 a 20% e uma incidência de 18% em pacientes do sexo feminino e 6% no sexo masculino. Clinicamente caracteriza-se como uma cefaleia de intensidade moderada a forte, pulsátil, na maioria das vezes unilateral e pode ter sintomas disautonômicos associados às crises, como náusea, vômitos, fotofobia, fonofobia e osmofobia. Além disso, pode ser classificada como enxaqueca com aura ou sem aura. A etiopatogenia da doença está relacionada, principalmente, a suscetibilidade a uma inflamação neurogênica, na qual as citocinas modulam a dor e o gatilho para desencadear as crises. Sendo assim, este estudo teve como objetivo avaliar o polimorfismo genético -308G/A do gene TNF-alfa na população avaliada.Material e MétodosOs participantes do estudo são provenientes do Ambulatório Acadêmico da PUCPR – Campus Londrina, em que foram diagnosticados de acordo com a 3ª CIH, responderam a um formulário desenvolvido pelo Grupo de Pesquisa em Cefaleia e às 3 escalas: MIDAS, STAI-Y1/ STAI-Y2 e HIT-6. Foram obtidas 90 amostras de DNA dos participantes da pesquisa (46 do grupo com enxaqueca e 44 do grupo controle). A genotipagem foi realizada por meio da técnica de PCR-SSP.ResultadosOs grupos caso e controle foram pareados por idade, sexo e IMC (p<0,05). Foi encontrado uma maior parcela de indivíduos heterozigotos AG (63,3%) e a frequência do alelo A se fez mais prevalente tanto no grupo controle (52%) quanto no grupo caso (54%) não havendo diferenças estatísticas para as frequências genotípicas e alélicas (Qui-quadrado, p>0,05).ConclusõesEm suma, não houve diferença significativa dos genótipos e alelos do gene TNF-alfa entre os participantes com e sem enxaqueca. Estudos futuros com maior número amostral e em diferentes populações devem ser investigados para avaliar o papel dos diferentes genótipos e alelos da variante no gene -308G/A TNF-alfa na migrânea.
Tratamento e prevenção da dor orofacial idiopática persistente: uma revisão sistemática da literatura
Authors: Lellis Caio , Diniz Paulo , Campos Luiza , Dib Maria , Paniago Samyla
Published: May 2021

IntroduçãoA dor orofacial idiopática persistente (DFIP) é um fenômeno que compreende um quadro de origem neuropática, composto pela dor facial persistente, restrita à hemiface. Nesse contexto, sabe-se que o uso de antidepressivos tricíclicos, como a amitriptilina ou nortriptilina, embora sejam o tratamento padrão, nem sempre se mostram eficazes. O objetivo deste estudo é revisar a literatura em busca dos tratamentos e profilaxias atuais no manejo da DOIP.Material e MétodosTrata-se de uma revisão sistemática da literatura no banco de dados PubMed, com os descritores: “Persistent Idiopathic Orofacial Pain AND (Treatment OR Prevention)”, selecionando os ensaios controlados randomizados, ensaios clínicos e relatos de caso publicados nos últimos 10 anos (n = 18 artigos). Excluiu-se os estudos ainda não concluídos e aqueles que não se enquadravam nos objetivos.ResultadosUm relato de caso concluiu que o bloqueio do gânglio esfenopalatino (BGEP) com anestésico local de curta ação gerou alívio temporário da DOIP, independentemente da medicação utilizada, enquanto a implantação de um eletrodo neuroestimulante neste gânglio levou a melhora do quadro clínico de dor e redução do consumo de opióides. Junto a isto, um ensaio clínico apontou que pacientes com essa síndrome dolorosa apresentam menor inibição intracortical de curto intervalo em comparação aos controles, fato que não possui relação com o uso de medicações analgésicas. Também, um relato de caso concluiu que a ablação dos nervos cervicais superiores, seguida por analgesia epidural cervical contínua por 3 semanas, fornecem controle satisfatório da dor em pacientes com DOIP. Por outro lado, um estudo randomizado, duplo cego, avaliou que a hipnose não influenciou significativamente a sensibilidade somatossensorial relacionada a DOIP quando comparada com o grupo placebo. Ademais, um ensaio clínico não controlado concluiu que a toxina botulínica tipo A (BoNT-A) se mostrou uma opção terapêutica segura e eficaz no manejo da odontalgia atípica, sub forma da DOIP, aliviando significativamente o desconforto e a dor intermitente.ConclusãoAs opções terapêuticas envolvendo neuromodulação, a ablação dos nervos cervicais superiores e injeções de BoNT-A mostraram segurança e eficácia no manejo da DOIP, enquanto o BGEP mostrou alívio temporário da dor e a hipnose não apresentou resultados positivos.