Deusvenir de Souza Carvalho

Epidemiology of primary and secondary headaches in a Brazilian tertiary-care center

OBJECTIVE To analyze the demographic features of the population sample, the time of headache complaint until first consultation and the diagnosis of primary and secondary headaches. METHOD 3328 patients were analyzed retrospectively and divided according to gender, age, race, school instruction, onset of headache until first consultation and diagnosis(ICHD-II, 2004). RESULTS Sex ratio (Female/Male) was 4:1, and the mean age was 40.7+/-15 years, without statistical differences between sexes. Approximately 65% of the patients were white and 55% had less than eight years of school instruction. Headache complaint until first consultation ranged from 1 to 5 years in 32.99% patients. The most prevalent diagnosis were migraine (37.98%), tension-type headache-TTH (22.65%) and cluster headache (2.73%). CONCLUSION There are few data on epidemiological features of headache clinic populations, mainly in developing countries. According to the literature, migraine was more frequent than TTH. It is noteworthy the low school instruction of this sample and time patient spent to seek for specialized attention. Hypnic headache syndrome was seen with an unusual frequency.

The cluster phenomenon: An unspecific feature?

The presence of the cluster phenomenon per se is important for a correct diagnosis of cluster headache (1). There is consensus among the experts in this field that for this reason it is difficult to establish a definite diagnosis of cluster headache on clinical grounds only, during the very first bout. Already during the second bout, a temporal pattern may seem to have been establishedand a diagnostic suspicion may be verified. It has, in previous years, been a widely accepted point of view that only cluster headache has a temporal pattern with typical attacks, accumulated in cluster periods, punctuated along the time axis. Once a cluster pattern was established, so was the diagnosis. Our view on this matter has changed somewhat over the last few years. We described chronic paroxysmal hemicrania (CPH) in 1974 (2) and at an early stage felt that this was a headache in its own right (3,4). Cluster headache is characterized by certain main features (5), as shown in Table 1. Admittedly, there are considerable similarities between CPH and cluster headache (Table 1). Only as far as one of the major points is concerned is there a clear difference: the sex preponderance. There may also be a difference as far as the temporal pattern (that is, the cluster phenomenon) is concerned, but this may be a more subtle one. The similarity of the temporal pattern of even the chronic stage of CPH with that of cluster headache is considerable. Moreover, there is a prechronic or non-continuous stage in several CPH cases (4,6-lo), and this stage may be like a blueprint copy of the temporal pattern of cluster headache. Moreover, many (all?) cases of CPH in the chronic stage demonstrate a considerable fluctuation in severity (“modified cluster pattern”) along the time axis. Failure to recognize the lowgrade pain, almost without minor peaks (“attacks”) may contribute to an incorrect categorization; they may be placed in the category of non-chronic CPH (which we suspect has really happened at times in recent years).

Migraine and cognition in children: a controlled study

OBJECTIVE Evaluate the cognitive functions of children with migraine and compare them to A control group. METHOD 30 migraineur children and 30 control group children without migraine, age ranging from 8 to 12 years old, were subjected to a cognitive functions assessment with Wechsler Intelligence Scale for Children (WISCIII). RESULTS Although both groups had a normal cognitive performance, children with migraine had significantly worse scores compared to the control group in the subtests of Information, Arithmetic, Vocabulary, Object Assembly and in the Indexes of Perceptual Organization, Resistance to Distraction and Processing Speed. CONCLUSION Children with migraine had impairment in some cognitive functions such as attention, memory, information speed, and perceptual organization compared to the control group.

Amitriptyline and aerobic exercise or amitriptyline alone in the treatment of chronic migraine: a randomized comparative study

UNLABELLED To compare the preventive treatment benefits of amitriptyline and aerobic exercise or amitriptyline alone in patients with chronic migraine. METHOD Sixty patients, both genders, aged between 18 and 50 years, with a diagnosis of chronic migraine, were randomized in groups called amitriptyline and aerobic exercise or amitriptyline alone. The following parameters were evaluated: headache frequency, intensity and duration of headache, days of the analgesic medication use, body mass index (BMI), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) scores. RESULTS In the evaluated parameters, was observed decrease in headache frequency (p=0.001), moderate intensity (p=0.048), in headache duration (p=0.001), the body mass index (p=0.001), Beck Depression Inventory (p=0.001) and Beck Anxiety Inventory scores (p=0.001), when groups were compared in the end of third month. CONCLUSION In this study, the amitriptyline was an effective treatment for chronic migraine, but its efficacy was increased when combined with aerobic exercise.

Bilateral SUNCT syndrome associated to chronic maxillary sinus disease

SUNCT syndrome (short lasting unilateral neuralgiform headache with conjuntival injection and tearing) is defined as short attacks of periorbital unilateral pain and accompanied by ipsilateral lacrimation and redness of the same eye. We present an unusual SUNCT case with bilateral pain that started five years ago after an acute maxillary sinus infection that evolved to chronic sinusitis. This association has been described in few SUNCT cases, but its causal role remains uncertain. The patient was a 58 years old man that fulfilled a headache diary that showed the usual circadian pattern, worsening in the morning and afternoon, and responded to treatment with gabapentina. He was submitted to a functional endoscopic sinus surgery and evolved with milder pain. In a review of 21 patients, 5 had a past medical history of sinusitis, but the causal role of this association remained uncertain.

Asthma Plus Migraine in Childhood and Adolescence: Prophylactic Benefits with Leukotriene Receptor Antagonist

Despite widespread acknowledgment that migraine may arise from a sterile inflammatory reaction, 1 few attempts have been made to use potential antiinflammatory drugs as prophylaxis for the prevention of migraine attacks. Leukotrienes are components of the lipid signaling pathway in neuroinflammation, and their potential role in the inflammatory cascade as contributors to migraine pathogenesis has recently been highlighted. 2-4

Cluster Headache: On the Significance of So-Called Minibouts

Cluster headache periods (bouts) have, at the lower end of the scale, been supposed to last for periods as short as 1–2 weeks. Patients who usually have bouts of ordinary duration occasionally have brief attacks in the remission phase (“abortive attacks”). The group described here had a temporal pattern, clearly at variance with both these patterns: The six patients had mostly or entirely bouts of < 1 weeks duration. We have termed such short-lasting bouts minibouts, on the supposition that such cases belong within the cluster headache, cycle. All the patients were men and had a history of unilateral headache without side shift, and usually the solitary attacks had some autonomic accompaniments, although of a moderate degree. In four cases only mild attacks occurred, whereas in two cases the attacks were rather severe and not consistent with full working ability. The group as such may not be homogeneous. The nosologic status of patients with bouts lasting only 1–2 days is somewhat uncertain. As long as the substrate of cluster headache is not outlined, the lower end of duration of minibouts cannot be accurately identified. The fact that three patients recently have experienced bouts of ordinary length strengthens the view that such cases really belong to the cluster headache cycle.

Cluster Headache: Forehead Sweating Pattern During Heating and Pilocarpine Tests: Variation as a Function of Time:

Thirty-one patients with cluster headache were examined with regard to their forehead sweating pattern, by means of the Evaporimeter. Sweating was stimulated in two different ways: by body heating and by parenterally administered pilocarpine. The resulting increase in evaporation was frequently measured at different positions on both sides of the forehead, and the possibility of variations in the pattern related to the passage of time was specifically scrutinized. Some typical patterns emerged. The previously reported, marked asymmetries of response (deficient heat-induced sweating and pilocarpine supersensitivity of the symptomatic side) at the medial positions in the forehead were confirmed. However, the asymmetries invariably faded to some extent with the passage of time. Patients with cluster headache show gross similarities with, but also some minor differences from, the sweat pattern of patients with brain stem lesions causing a Horners syndrome. A subdivision of the material into groups in accordance with the pupillometric pattern after sympathomimetic stimulation made it clear that the cases of definite evaporimetric asymmetries (“typical reactions”) belonged to the group with a typical pupillometric pattern. These results suggest that from an “autonomic” point of view, subpopulations may exist within the clinical entity of cluster headache.

Latin American consensus on guidelines for chronic migraine treatment

Chronic migraine is a condition with significant prevalence all around the world and high socioeconomic impact, and its handling has been challenging neurologists. Developments for understanding its mechanisms and associated conditions, as well as that of new therapies, have been quick and important, a fact which has motivated the Latin American and Brazilian Headache Societies to prepare the present consensus. The treatment of chronic migraine should always be preceded by a careful diagnosis review; the detection of possible worsening factors and associated conditions; the stratification of seriousness/impossibility to treat; and monitoring establishment, with a pain diary. The present consensus deals with pharmacological and nonpharmacological forms of treatment to be used in chronic migraine.

Glossopharyngeal neuralgia with syncope as a sign of neck cancer recurrence

Glossopharyngeal neuralgia with syncope as a sign of neck cancer is a very rare condition. A review of the literature revealed only 29 cases formerly reported. We present the first Brazilian case of such association. A 68-year-old man presented with paroxysmal excruciating pain over the right side of the neck, sometimes followed by syncope. Given the suspicion of recurrent tumor from a previously treated neck malignancy, a computed tomography scan was performed and a right parapharyngeal tumor was shown. Pain and syncope were successfully controlled with carbamazepine and the patient underwent palliative radiotherapy.