Marcelo Cedrinho Ciciarelli

Decreasing the minimal duration of the attack to 1 hour: is this sufficient to increase the sensitivity of the ICHD-II diagnostic criteria for migraine in childhood?

We applied the second edition of the International Classification of Headache Disorders (ICHD-II) in 417 children (age range, 2–12 years) with chronic headaches attending a pediatric headache clinic. The initial diagnosis was made according to the ICHD-II while the final diagnosis was, based on the longitudinal intuitive clinical diagnosis (LICD), deemed to be the gold standard. The diagnosis of migraine without aura had a sensitivity of 52%, a specificity of 100% and a positive predictive value of 100%; for the diagnosis of migraine (at the one-digit level) these values were 87%, 100% and 100%, respectively. The ICHD-II criteria for migraine without aura have high specificity but low sensitivity in childhood, even considering the minimal duration of the attacks to be 1 hour. Other factors, such as the existence of subgroup 2.4 (probable tension-type headache), are responsible for the low sensitivity of ICHD-II criteria for the diagnosis of migraine without aura in patients of this age group.

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.

Recommendations for the treatment of migraine attacks - a Brazilian consensus.

In this article, a group of experts in headache management of the Brazilian Headache Society developed through a consensus strategic measurements to treat a migraine attack in both the child and the adult. Particular emphasis was laid on the treatment of migraine in women, including at pregnancy, lactation and perimenstrual period.

Evaluation of cognitive impairment in patients with episodic migraine

BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the presence of cognitive deficits in patients with episodic migraine and control group, and to compare with the results previously described in the literature. METHODS: Patients with episodic migraine were included according to the International Headache Society criteria, and a control group was selected, matched by sex, age, and schooling. Patients were asked about the frequency and intensity of headaches, medications used, and comorbidities. Afterwards, a neuropsychological assessment was applied using the Montreal Cognitive Assessment, the clock drawing test, the verbal fluency test, and the Stroop test. The main variables influencing cognitive dysfunctions were analyzed (depressive disorder, anxiety disorder, sleep disorder, use of medication). RESULTS: Thirty patients with episodic migraine and 30 controls were evaluated. Patients with episodic migraine had a performance in the Montreal Cognitive Assessment test (p=0.53), the clock drawing test (p=0.80), the verbal fluency test (p=0.44) and the Stroop test (p=0.97) similar to the control group. Patients with chronic migraine (30 patients and 30 controls) performed a Montreal Cognitive Assessment test (p=0.00), verbal fluency test (p=0.00) and Stroop test (p=0.00) lower than the group control. The main variables influencing cognitive disorders were studied by linear regression, and none of these variables was an influencing factor in the Montreal Cognitive Assessment test. CONCLUSION: Patients with episodic migraine did not present cognitive deficits compared to a control group.