Mario F. P. Peres

Hemicrania continua is not that rare

Background: Hemicrania continua is an indomethacin-responsive headache disorder characterized by a continuous, moderate to severe, unilateral headache. More than 90 cases of hemicrania continua have been reported, but there is still uncertainty about its clinical features. Methods: The authors compared 34 new cases (24 women, 10 men) with previously reported cases. All the patients met Goadsby and Lipton’s proposed criteria. The authors compared baseline (continuous background headache) and exacerbation (attacks of severe periods of headaches). Results: The baseline headache was typically mild to moderate in intensity and usually not associated with severe disability. In contrast, the headache exacerbations were severe and associated with photophobia, phonophobia, nausea, and disability. At least one autonomic symptom was present in 25 patients (74%). Jabs and jolts were present in 14 patients (41%). The mean indomethacin dose was 136.7 ± 60 mg (range 25 to 225 mg). Twenty-four patients (70.6%) met International Headache Society criteria for migraine in their exacerbation period. Occipital tenderness was observed in 23 patients (67.6%). The temporal pattern was remitting in four patients (11.8%), continuous from onset in 18 (52.9%), and continuous evolving from remitting in 12 (35.3%). Conclusion: Hemicrania continua is not a rare disorder. All cases of chronic unilateral daily headaches should receive an indomethacin trial early if not first in treatment.

Fibromyalgia is common in patients with transformed migraine

Fibromyalgia (FM) and transformed migraine (TM) are common chronic pain disorders. The authors estimated the prevalence of FM in 101 patients with TM, and analyzed its relationship to depression, anxiety, and insomnia. FM was diagnosed in 35.6% of cases. Patients with FM had more insomnia, were older, and had headaches that were more incapacitating than patients without FM. Insomnia and depression predicted FM in patients with TM.

Validation of the Duke Religion Index: DUREL (Portuguese version).

The purpose of the current study was to examine the psychometric properties of the Portuguese version of the Duke Religion Index (PDUREL) in a community setting. PDUREL was translated and adapted for administration to 383 individuals from a population-based study of low-income community-dwelling adults. The PDUREL intrinsic subscale and total scores demonstrated high internal consistency (alphas ranging from 0.733 for the total scale score to 0.758 for the intrinsic subscale). Correlations among the DUREL subscales were also examined for evidence of discriminant validity. Correlations were ranging from 0.36 to 0.46, indicating significant overlap between the scales without marked redundancy. PDUREL is a reliable and valid scale. The availability of a comprehensive, but brief measure of religiousness can help to study the role of religiousness in health by researchers from countries that speak the Portuguese language.

Melatonin, 3 mg, is effective for migraine prevention.

There is increasing evidence that melatonin secretion and pineal function are related to headache disorders. Altered melatonin levels have been found in cluster headache, migraine with and without aura,1 menstrual migraine,2 and chronic migraine.3 A great variety of melatonin mechanisms may be linked to headache pathophysiology.3 Melatonin may have anti-inflammatory effect, it scavenges toxic free radicals, reduces the up-regulation of proinflammatory cytokines, and inhibits nitric oxide synthase activity and dopamine release. It also interferes with membrane stabilization, γ-aminobutyric acid and opioid analgesia potentiation, protection from glutamate neurotoxicity, neurovascular regulation, and serotonin modulation. Melatonin and indomethacin share similar chemical structure.4 Melatonin is then a possible candidate for migraine prevention. We tested the hypothesis of the potential effectiveness of melatonin for migraine prophylaxis. We performed an open-label trial of melatonin, 3 mg, for migraine prevention. Forty patients with episodic migraine with or without aura according to the International …

A importância da integração da espiritualidade e da religiosidade no manejo da dor e dos cuidados paliativos

Background: Pain is one of the most common physical complaints which negatively affects the patient’s quality of life. Patients with chronic pain are difficult and often frustrating to treat. Objective: To describe the current strategies for approaching patients with chronic pain based on scientific literature, emphasizing measures related to spirituality and religiosity. Method: For the present work, authors reviewed data supporting the application of clinical procedures regarding to chronic pain and palliative care with the importance of spirituality background incorporation based on indexed Medline data. Results: Many studies have demonstrated a positive association between spirituality and religiosity and improvement of chronic diseases’ variables and markers. Conclusion: As religiosity and spirituality are notoriously related to the patient’s clinical improvement, it is highly important that the recognition of these aspects and their incorporation in the management of patients with chronic pain be conducted by health professionals.

Coping Strategies in Chronic Pain

Patients with chronic pain need strategies to manage their pain and its impact, also known as coping. Coping is not restricted to one dimension of functioning; it involves virtually every dimension of human functioning: cognitive, affective, behavioral, and physiological. We review the literature on coping strategies for chronic pain, including concept and types of coping (eg, religious, social, psychological), as well as coping-with-pain questionnaires, studies available, other topics of interest, interventions to enhance coping with pain, and future directions in this field.

Portuguese version of Duke Religious Index: DUREL

Endereço para correspondência: Alexander Moreira-Almeida. Rua Cap. Arnaldo de Carvalho, 693/202 – 36036-180 – Juiz de Fora, MG. E-mail: alex.ma@ufjf.edu.br As relações entre religiosidade e saúde têm sido cada vez mais investigadas e as evidências têm apontado para uma relação habitualmente positiva entre indicadores de envolvimento religiosos e de saúde mental (Moreira-Almeida et al., 2006). Como a maioria dos estudos disponíveis na área foi realizada nos Estados Unidos, há uma necessidade de replicação em outras culturas. Tendo como um dos objetivos a ampliação das pesquisas em espiritualidade e saúde em nosso meio, a Revista de Psiquiatria Clínica publicou recentemente um suplemento especial com esse tema (Moreira-Almeida, 2007). No entanto, uma limitação ao desenvolvimento de mais pesquisas em países de língua portuguesa é a carência de escalas de religiosidade que sejam curtas, simples e que forneçam dados relevantes. Com o objetivo de suprir essa carência, apresentamos uma versão em português de uma breve escala de religiosidade que se tem mostrado muito útil em outras pesquisas, a Duke Religious Index (DUREL) (Koenig et al., 1997). A DUREL possui cinco itens que captam três das dimensões de religiosidade que mais se relacionam com desfechos em saúde: organizacional (RO), nãoorganizacional (RNO) e religiosidade intrínseca (RI). Os primeiros dois itens abordam RO e RNO, foram extraídos de grandes estudos epidemiológicos realizados nos Estados Unidos e se mostraram relacionados a indicadores de saúde física, mental e suporte social. Os outros itens se referem à RI e são os três itens da escala de RI de Hoge que melhor se relacionam com a pontuação total nesta escala e com suporte social e desfechos em saúde (Koenig et al., 1997). Na análise dos resultados da DUREL, as pontuações nas três dimensões (RO, RNO e RI) devem ser analisadas separadamente e os escores dessas três dimensões não devem ser somados em um escore total. Para produzir a versão em português, um dos autores (MFP) fez a tradução inicial que foi revisada por dois outros (AMA e FLN). Essa versão revisada foi retrotraduzida para o inglês por FA. Essa versão em inglês foi avaliada e aprovada pelo autor sênior da DUREL (HGK). A versão final em português é apresentada a seguir. Entretanto, é muito importante que sejam feitos estudos de validade e confiabilidade dessa versão na população brasileira. Não se sabe ao certo o quanto estas questões desenvolvidas para a população norte-americana se aplicam aos brasileiros. Entretanto, o fato de ambos os países serem majoritariamente cristãos e de a DUREL apresentar itens mais genéricos, provavelmente aplicáveis à maioria das religiões de nosso meio, sugere que essa versão em português possa ser bem aplicável em nossa realidade.

Chronic paroxysmal hemicrania–tic syndrome

Article abstract The association of chronic paroxysmal hemicrania and ticlike pain—chronic paroxysmal hemicrania–tic (CPH-tic)—is a recently described syndrome. The authors found only two previously reported cases. They report three new cases of this rare syndrome with both chronic paroxysmal hemicrania and ticlike pain concurrently and ipsilaterally. The trigeminal–autonomic cephalalgias (TAC) are considered as differential diagnoses. CPH-tic syndrome could be a different clinical entity.

Randomised clinical trial comparing melatonin 3 mg, amitriptyline 25 mg and placebo for migraine prevention

Introduction Melatonin has been studied in headache disorders. Amitriptyline is efficacious for migraine prevention, but its unfavourable side effect profile limits its use. Methods A randomised, double-blind, placebo-controlled study was carried out. Men and women, aged 18–65 years, with migraine with or without aura, experiencing 2–8 attacks per month, were enrolled. After a 4-week baseline phase, 196 participants were randomised to placebo, amitriptyline 25 mg or melatonin 3 mg, and 178 took a study medication and were followed for 3 months (12 weeks). The primary outcome was the number of migraine headache days per month at baseline versus last month. Secondary end points were responder rate, migraine intensity, duration and analgesic use. Tolerability was also compared between groups. Results Mean headache frequency reduction was 2.7 migraine headache days in the melatonin group, 2.2 for amitriptyline and 1.1 for placebo. Melatonin significantly reduced headache frequency compared with placebo (p=0.009), but not to amitriptyline (p=0.19). Melatonin was superior to amitriptyline in the percentage of patients with a greater than 50% reduction in migraine frequency. Melatonin was better tolerated than amitriptyline. Weight loss was found in the melatonin group, a slight weight gain in placebo and significantly for amitriptyline users. Conclusions Melatonin 3 mg is better than placebo for migraine prevention, more tolerable than amitriptyline and as effective as amitriptyline 25 mg.

Generalized anxiety disorder, subthreshold anxiety and anxiety symptoms in primary headache

The aim of the present study was to evaluate the association between generalized anxiety disorder, subthreshold anxiety (SubAnx) and anxiety symptoms in the prevalence of primary headache.