Rodrigo Santiago Gomez

Chronic Headache and Comorbibities: A Two-Phase, Population-Based, Cross-Sectional Study

Background.— Studies using resources of a public family health program to estimate the prevalence of chronic daily headaches (CDH) are lacking.

Prevalence of Headache in the Entire Population of a Small City in Brazil

Objective.— To estimate the 1‐year prevalence of headache, using face‐to‐face interviews of the entire population of a city in Brazil.

Psychiatric disorders in myasthenia gravis

OBJECTIVE To investigate the prevalence of psychiatric disorders in patients with myasthenia gravis (MG). METHOD Forty-one patients with MG answered to a structured psychiatric interview (MINI-Plus). RESULTS Eleven (26.1%) patients were diagnosed with a depressive disorder and 19 (46.3%) were diagnosed with an anxiety disorder. Patients with dysthymia were older (p=0.029) and had longer disease duration (p=0.006). Patients with social phobia also had longer disease duration (p=0.039). CONCLUSION Psychiatric disorders in MG are common, especially depressive and anxiety disorders.

Temporo-mandibular disorders are an important comorbidity of migraine and may be clinically difficult to distinguish them from tension-type headache

UNLABELLED Clinical differentiation between the primary headaches and temporomandibular disorders (TMD) can be challenging. OBJECTIVES To investigate the relationship between TMD and primary headaches by conducting face to face assessments in patients from an orofacial pain clinic and a headache tertiary center. METHOD Sample consists of 289 individuals consecutively identified at a headache center and 78 individuals seen in an orofacial pain clinic because of symptoms suggestive of TMD. RESULTS Migraine was diagnosed in 79.8% of headache sufferers, in headache tertiary center, and 25.6% of those in orofacial pain clinic (p<0.001). Tension-type headache was present in 20.4% and 46.1%, while the TMD painful occurred in 48.1% and 70.5% respectively (p<0.001). CONCLUSION TMD is an important comorbidity of migraine and difficult to distinguish clinically from tension-type headache, and this headache was more frequent in the dental center than at the medical center.

Prevalence and burden of headaches as assessed by the health family program.

Background.— Unified health systems often have Family Health Programs (FHPs) as a core component of their preventive and early curative strategies. In Brazil, the FHP is established to proactively identify diseases such as diabetes and hypertension.

Temporomandibular disorders and chronic daily headaches in the community and in specialty care.

Chronic daily headaches (CDHs) are often associated with temporomandibular disorders (TMDs). However, large studies assessing the relationship were conducted in general, and not clinical, populations. Thus, clinical exams were not completed. Clinic‐based studies with expert diagnosis are, in turn, often small and may not be representative.

Frequência dos tipos de cefaleia no centro de atendimento terciário do Hospital das Clínicas da Universidade Federal de Minas Gerais

OBJECTIVE To assess the frequency of different diagnoses of headaches in the Headache Outpatient Clinic of the Hospital das Clínicas of the Universidade Federal de Minas Gerais (AmbCef-UFMG). METHODS Cross sectional study with 289 patients consecutively attended to at AmbCef-UFMG. Headaches were diagnosed based on the criteria established by the International Classification of Headache Disorders (ICDH-2004). RESULTS The average age of patients was 42.6 years, mostly women (86.9%) with less than nine years of education. Primary headaches were the most common type, with migraine found in 79.8% of cases, and tension-type headache (TTH) in 20.4%. Among the secondary types, the most common was headache caused by overuse of analgesics (16.6%), followed by less common types, such as idiopathic intracranial hypertension. Chronic daily headache (CDH) was found in 31.8% of cases. CONCLUSION This study confirms literature data showing migraine as the most common headache in tertiary care centers. The expressive number of cases of CDH and headaches caused by overuse of analgesics indicates that, starting at the primary care level, patients should be advised to avoid the abuse of symptomatic drugs.

Ophthalmoplegic migraine: a case with recurrent palsy of the abducens nerve.

Ophthalmoplegic migraine (OM) is a rare disorder characterized by recurrent episodes of migraine‐like headaches associated with extrinsic ocular musculature palsy. In this article, we report a patient with OM that presented recurrent palsy of the abducens nerve and other atypical features. Case reports of OM with abducens nerve palsy were also reviewed.

Relative frequency of headache types: a longitudinal study in the tertiary care

UNLABELLED In order to properly assess patients with primary headache, one needs to follow the cases up longitudinally. In Brazil, there were no studies using this methodology published after the publication of the latest issue of the International Classification of Headaches in 2004 - ICHD-2. This is especially important when we consider that it was only after such publication that we had the criteria used to classify some types of headaches which evolve with daily, or almost daily, spells, and which are very common in tertiary health care centers. OBJECTIVE To assess the frequency of headache types in a tertiary health care center, in a longitudinal fashion. METHOD We assessed 95 consecutive patients. These patients were diagnosed and classified according to the ICDH-2. The subjects were followed up for 18 months, they were treated and reassessed. RESULTS Most of the individuals had more than one type of headache. Among those with episodic migraine in 2007, 6 developed chronic migraine in 2008, producing an incidence rate of 7.2%. Among those with chronic migraine in 2007, 9 remitted, producing a remission rate of 75%. In 2007, 24 individuals abused analgesic agents and 17 no longer showed abuse criteria in 2008 - when 7 new cases were found. CONCLUSION The diagnosis of migraine remained stable. On the other hand, treatment brought about a reduction in the frequency of headaches caused by excessive use of analgesic, although the frequency of daily chronic headache was almost unaltered.

Obsessive compulsive disorder and migraine: case report, diagnosis and therapeutic approach

Psychiatric disorders, notably mood and anxiety disorders, are frequently associated with migraine and chronic daily headaches. The obsessive–compulsive disorder (OCD) is included in the spectrum of anxiety disorders and may be a comorbid condition in headache patients. However, little information has been reported in the literature about this association. This is an important issue as OCD may contribute to the development or maintenance of treatment-resistant chronic headaches. In this paper, we describe a young female patient with refractory chronic migraine and OCD. Considerations on diagnosis, management and treatment of these comorbid conditions are presented.