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. Houve estabilidade diagnóstica da migrânea. Por outro lado, a intervenção terapêutica permitiu a redução da frequência dos casos de cefaléia por uso excessivo de analgésicos, embora a frequência de cefaléia crônica diária mostrou-se praticamente inalterada. Palavras-chave: cefaléia, migrânea, diagnóstico.
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.
The neurological involvement in acute liver failure (ALF) is characterized by arousal impairment with progression to coma. There is a growing body of evidence that neuroinflammatory mechanisms play a role in this process, including production of inflammatory cytokines and microglial activation. However, it is still uncertain whether brain-derived cytokines and glial cells are crucial to the pathophysiology of ALF at the early stage, before coma development. Here, we investigated the influence of cytokines and microglia in ALF-induced encephalopathy in mice as soon as neurological symptoms were identifiable. Behavior was assessed at 12, 24, 36 and 48 h post-injection of thioacetamide, a hepatotoxic drug, through locomotor activity by an open field test. Brain concentration of cytokines (TNF-α and IL-1β) and chemokines (CXCL1, CCL2, CCL3 and CCL5) were assessed by ELISA. Microglial activation in brain sections was investigated through immunohistochemistry, and cellular ultrastructural changes were observed by transmission electron microscopy. We found that ALF-induced animals presented a significant decrease in locomotor activity at 24 h, which was accompanied by an increase in IL-1β, CXCL1, CCL2, CCL3 and CCL5 in the brain. TNF-α level was significantly increased only at 36 h. Despite marked morphological changes in astrocytes and brain endothelial cells, no microglial activation was observed. These findings suggest an involvement of brain-derived chemokines and IL-1β in early pathophysiology of ALF by a mechanism independent of microglial activation.
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.
BACKGROUND AND OBJECTIVES: The comparison of headache features in general population and in tertiary care centers may explain factors associated to the search for medical assistance and the obstacles to such assistance. This study aimed at comparing demographic findings and the frequency of migraine and tension headache (THA) in general population and in a specialized care center. METHOD: All inhabitants of a small village were interviewed about the presence of headache. In one randomly selected region, people who answered positively were evaluated by a team of neurologists specialized in headache. They have also evaluated a number of patients consecutively treated by a specialized center. Diagnoses have followed International Headaches Classification criteria (2004). RESULTS: Participated in this study 1605 inhabitants of the whole village and 258 inhabitants of the region selected as sample. From these, 76 people reporting headache went through a neurological evaluation, as well as 289 patients of the specialized center. THA was the most common headache among general population (77.6%), followed by migraine (61.8%) with diagnostic overlapping in a good percentage of cases. In the outpatient setting the vast majority of patients had migraine (79.8%), while only 20.4% had THA, being the diagnostic association far less common. Frequency of primary headaches in the community and in specialized care centers* Frequência das cefaleias primárias na comunidade e em centros de cuidados especializados
A relação entre migrânea e epilepsia é reconhecida há anos. Ambas as condições são crônicas, ocorrem em crises paroxísticas e apresentam aspectos semiológicos, fisiopatológicos e terapêuticos em comum. O objetivo deste trabalho foi determinar a frequência de migrânea entre os pacientes epilépticos acompanhados no Ambulatório de Epilepsia do Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brasil. Trata-se de um estudo descritivo transversal baseado na análise de 554 prontuários médicos de pacientes atendidos consecutivamente em um ano. O diagnóstico de migrânea foi registrado no prontuário de 3,1% dos pacientes. Comparando-se variáveis clínicas entre os pacientes epilépticos com e sem migrânea, houve diferença apenas no sexo. A frequência de migrânea encontrada é menor que a relatada na literatura. Possivelmente, essa divergência decorre da metodologia utilizada no estudo e/ou fatores como a negligência da queixa de cefaléia e o empregode drogas como ácido valpróico e topiramato, também eficazes na profilaxia da migrânea. É importante realizar investigaçãoativa de migrânea em pacientes epilépticos no sentido de proporcionar melhor tratamento clínico e qualidade de vida para os mesmos.
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