-Background: Migraine is a chronic neurological disease with several trigger factors, including dietary, hormonal and environmental factors. Purpose: To analyse precipitating factors in a sample of migraine patients. Method: Two hundred consecutive migraine patients were interviewed about possible trigger factors for migraine attacks. Results: Most patients showed at least one dietary trigger, fasting was the most frequent one, followed by alcohol and chocolate. Hormonal factors appeared in 53% , being the pre-menstrual period the most frequent trigger. Physical activities caused migraine in 13%, sexual activities in 2.5% and 64% reported emotional stress a trigger factor. 81% related some sleep problem as a trigger factor. Regarding environmental factors, smells were reported by 36.5%. Conclusion: Trigger factors are frequent in migraine patients, its avoidance may decrease headache frequency and also improve patients' quality of life.KEY WORDS: migraine, trigger factors. fatores desencadeantes de enxaquecaResumo -Introdução: A enxaqueca é uma doença neurológica crônica que apresenta diversos desencadeantes como fatores alimentares, hormonais e ambientais. Objetivo: Analisar os fatores desencadeantes em uma amostra de pacientes com enxaqueca. Método: Duzentos pacientes com diagnóstico de enxaqueca foram questionados sobre fatores que pudessem desencadear suas crises. Resultados: 83,5% apresentaram algum fator alimentar, jejum foi o fator mais freqüente, seguido de álcool e chocolate. Dos fatores hormonais, o período pré-menstrual foi o mais freqüente. Atividade física causou enxaquecas em 13%, atividade sexual em 2,5%, estresse em 64% e 81% relataram o sono como fator desencadeante. Em relação aos fatores ambientais, odores foram desencadeantes em 36,5%. Conclusão: Os fatores desencadeantes são freqüentes em enxaqueca e a sua detecção deve ser pormenorizada para que se reduza a freqüência de crises e melhore a qualidade de vida do paciente.PAlAvRAS-cHAvE: enxaqueca, fatores desencadeantes. Migraine is a chronic debilitating neurological condition with several trigger factors. It usually begins in childhood or adolescence and can remain with the patient for the whole life. It is more common in women than men, its prevalence is 12% of the general population, affecting 18% to 20% of women, occurring mainly during their productive and reproductive phases (20 to 50 years old). Therefore, migraine has a significant socioeconomic impact and in patients quality of life 1 . Migraine is a complex disorder with several pathopsysiological mechanisms involved, such as hypothalamic dysfunction shown by a chronobiologic dysregulation, and a possible hyperdopaminergic state 2 . A variety of external and internal factors have been demonstrated to precipitate migraine attacks.Trigger factors are important in migraine management since their avoidance may result in a better control of the disorder. Several studies are consistent with stress, lack of sleep, and fasting being the most common trigger factors 3,4 , but some o...

Neural mechanisms involved in subthreshold PTSD may share neural similarities with those underlying the fragmented and non-verbal nature of traumatic memories in full PTSD. Moreover, psychotherapy may influence the development of a narrative pattern overlaying the declarative memory neural substrates.

BackgroundAnxiety and mood disorders have been shown to be the most relevant psychiatric comorbidities associated with migraine, influencing its clinical course, treatment response, and clinical outcomes. Limited information is available on how specific anxiety and depression symptoms are related to migraine. Symptoms-based approach, a current trend in mental health research, may improve our understanding in migraine comorbidity. The purpose of this study was to analyze how anxiety and depression aspects are related to migraine through a symptom-based approach.MethodsWe studied 782 patients from the general population who completed a self-administered questionnaire assessing demographics, headache features, anxiety and depression symptoms. A binary logistic regression analyses were conducted to test the association between all four ratings in GAD-7 (anxiety) and PHQ-9 (depression) scales subitems as covariates, and migraine vs no headache as the outcome.ResultsThe leading Odd Ratios (OR) observed in individuals with migraine relative to those without migraine were anxiety related, “Not being able to stop or control worrying” on a daily basis [OR (CI 95%)] 49.2 (13.6–178.2), “trouble relaxing” 25.7 (7.1–92.6), “Feeling nervous, anxious or on edge” on a daily basis 25.4 (6.9–93.8), and “worrying too much about different things” 24.4 (7.7–77.6). Although the hallmark symptoms of depression are emotional (hopelessness and sadness), the highest scores found were physical: apetite, fatigue, and poor sleep. Irritability had a significant increase in migraine risk [OR 3.8 (1.9–7.8) if experienced some days, 7.5 (2.7–20.7) more than half the days, and 22.0 (5.7–84.9) when experienced nearly every day].ConclusionsAnxiety was more robustly associated with increase in migraine risk than depression. Lack of ability to properly control worrying and to relax are the most prominent issues in migraine psychiatric comorbidity. Physical symptoms in depression are more linked to migraine than emotional symptoms. A symptom-based approach helps clarifying migraine comorbidity and should be replicated in other studies.

Positive results of M1 stimulation in other studies, and the absence of significant benefits of active high-frequency rTMS of the DLPFC in the present study, point to M1 as a more promising target than the DLPFC, for larger trials of noninvasive brain stimulation in patients with chronic migraine.

Psychiatric comorbidity, mainly anxiety and depression, are common in chronic migraine (CM). Phobias are reported by half of CM patients. Phobic avoidance associated with fear of headache or migraine attack has never been adequately described. We describe 12 migraine patients with particular phobic-avoidant behaviours related to their headache attacks, which we classified as a specific illness phobia, coined as cephalalgiaphobia. All patients were women, mean age 42, and all had a migraine diagnosis (11 CM, all overused acute medications). Patients had either a phobia of a headache attack during a pain-free state or a phobia of pain worsening during mild headache episodes. Patients overused acute medication as phobic avoidance. It is a significant problem, associated with distress and impairment, interfering with medical care.Cephalalgiaphobia is a possible specific phobia of illness, possibly linked to progression of migraine to CM and to acute medication overuse headache.

Musculoskeletal pain (MP) is common in the general population and has been associated with anxiety in several ways: (a) muscle tension is included as a part of the diagnostic criteria for generalized anxiety disorder, (b) pain can be a common symptom and a good indicator of an anxiety disorder, (c) anxiety is an independent predictor of quality of life in patients with chronic MP, (d) anxiety leads to higher levels of pain chronification, and (e) fear, anxiety, and avoidance are related to MP. The objective of this article is to explore the mechanisms underlying the relation between anxiety disorders and musculoskeletal pain as well as its management. We have also highlighted the role of spirituality and religiosity in MP treatment. We found some similarities between proposed mechanisms and explicative models for both conditions as well as an overlapping between the treatments available. The recognition of this association is important for professionals who deal with chronic pain.

Although anxiety disorders and headaches are comorbid conditions, there have been no studies evaluating the prevalence of primary headaches in patients with generalized anxiety disorder (GAD). The aim of this study was to analyze the lifetime prevalence of primary headaches in individuals with and without GAD. A total of 60 individuals were evaluated: 30 GAD patients and 30 controls without mental disorders. Psychiatric assessments and primary headache diagnoses were made using structured interviews. Among the GAD patients, the most common diagnosis was migraine, which was significantly more prevalent among the GAD patients than among the controls, as were episodic migraine, chronic daily headache and aura. Tension-type headache was equally common in both groups. Primary headaches in general were significantly more common and more severe in GAD patients than in controls. In anxiety disorder patients, particularly those with GAD, accurate diagnosis of primary headache can improve patient management and clinical outcomes.

The search to understand response to trauma has turned to the contribution of personality factors. The way people process the stressor event is critical in determining whether a trauma will be configured or not. Neuroscience shows that the brain does not store memories, but traces of information that are later used to create memories, which do not always express a completely factual picture of the past experience. Whenever an event is retrieved, it may undergo a cognitive and emotional change. Psychological dynamics--emotional interpretative tendency that affects the internal dialogue related to a meaningful event--may influence the development of positive or negative outcomes after stressor events. We postulate that therapists must see beyond the traumatic event itself and work with the internal dialogues that maintain the pathological relationship with the past episode. Thus, they may better treat traumatized patients by therapeutically rebuilding the memory. A brief clinical case is presented to show how exposure-based and cognitive restructuring therapy may help trauma victims experience psychological growth from their negative experiences, by fostering healthy psychological dynamics.