To compare the preventive treatment benefits of amitriptyline and aerobic exercise or amitriptyline alone in patients with chronic migraine. Method: Sixty patients, both genders, aged between 18 and 50 years, with a diagnosis of chronic migraine, were randomized in groups called amitriptyline and aerobic exercise or amitriptyline alone. The following parameters were evaluated: headache frequency, intensity and duration of headache, days of the analgesic medication use, body mass index (BMI), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) scores. Results: In the evaluated parameters, was observed decrease in headache frequency (p=0.001), moderate intensity (p=0.048), in headache duration (p=0.001), the body mass index (p=0.001), Beck Depression Inventory (p=0.001) and Beck Anxiety Inventory scores (p=0.001), when groups were compared in the end of third month. Conclusion: In this study, the amitriptyline was an effective treatment for chronic migraine, but its efficacy was increased when combined with aerobic exercise.
The aim of this study was to evaluate the visual attention of children with migraine and compare it with a control group. Thirty migrainous children and 30 controls without headache were subjected to a visual attention assessment with Trail Making Tests (TMT) A/B, Letter Cancellation Test, and the Brazilian computerized test Visual Attention Test, third edition. The migraine group was evaluated after 2 days without headache. The migraine group had an inferior performance compared with the control group on TMT A (P = 0.03) and B (P = 0.001), and more errors on tasks 1 (P = 0.032) and 2 (P = 0.015) of the Visual Attention Test, presenting difficulty with selective and alternate attention. Attention is a neurological function that depends on structures such as the brainstem, cerebral cortex and the limbic system and on neurotransmitters such as dopamine and noradrenaline. The neurochemical aspects involved in the physiopathology of migraine and attention mechanisms probably predispose these children to visual attention deficits.
Objective: Evaluate the cognitive functions of children with migraine and compare them to A control group. Method: 30 migraineur children and 30 control group children without migraine, age ranging from 8 to 12 years old, were subjected to a cognitive functions assessment with Wechsler Intelligence Scale for Children (WISCIII). Results: Although both groups had a normal cognitive performance, children with migraine had significantly worse scores compared to the control group in the subtests of Information, Arithmetic, Vocabulary, Object Assembly and in the Indexes of Perceptual Organization, Resistance to Distraction and Processing Speed. Conclusion: Children with migraine had impairment in some cognitive functions such as attention, memory, information speed, and perceptual organization compared to the control group.
A 20-year-old man submitted to surgical insertion of a lumboperitoneal drain as a treatment for intracranial hypertension, secondary to venous sinus thrombosis, developed severe headache accompanied by nausea, vomiting, and diplopia 24 hours postoperative. Cerebral spinal fluid low-pressure headache was diagnosed. A transnasal sphenopalatine ganglion block with ropivacaine was performed without complications. Pain relief was immediate, complete, and sustained for about 24 hours; a second block was performed effectively with pain control, and the patient was discharged. Sphenopalatine ganglion block may be a safe and efficient treatment for the cerebral spinal fluid hypotension headache secondary to lumboperitoneal shunt.
According to the second edition of the International Classification of Headache Disorders (ICHD-II) 1 , migrainous infarction (MI) is a complication of migraine with aura. MI is diagnosed when one or more aura symptoms last longer than 60 minutes, and neuroradiological studies demonstrate ischemic stroke that potentially explains the symptoms. Stroke should not be attributed to another disorder. The ICHD-II also defines sporadic hemiplegic migraine (SHM) as a subtype of migraine with aura associated with fully reversible motor weakness in association to the typical aura symptoms (visual, sensory or dysphasic aura). Unlike familial hemiplegic migraine (FHM), familial history of migraine with motor weakness in first-or second-degree relatives is absent. MI in childhood is very rare and epidemiological studies are scarce 2 . Reports of incidence of migrainous stroke in this group range from 0.5% 2 to 1.7% 3. A fairly and diligent review of the literature found no previous reports of MI during childhood following SHM in Brazil.Herein we report a case of MI following SHM in a child. We obtained written informed consent to publish the case, as well as the results of genetic testing. The principles outlined in the declaration of Helsinki were followed. CASEA 10-year-old boy was initially referred to our service on May of 2004, with a 2-year history of attacks of bifrontal and throbbing headache, preceded by right hemi-hypoesthesia and hemiparesis that typically lasted less than 60 minutes. Headache attacks were of moderate intensity and were associated with photophobia and phonophobia. Frequency was around 3 per month and duration ranged from 10 to 72 hours.Family reported a single episode of headache in which the associated right hemiparesis lasted about three days. Although attack was longer and clearly not suggestive of a benign migraine attack, it had not been investigated.The patient had no relevant prior medical history. Relevant familial history included mother suffering from migraine with visual aura, and brother with a past episode of transient left hemiparesis (without headache) in the context of varicella infection.Two months before the first consultation, patient suffered a partial seizure, characterized by right hemi-body hypertonia, cephalic deviation and gaze shift to the right side, during a typical attack of hemiplegic migraine. Patient recovered totally and neurological exam was normal. Magnetic resonance imaging revealed a left thalamic (pulvinar) lesion, suggestive of ischemia (Fig 1). The patient was then referred to our division for investigation and treatment.A comprehensive complementary investigation with blood tests, imaging tests, genetic tests, EEG and CSF for ischemic stroke was performed and revealed no abnormalities. Treatment with flunarizine yielded adequate control of the migraine attacks, but it was suspended due to significant drowsiness and weight gain. Patient responded well to propranolol and is free of headaches since then (headache free for 2 years). Mutation screeningScreening ...
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