The Brazilian Headache Society (Sociedade Brasileira de Cefaleia, SBCe, in Portuguese) nominated a Committee of Authors with the aim of establishing a consensus with recommendations regarding prophylactic treatment for episodic migraine based on articles published in the worldwide literature, as well as personal experience. Migraine affects 1 billion people around the world and more than 30 million Brazilians. In addition, it is an underdiagnosed and undertreated disorder. It is well known within the medical community of neurologists, and especially among headache specialists, that there is a need to disseminate knowledge about prophylactic treatment for migraine. For this purpose, together with the need for drug updates and to expand knowledge of the disease itself (frequency, intensity, duration, impact and perhaps the progression of migraine), this Consensus was developed, following a full online methodology, by 12 groups who reviewed and wrote about the pharmacological categories of the drugs used and, at the end of the process, met to read and establish conclusions for this document. The drug classes studied were: anticonvulsants, tricyclic antidepressants, monoclonal anti-calcitonin gene-related peptide (anti-CGRP) antibodies, beta-blockers, antihypertensives, calcium channel inhibitors, other antidepressants (selective serotonin reuptake inhibitors, SSRIs, and dual-action antidepressants), other drugs, and polytherapy. Hormonal treatment and anti-inflammatories and triptans in minimum prophylaxis schemes (miniprophylaxis) will be covered in a specific chapter. The drug classes studied for part I of the Consensus were: anticonvulsants, tricyclic antidepressants, monoclonal anti-CGRP antibodies, and beta-blockers.

Background Migraine affects 1 billion people worldwide and > 30 million Brazilians; besides, it is an underdiagnosed and undertreated disorder. Objective The need to disseminate knowledge about the prophylactic treatment of migraine is known, so the Brazilian Headache Society (SBCe, in the Portuguese acronym) appointed a committee of authors with the objective of establishing a consensus with recommendations on the prophylactic treatment of episodic migraine based on articles from the world literature as well as from personal experience. Methods Meetings were held entirely online, with the participation of 12 groups that reviewed and wrote about the pharmacological categories of drugs and, at the end, met to read and finish the document. The drug classes studied in part II of this Consensus were: antihypertensives, selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, calcium channel blockers, other drugs, and rational polytherapy. Results From this list of drugs, only candesartan has been established as effective in controlling episodic migraine. Flunarizine, venlafaxine, duloxetine, and pizotifen were defined as likely to be effective, while lisinopril, enalapril, escitalopram, fluvoxamine, quetiapine, atorvastatin, simvastatin, cyproheptadine, and melatonin were possibly effective in prophylaxis of the disease. Conclusions Despite an effort by the scientific community to find really effective drugs in the treatment of migraine, given the large number of drugs tested for this purpose, we still have few therapeutic options.

Opinião Pessoal

No abstract

Neuroimaging in Headache

Imagens

Cardiac cephalalgia is a nosologic entity that has only been acknowledged by the turn of the century, and is, consequently, often underdiagnosed, even by experienced neurologists. Unlike most headaches, however, failing to provide a proper and timely diagnosis can have deadly consequences. Report of a case of cardiac headache attended at the emergency department and literature review. This entity was first described in 1997; no studies have yet determined its prevalence, with the literature relying on case reports. The pathophysiology remains a mystery, with three main hypothesis: spinal convergence of cardiac visceral afferent nerves with somatic afferent nerves from the head, increase of intracranial pressure from decrease in cerebral venous return originated from the reduced cardiac output, and release of inflammatory markers during cardiac ischaemia, such as bradykinin, serotonin and histamin, causing vascular changes. Distinguishing this pathology from others, especially migraine, with which it shares many traits, is of paramount importance: vasoconstrictor drugs such as triptans are absolutely contraindicated, and the outcome can be dramatic. This case illustrates the need to promptly recognize this rare entity since failure to diagnose it can have devastating consequences.

www.trasso.com.br. Os manuscritos aceitos para publicação passam a pertencer à Sociedade Brasileira de Cefaleia e não podem ser reproduzidos ou publicados, mesmo em parte, sem autorização da HM & SBCe. Os artigos e correspondências deverão ser encaminhados para a HM através de submissão on-line, acesso pela página www.sbce.med.br -caso haja problemas no encaminhamento, deverão ser contatados o webmaster, via site da SBCe, a Sra. Josefina Toledo, da Trasso Comunicação, ou o editor (mmvalenca@yahoo.com.br). Tiragem: 1.500 exemplares. Distribuição gratuita para os membros associados, bibliotecas regionais de Medicina e faculdades de Medicina do Brasil, e sociedades congêneres.