Eficácia de três drogas sobre a aura migranosa: um estudo randomizado placebo controlado

Abstract

RESUMO -A despeito da enorme quantidade de pesquisas referentes à classificação, epidemiologia, diagnóstico, fisiopatologia e tratamento da migrânea, a aura migranosa permanece bem menos estudada. O objetivo do presente estudo é, portanto, verificar a evolução da aura em pacientes submetidos a placebo e a três diferentes drogas disponíveis em unidades públicas de saúde brasileiras. Foram estudados 86 pacientes em vigência de crise de migrânea com aura, apresentando aura no momento da randomização. Após a randomização os pacientes recebiam uma das seguintes substâncias, por via endovenosa: placebo, dipirona, clorpromazina, sulfato de magnésio. O sulfato de magnésio foi superior ao placebo (p < 0,05) 30 e 60 minutos após a administração. Dipirona e clorpromazina reduziram o número de pacientes com aura, em relação ao placebo, 60 minutos após a administração. Os achados acima possibilitam especulações sobre a fisiopatologia da migrânea e apresentam opções terapêuticas para o tratamento da aura.PALAVRAS-CHAVE: migrânea com aura, aura, tratamento, placebo, dipirona, clorpromazina, sulfato de magnésio.Efficacy of three drugs in the treatment of migrainous aura: a randomized, placebo-controlled study Efficacy of three drugs in the treatment of migrainous aura: a randomized, placebo-controlled study Efficacy of three drugs in the treatment of migrainous aura: a randomized, placebo-controlled study Efficacy of three drugs in the treatment of migrainous aura: a randomized, placebo-controlled study Efficacy of three drugs in the treatment of migrainous aura: a randomized, placebo-controlled study ABSTRACT -In spite of the enormous amount of research regarding classification, epidemiology, diagnosis, pathophisiology and treatment of migraines, aura, one of its hallmarks, stays much less studied. The objective of this study is, therefore, to evaluate the evolution of aura in patients submitted to placebo and three different drugs available in Brazilian public health units. We studied 86 patients during an acute migrainous attack, with aura at the moment of the evaluation. Patients were randomized to receive one of the following substances, in a parenteral route: placebo, dipyrone, chlorpromazine and magnesium sulphate. Magnesium sulphate was superior to placebo (p <0,05) 30 and 60 minutes after its administration. Dipyrone and chlorpromazine reduced the duration of the aura, when compared to placebo, 60 minutes following their administration. Our findings make possible some speculations about the pathophisiology of migraine, as well as about the therapeutic approach of patients presenting migrainous aura.KEY WORDS: migraine with aura, aura, treatment, placebo, dipyrone, chlorpromazine, magnesium sulphate.A despeito da enorme quantidade de pesquisas referentes à classificação, epidemiologia, diagnós-tico, fisiopatologia e tratamento da migrânea 1-3 , a aura migranosa permanece bem menos estudada. Define-se aura como fenômeno neurológico focal que se relaciona ao ataque de migrânea, durando usualmente de 5 a 20 e não ultrapass...

Dipyrone for acute primary headaches

“…All of them were intention-to-treat randomized controlled trials with a parallel-group design and were classified as B according to the Cochrane Handbook criteria (13) . According to Jadad scale, one 23 was classified as 5, and the other three [24][25][26] as 4. Only one included trial 23 reported any dropouts: 4 patients (1 randomized to dipyrone 0.5 g and 3 randomized to dipyrone 1 g) were excluded from the analysis for failing to return their study diaries.…”

“…Three of these studies were performed in the same centers (two public health units) in Brazil by the same group of authors [24][25][26] . One trial 23 included 31 participating centers, and subjects were not hospitalized.…”

“…The four studies included 636 subjects (187 males), with a mean age ranging from 29.5 to 44.2 years. They used the International Headache Society structured diagnostic criteria for episodic tension-type headache 23 , 24 , migraine with aura 26 , and migraine with or without aura 25 . No pediatric trials were identified.…”

“…All four trials compared dipyrone to placebo; two of them also compared dipyrone to other active treatments 23,26 . In three studies [24][25][26] , dipyrone 1g was administered intravenously, whereas in one 23 oral administration of dipyrone 0.5g and 1g was evaluated. Acetylsalicylic acid 23 , magnesium sulphate 26 and chlorpromazine 26 were the comparative medications evaluated.…”

“…In three studies [24][25][26] , dipyrone 1g was administered intravenously, whereas in one 23 oral administration of dipyrone 0.5g and 1g was evaluated. Acetylsalicylic acid 23 , magnesium sulphate 26 and chlorpromazine 26 were the comparative medications evaluated. Intravenous placebo was 0.9% physiological saline solution.…”