Epidemiology of primary and secondary headaches in a Brazilian tertiary-care center

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.

Section: Discussionsupporting

confidence: 52%

Temporo-mandibular disorders are an important comorbidity of migraine and may be clinically difficult to distinguish them from tension-type headache

Júnior¹,

Brandão

Faleiros

et al. 2014

“…Around 87% of the patients had some form of migraine both in the first and second assessments. Other studies conducted at the tertiary care found that the prevalence of migraine at this setting ranges from 33 to 80% [3][4][5][6]8 . A past study conducted in our clinic diagnosed migraine in 79.2% of the patients 3 .…”

Section: Discussionmentioning

confidence: 99%

“…In this setting, tension-type headache (TTH) is the most common headache type, followed by migraine 1,2 . In the tertiary care, however, migraine and chronic daily headaches (CDH), are far more common than TTH [3][4][5][6][7][8] . CDHs do not represent a distinct nosologic entity, as per the second edition of the International Classification of Headache Disorders (ICDH-II) 9 .…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, CDHs describe primary or secondary headache happening on 15 or more days per month, for at least 3 months, lasting at least 4 hours per day 10 . Most studies conducted in the tertiary care are retrospective or cross-sectional [3][4][5][6][7] . Few studies followed the patients longitudinally, using the ICDH-II to diagnose the headaches.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Relative frequency of headache types: a longitudinal study in the tertiary care

Silva-Júnior

Faleiros²,

Santos³

et al. 2010

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.

“…Migraine has also been the most frequent headache type found in studies performed in Brazilian tertiary-care centers, ranging from 38 to 45.1% 2,6,7 . It is important to note that the patients selected in the present study sought medical care spontaneously.…”

Section: Discussionmentioning

confidence: 99%

Clinical features, diagnosis and treatment of acute primary headaches at an emergency center: why are we still neglecting the evidence?

Junior

Santos

Siqueira

et al. 2007

-In order to analyze the clinical features, approach and treatment of patients with acute primary headaches seen at the Clinics Hospital of the Federal University of Uberlândia (HC-UFU) throughout 2005, the medical charts of 109 patients were evaluated through a standardized questionnaire as to age, gender, main diagnosis, characteristics of the headache attacks, diagnostic tests and treatment. Probable migraine was the most common type of primary headache (47.7%), followed by probable tension-type headache (37.6%), unspecified headache (11.9%), and headache not elsewhere classified (2.8%). As to characteristics of the crisis, the location of the pain was described in 86.2% of the patients. The most commonly used drugs for treatment of acute headache attacks were dipyrone (74.5%), tenoxicam (31.8%), diazepam (20.9%), dimenhydrate (10.9%), and metochlopramide (9.9%). The data collected are in agreement with those reported in literature. In most cases, treatment was not what is recommended by consensus or clinical studies with appropriate methodology. Therefore, we suggest the introduction of a specific acute headache management protocol which could facilitate the diagnosis, treatment and management of these patients.KEY WORDS: headaches, diagnostic approach, treatment. Características clínicas, diagnóstico e tratamento das cefaléias primárias agudas em um serviço de emergência. Por que ainda negligenciamos as evidências?RESUMO -Com o objetivo de avaliar as características clínicas, abordagem e tratamento das cefaléias agudas primárias atendidas no Hospital de Clínicas da Universidade Federal de Uberlândia (HC-UFU) no ano de 2005, 109 prontuários foram analisados através de questionário padronizado, segundo idade, sexo, diagnós-tico principal, características das crises, propedêutica e tratamento. A distribuição dos pacientes quanto ao tipo de cefaléia foi a seguinte: provável enxaqueca 47,7%, provável cefaléia tensional 37,6%, cefaléia não classificada 11,9% e cefaléia não classificada em outro local 2,8%. No que tange às características da crise, a localização da dor foi descrita em 86,2% dos pacientes. No tratamento dos pacientes com crise aguda de cefaléia, as drogas mais utilizadas foram: dipirona (74,5%), seguido de tenoxicam (31,8%), diazepam (20,9%), dramin ® (10,9%) e metoclopramida (9,9%). Os dados levantados são condizentes com os relatados na literatura. O tratamento efetuado, na maioria dos casos, não foi o recomendado por consensos ou estudos clíni-cos com metodologia aceitável. Recomendamos, portanto, a introdução de um protocolo específico para o atendimento das cefaléias agudas, o que facilitará o diagnóstico, tratamento e manejo destes pacientes.