Headache changes in individuals with migraine post-Covid-19: general characteristics of the acute phase and worsening of the migraine pattern / Alterações da cefaleia em indivíduos com enxaqueca pós-Covid-19: características gerais da fase aguda e piora do padrão enxaqueca

Introduction:The aim of this study was to investigate how infection with SARS-CoV-2 affected headache in individuals with migraine, and to identify characteristics associated with a worsening of the migraine post COVID-19. Methods:Observational study composed of 157 individuals with migraine and who had been infected with the SARS-CoV-2 virus. They were recruited from the database of the headache research group at the Pontifical Catholic University of Paraná. The participants responded online to questions about their anthropometric data, history of infection with SARS-CoV-2, presence and characteristics of the headache in the acute phase, perception of a worsening of the migraine after infection, use of analgesics and prophylactic migraine medication. Validated digital questionnaires were used: Migraine Disability Assessment (MIDAS), Beck Depression Inventory (BDI) and Allodynia Symptom Checklist (ASC-12). The results of these questionnaires were compared to values previously recorded in the database, this information having been obtained prior to the infection with COVID-19. Results:The first symptom of infection was respiratory for 76/157 (48.7%) individuals, followed by headache with 18 (11.5%). Headache was present in the acute phase of COVID-19 in 142 (90.4%) participants. A worsening of the migraine pattern post-COVID-19 occurred in 48 (30.6%) participants and they mostly suffered from presence of headache [48/48 (100.0%) vs. 94/109 (86.2%); p=0.006], throbbing headache [46/48 (95.8%) vs. 63/109(57.8%); p<0.001] and which lasted longer (5 vs. 3 days; p=0.001). Prior to contracting COVID-19, these patients already were presenting with greater MIDAS score (31 vs. 13; p=0.001), ASC-12 score (8 vs. 4; p=0.004) and BDI score (14 vs. 10; p=0.033). After infection with COVID-19, those who suffered a worsening of the migraine pattern increased their use of analgesics [41/48 (85.4%) vs. 29/109 (26.6%); p<0.001], needed to adjust or substitute their prophylactic medication [30/48 (62.5%) vs. 37/109 (33.9%); p=0.004] and continued to be more severe with regard to the MIDAS scores (34 vs. 12; p=0.001) and BDI score (16 vs. 9; p=0.008). Conclusion:Individuals who notice a worsening in migraine post-COVID-19 have a more severe migraine condition prior to infection, have more prominent headache during the acute phase and, subsequently, present with greater disability.

Introdução: O objetivo deste estudo foi investigar como a infecção pelo SARS-CoV-2 afetou a cefaleia em indivíduos com enxaqueca e identificar características associadas ao agravamento da enxaqueca pós-COVID-19. Métodos:Estudo observacional composto por 157 indivíduos com enxaqueca e que haviam sido infectados pelo vírus SARS-CoV-2. Eles foram recrutados no banco de dados do grupo de pesquisa em cefaleias da Pontifícia Universidade Católica do Paraná. Os participantes responderam online a perguntas sobre seus dados antropométricos, histórico de infecção por SARS-CoV-2, presença e características da cefaleia na fase aguda, percepção de piora da enxaqueca após infecção, uso de analgésicos e medicação profilática para enxaqueca. Foram utilizados questionários digitais validados: Migraine Disability Assessment (MIDAS), Beck Depression Inventory (BDI) e Allodynia Symptom Checklist (ASC-12). Os resultados destes questionários foram comparados com valores previamente registados na base de dados, tendo esta informação sido obtida antes da infecção por COVID-19. Resultados: O primeiro sintoma de infecção foi respiratório em 76/157 (48,7%) indivíduos, seguido de cefaleia em 18 (11,5%). A cefaleia esteve presente na fase aguda da COVID-19 em 142 (90,4%) participantes. Uma piora do padrão de enxaqueca pós-COVID-19 ocorreu em 48 (30,6%) participantes e eles sofriam principalmente com presença de dor de cabeça [48/48 (100,0%) vs. 94/109 (86,2%); p=0,006], cefaleia latejante [46/48 (95,8%) vs. 63/109 (57,8%); p<0,001] e que duraram mais tempo (5 vs. 3 dias; p=0,001). Antes de contrair COVID-19, esses pacientes já apresentavam maior pontuação MIDAS (31 vs. 13; p=0,001), pontuação ASC-12 (8 vs. 4; p=0,004) e pontuação BDI (14 vs. 10; p=0,033). Após a infecção por COVID-19, aqueles que sofreram um agravamento do padrão de enxaqueca aumentaram o uso de analgésicos [41/48 (85,4%) vs. 29/109 (26,6%); p<0,001], necessitaram ajustar ou substituir a medicação profilática [30/48 (62,5%) vs. 37/109 (33,9%); p=0,004] e continuou mais grave em relação aos escores MIDAS (34 vs. 12; p=0,001) e escore BDI (16 vs. 9; p=0,008). Conclusão:Indivíduos que notam piora da enxaqueca pós-COVID-19 apresentam quadro de enxaqueca mais grave antes da infecção, apresentam cefaleia mais proeminente durante a fase aguda e, posteriormente, apresentam maior incapacidade.

Impact of headache on a supplemental healthcare emergency unit and on use of opioids.

BACKGROUND: Headache is one of the most common causes of emergency care and migraines are the most common primary headache in this regard. OBJECTIVE: The aim of this research study was to assess the incidence of medical consultations due to headache, along with demographic characteristics and treatments pertaining to cephalalgia that were offered to patients cared for in supplemental healthcare emergency rooms. METHODS: In 2017, a total of 11,105 consultations took place, and 4,865 (43.8%) of them were complaints relating to headache. 407 records of patients with headache were randomly selected and assessed. Demographic, clinical and therapeutic data were collected using a structured form. RESULTS: The cause of headache was diagnosed as migraine in 60.0% of the patient records. Patients were mostly female (75.2%), with an average age of 33.9 ± 13.7 years. Patient management consisted of administering dipyrone in 62.4% of cases, antiemetics in 66.9%, corticosteroids in 58.9%, opioids in 24.3% and NSAIDs in 13.5%. Use of opioids was associated with a diagnosis of migraine (OR 2.4; CI 1.4-3.9; p = 0.001). Patients who received opioids were kept under observation for longer periods of time (OR 3.4; CI 2.1-5.4; p < 0.001) and exhibited a higher rate of use of antiemetics (OR 11.0; CI 4.7-25.9; p < 0.001), compared with patients who did not receive opioids. CONCLUSION: Dipyrone and antiemetics were administered to most of the patients. Opioids were used for a significant proportion of these individuals, despite the diagnosis of migraine, a condition for which their use is discouraged.

Clinical features of multiple sclerosis in the south of Brazil: a partial analysis / Características clínicas da esclerose múltipla no sul do Brasil: uma análise parcial

There are no published studies on the characteristics of multiple sclerosis (MS) patients from the south of Brazil. OBJECTIVE: To identify the clinical features of a series of MS patients and to compare to other Brazilian series. METHOD: Retrospective study with 67 patients followed in The MS Reference Center - RS, Brazil during the year of 2008. We analyzed demographic and clinical data. RESULTS: Most were women (74.6 percent), the general average age was 43.5 years old, and the general average EDSS score was 4.1. Of those patients, 81.8 percent had relapsing-remitting MS. Sexual dysfunction prevalence was 31.1 percent in men and 68.9 percent in women (p<0.01). We found a positive correlation (Spearman=0.444, p<0.05) between EDSS and depressive symptoms. CONCLUSION: This study showed a very similar sample compared to other states of Brazil. Moreover, there was found a high prevalence of sexual dysfunction and a straight relation between EDSS and depressive symptoms.

Não há dados publicados sobre as características clínicas da esclerose múltipla (EM) no estado do Rio Grande do Sul (RS). OBJETIVO: Identificar e comparar as características clínicas de uma série de pacientes com EM no RS com as de outras séries nacionais. MÉTODO: Foram coletados e avaliados dados demográficos e clínicos de 67 pacientes atendidos em nosso centro. RESULTADOS: Houve predomínio de mulheres (74,6 por cento), idade média geral foi de 43,5 anos e EDSS médio de 4,1. O tipo surto-remissão correpondeu a 81,8 por cento. A prevalência de disfunção sexual foi de 31,1 por cento nos homens e 68,9 por cento nas mulheres (p<0,01). Encontrou-se correlação de 0,444 (p<0,05) entre depressão e EDSS. CONCLUSÃO: Este estudo demonstrou uma amostra semelhante às demais amostras brasileiras, apresentando, adicionalmente, elevada prevalência de sintomas sexuais e a estreita associação entre depressão e o grau de incapacidade.

Clinical features of multiple sclerosis in the south of Brazil: a partial analysis.

UNLABELLED: There are no published studies on the characteristics of multiple sclerosis (MS) patients from the south of Brazil. OBJECTIVE: To identify the clinical features of a series of MS patients and to compare to other Brazilian series. METHOD: Retrospective study with 67 patients followed in The MS Reference Center - RS, Brazil during the year of 2008. We analyzed demographic and clinical data. RESULTS: Most were women (74.6%), the general average age was 43.5 years old, and the general average EDSS score was 4.1. Of those patients, 81.8% had relapsing-remitting MS. Sexual dysfunction prevalence was 31.1% in men and 68.9% in women (p<0.01). We found a positive correlation (Spearman=0.444, p<0.05) between EDSS and depressive symptoms. CONCLUSION: This study showed a very similar sample compared to other states of Brazil. Moreover, there was found a high prevalence of sexual dysfunction and a straight relation between EDSS and depressive symptoms.