A nationwide population-based study of migraine in Brazil.

The aim of this study was to estimate the 1-year prevalence of migraine and the degree of the association of migraine with some sociodemographic characteristics of a representative sample of the adult population of Brazil. This was a cross-sectional, population-based study. Telephone interviews were conducted on 3848 people, aged 18-79 years, randomly selected from the 27 States of Brazil. The estimated 1-year gender- and age-adjusted prevalence of migraine was 15.2%. Migraine was 2.2 times more prevalent in women, 1.5 times more in subjects with > 11 years of education, 1.59 times more in subjects with income of < 5 Brazilian Minimum Wages per month, and 1.43 times more in those who do not do any physical exercise. The overall prevalence of migraine in Brazil is 15.2%. Migraine is significantly more prevalent in women, subjects with higher education, with lower income, and those who do not exercise regularly, independently of their body mass index.

Chronic daily headache in Brazil: a nationwide population-based study.

The objectives of this study were to estimate the 1-year prevalence of chronic daily headache (CDH) and the degree of the association of CDH with some sociodemographic characteristics of the adult population of Brazil. This was a cross-sectional, population-based study. We conducted telephone interviews with 3848 people, aged 18-79 years, randomly selected from the 27 States of Brazil. The degree of the association was calculated through prevalence ratios, adjusted with Poisson regression by gender, age and some sociodemographic factors. The estimated 1-year gender- and age-adjusted prevalence of CDH was 6.9%. CDH was 2.4 times more prevalent in women, 1.72 times more in unemployed, 1.63 times more in subjects with high household income and two times greater in those who did not exercise. The overall prevalence of CDH in Brazil is high. CDH is significantly more prevalent in women, the unemployed, subjects with higher income, and in those who do not exercise.

Idiopathic intracranial hypertension with and without papilloedema in a consecutive series of patients with chronic migraine.

Chronic migraine (CM) has been associated with idiopathic intracranial hypertension without papilloedema (IIHWOP), a significant percentage of these cases occurring in obese patients with intractable headache. A prospective study from February 2005 to June 2006 was made of 62 CM patients who fulfilled International Headache Society diagnostic criteria and had cerebral magnetic resonance venography (MRV) and lumbar puncture (LP) done. Two patients were excluded, six (10%) with elevated cerebrospinal fluid (CSF) open pressure (OP), five with body mass index (BMI) > 25. None of the patients had papilloedema or abnormal MRV. BMI and CSF OP were significantly correlated (r = 0.476, P < 0.001, Pearson's correlation test). Obesity (defined as BMI > 30) was a predictor of increase in intracranial pressure (defined as OP > 200 mmH(2)O) (f = 17.26, 95% confidence interval 6.0, 8.6; P < 0.001). From our study we strongly recommend that not only intractable CM patients with high BMI, but also first diagnosed patients with BMI > 30 should be systematically evaluated by a LP to rule out IIHWOP.

Cerebrospinal fluid GABA levels in chronic migraine with and without depression.

Psychiatric comorbidity is one of the key elements in chronic migraine (CM) management. Depression is particularly common in these patients, occurring in up to 85%. Preclinical studies have suggested that gamma-aminobutyric acid (GABA) levels may be decreased in animal models of depression. Also, clinical studies have reported low level in mood disorder patients for both plasma and cerebrospinal fluid (CSF) GABA. We hypothesized that low GABA levels in the brain might be related to the depression associated with CM. We studied 14 chronic migraine patients, with or without depression, compared to age-and sex-matched controls. CSF GABA levels were measured by HPLC. CSF GABA levels showed significant lower levels in depressed patients than those without depression. No difference was found when comparing patients versus controls. A GABA deficiency may be the underlying mechanism of depression in CM. Hence, preventive therapies modulating GABA neurotransmission could be used in CM associated with depression.

Chronic paroxysmal hemicrania-tic syndrome.

The association of chronic paroxysmal hemicrania and ticlike pain-chronic paroxysmal hemicrania-tic (CPH-tic)-is a recently described syndrome. The authors found only two previously reported cases. They report three new cases of this rare syndrome with both chronic paroxysmal hemicrania and ticlike pain concurrently and ipsilaterally. The trigeminal-autonomic cephalalgias (TAC) are considered as differential diagnoses. CPH-tic syndrome could be a different clinical entity.

Fibromyalgia is common in patients with transformed migraine.

Fibromyalgia (FM) and transformed migraine (TM) are common chronic pain disorders. The authors estimated the prevalence of FM in 101 patients with TM, and analyzed its relationship to depression, anxiety, and insomnia. FM was diagnosed in 35.6% of cases. Patients with FM had more insomnia, were older, and had headaches that were more incapacitating than patients without FM. Insomnia and depression predicted FM in patients with TM.

Hemodynamic instability in chronic fatigue syndrome: indices and diagnostic significance.

OBJECTIVES: To evaluate the cardiovascular response to postural challenge in patients with chronic fatigue syndrome (CFS) and to determine whether the degree of instability of the cardiovascular response may aid in diagnosing CFS. METHODS: Patients with CFS (n = 25) and their age- and gender-matched healthy controls (n = 37), patients with fibromyalgia (n = 30), generalized anxiety disorder (n = 15), and essential hypertension (n = 20) were evaluated with the aid of a standardized tilt test. The blood pressure (BP) and heart rate (HR) were recorded during 10 minutes of recumbence and 30 minutes of head-up tilt. We designated BP changes as the differences between successive BP values and the last recumbent BP. The average and standard deviation (SD) were calculated. Time curves of BP differences were loaded into a computerized image analyzer, and their outline ratios and fractal dimensions were measured. HR changes were determined similarly. The average and SD of the parameters were calculated, and intergroup comparisons were performed. RESULTS: On multivariate analysis, the independent predictors of CFS patients versus healthy controls were the fractal dimension of absolute values of the systolic BP changes (SYST-FD.abs), the standard deviation of the current values of the systolic BP changes (SYST-SD.cur), and the standard deviation of the current values of the heart rate changes (HR-SD.cur). The following equation was deduced to calculate the hemodynamic instability score (HIS) in the individual patient: HIS = 64.3303 + (SYST-FD.abs x -68.0135) + (SYST-SD.cur x 111.3726) + (HR-SD.cur x 60.4164). The best cutoff differentiating CFS from the healthy controls was -0.98. HIS values >-0.98 were associated with CFS (sensitivity 97%, specificity 97%). The HIS differed significantly between CFS and other groups (P <.0001) except for generalized anxiety disorder. Group averages (SD) of HIS were CFS = +3.72 (5.02), healthy = -4.62 (2.26), fibromyalgia = -3.27 (2.63), hypertension = -5.53 (2.24), and generalized anxiety disorder = +1.08 (5.2). CONCLUSION: The HIS adds objective criteria confirming the diagnosis of CFS.

[Familial paroxysmal choreoathetosis. Report of 2 cases in one family]. / Coreoatetose paroxistica familiar. Registro de dois casos em uma familia.

The authors present two cases of a very rare condition known as familial paroxysmal choreoathetosis. The patients, mother and daughter, were 28 and 8 years old and the disease started when they were 6 and 2 year-old, respectively. The paroxystic involuntary movements were generalized, producing speech and gait disturbances, without any impairment of consciousness. The duration of the episodes lasted 30 to 180 minutes. The paroxysmals occasionally could be triggered by physical stress or alcohol intake. The neurological examination and the electroencephalogram during free intervals were normal. Searching the available literature these two cases could be classified as belonging to the same form described by Mount and Reback, in 1940.

[Transient global amnesia: study of 26 cases]. / Amnésia global transitória: estudo de 26 casos.

The clinical picture and investigation of 26 patients (16 males and 10 females) with diagnosis of transient global amnesia (TGA) are reported. Age ranged from 51 to 78 years at the time of TGA, which occurred mor often between 60 and 70 year-old people. Three patients presented more than one episode (3, 4 and 5). Precipitating factors were identified in 8 cases (emotional stress in 7 and physical exercise in 1). Risk factors for cerebrovascular disease were found in 13 cases, mainly hypertension (9 cases) and diabetes (3 cases). EEG was normal in 20 cases and disclosed diffuse delta waves in 2, temporal delta waves in 1 and temporal theta waves in another patient. CAT scan showed no abnormalities in 3 cases and ischemia in the vertebro-basilar system in another 2. Brain angiography was normal in 1 case and showed abnormalities in the vertebro-basilar system arteries in 3. During the follow-up period, which ranged from 1 to 84 months, no neurologic deterioration was seen. The role of risk factors for vascular diseases, epilepsy and migraine in the development of TGA is discussed.

The role of sleep in migraine attacks.

Migraine attacks may be precipitated by sleep deprivation or excessive sleep and sleep is also associated with relief of migraine attacks. In view of this variable relationship we studied the records of 159 consecutive outpatients of our Headache Unit. In 121 records there was reference to sleep involvement, in 55% by a single form and in 45% by more than one form. When only one form was related, relief was most common (70%). 30% of that group of patients had the migraine attack precipitated by sleep, 24% by deprivation and 6% by sleep excess. When the effects of sleep were multiple, these effects were as expected logically in 65%: "in accordance" group (e.g attack precipitated by sleep deprivation and relieved by sleep onset. In a second group, ("conflicting") where the involvement was not logical, there were three different combinations of sleep involvement, possibly due to more than one pathophysiological mechanism.

[CSF eosinophils in malignant tumors: a case report]. / Eosinofilorraquia em tumor maligno: apresentação de caso.

It is presented a case of a patient with a cerebral malignant astrocytoma in which the spinal fluid cytomorphology showed numerous eosinophilic granulocytes.

[Fibrous dysplasia of the temporal bone and cerebral occlusive vasculopathy: report of a case]. / Displasia fibrosa do osso temporal e vasculopatia oclusiva cerebral. Relato de caso.

Fibrous dysplasia is a benign disease with unknown etiology. Skull attempt may cause neurological disorders. The diagnostic can be made through radiological examination. A case of a patient with right temporal bone involvement with facial palsy, right parietal lobe infarctions and elevated anticardiolipin antibody titers is presented. Cerebral angiography showed occlusion of several cerebral arteries. Post mortem examination displayed recent myocardial infarction, ischemic cerebral softening, and generalized arteriosclerosis. The simultaneous occurrence of fibrous dysplasia and a probable anticardiolipin syndrome is commented.

Episodic paroxysmal hemicrania with seasonal variation: case report and the EPH-cluster headache continuum hypothesis.

Episodic paroxysmal hemicrania (EPH) is a rare disorder characterized by frequent, daily attacks of short-lived, unilateral headache with accompanying ipsilateral autonomic features. EPH has attack periods which last weeks to months separated by remission intervals lasting months to years, however, a seasonal variation has never been reported in EPH. We report a new case of EPH with a clear seasonal pattern: a 32-year-old woman with a right-sided headache for 17 years. Pain occurred with a seasonal variation, with bouts lasting one month (usually in the first months of the year) and remission periods lasting around 11 months. During these periods she had headache from three to five times per day, lasting from 15 to 30 minutes, without any particular period preference. There were no precipitating or aggravating factors. Tearing and conjunctival injection accompanied ipsilaterally the pain. Previous treatments provided no pain relief. She completely responded to indomethacin 75 mg daily. After three years, the pain recurred with longer attack duration and was just relieved with prednisone. We also propose a new hypothesis: the EPH-cluster headache continuum.

[Confusional state and infantile migraine: report of a case]. / Estado confusional e enxaqueca infantil: relato de um caso.

The case of a male patient having had episodes of confusion and motor deficits at age 5, 9 and 11, admitted to the hospital on these three occasions is reported. All investigations showed negative results, except for the EEG. A clue for the clinical diagnosis of confusional state due to migraine was the past history of the patient, who suffered several migranous attacks from the age of 9. A review of the pathophysiology is made, based on the available literature.

[Binswanger's subcortical arteriosclerotic encephalopathy: a special form of dementia associated with systemic arterial hypertension]. / Encefalopatia subcortical arteriosclerótica de Binswanger: forma especial de demência associada a hipertensão arterial sistêmica.

The encephalopathy is characterized by an important arteriosclerotic involvement of the vessels of the cerebral white matter and a diffuse subcortical demyelination, sparing the cortex. The diagnosis is presently possible, ante mortem, by connecting the clinical picture with the CT scan findings, which are essential. Three cases with Binswanger encephalopathy are reported and the following picture was found: age 50 to 70 years old at the onset; dementia with scanty neurological signs; systemic arterial hypertension; subacute course of the disease; and a CT scan, highly characteristic, that shows bilateral and symmetric subcortical hypodensity. In one of the patients, that eventually died, an angiography disclosed a right internal carotid thrombosis and a diminished flow in the thalamic striate arteries in both sides. The other two patients are apparently stabilized with anti-hypertensive medication. Binswanger encephalopathy is still seldom described in spite of being a very well defined entity. This diagnosis should be considered much more frequently because it is possible to prevent the encephalopathy avoiding systemic hypertension that is probably intimately linked with the genesis of the disease.

[Risk factors in headache in children from 7 to 15]. / Fatores de risco da enxaqueca na faixa etária de 7 a 15 anos.

The occurrence of sleep troubles, recurrent abdominal pain, motion sickness, hyperactivity, dizziness, limb pain, cyclic vomiting, pseudoangine and the headache or migraine family history have been studied in 68 children migraine sufferers and compared to 68 non-headache sufferers whose ages range from 7 to 15. Data have revealed a significant predominance of those symptoms and family histories in migraine sufferers except pseudoangine which has had no significance, sleep troubles significant only in males and limb pains in females. The possibility of considering those factors as migraine risk factors is discussed.

Median nerve SEP after a high medullary lesion. Preserved N18 and absent P14 components. Case report.

Median nerve SEPs recorded from a patient with a high medullary lesion are described. The lesion involved the anteromedial and anterolateral right upper third of the medulla, as documented by MRI. Forty one days after the lesion, left median nerve SEP showed preserved N18 and absent P14 and N20 components; stimulation of the right median nerve evoked normal responses. These findings agree with the proposition that low medullary levels are involved in the generation of the N18 component of the median nerve SEP.

[Incidence of neurosyphilis and incidence of its clinical forms 1962-1981]. / Incidência da neurossífilis e frequênica de suas formas clínicas no período 1962-1981.

After 1950 it was observed an increase in the incidence of syphilis in the general population and this fact determined an investigation in order to evaluate the possible repercussion of this occurrence on the central nervous system, as an after effect of the elevated incidence. However, in this first study it was verified that there was a progressive and marked decrease of the neurosyphilis incidence in the 1936-1964 period, and that the frequency of meningovascular forms of the disease had increased lately in regard to the parenchymatous forms. The aim of the present work has been the continuation of this study after so many years. The material for this survey consisted of the clinical records of 148 patients picked out from 34.430 cases seen at the Neurological Department of Escola Paulista de Medicina (São Paulo, Brasil), during the 1962-1981 period, i.e., on twenty consecutive years. The results of this complementary investigation have shown instead that the incidence of neurosyphilis remained steady, changing very little every year, with an incidence at the rate of about 1:200. On the other hand, the frequency of the clinical forms of neurosyphilis changed very much. The usual forms such as general paresis and tabes are now scant and the observation of the uncommon forms, seldom seen in the past, is now progressively increasing through the years, so that they are the preponderant clinical forms today.

[Use of substances for immediate management of pain in patients with headache. Study in an ambulatory population]. / Uso de substâncias para alívio imediato da dor (SAID) em pacientes com cefaléia. Estudo em uma população ambulatorial.

Data about the use of pain relieving drugs in 411 patients, collected during 24 months are presented. The patients were interviewed personally by one of the authors during a selection process. Demographic data were obtained as well as information about headaches and other pains, duration of the disease, previous headache treatment, clinical characteristics of the headache and a diagnostic hypothesis was formulated. Regarding the use of medication the following factors were considered: amount and quality of medication taken, duration of disease, person responsible for the prescription and awareness of side effects. The results showed that 82% of the patients used substances for immediate relief to headache. Eighty per cent of these patients used commercial products without ergot derivatives, 9% with ergot derivatives and 12%, both. At the same time, 27% of the patients used 3 or more commercial products. The most frequently used substance was dipyrone. Several patients used, as PRD, substances without these properties. Forty eight per cent of the patients used PRD daily or more than once a day and 63% used them for over 90 days. Thirty two per cent of the patients used 5 or more doses of PRD during one single crisis of pain. Seventy four per cent of the patients used self-medication and 81% were not aware of side effects. The present data indicate that the use of PRD is high and chronic. The main implications of this fact and preventive measures are discussed.

[Abuse of substances for immediate management of pain in patients with headache]. / Abuso de substâncias para alívio imediato da dor (SAID) em pacientes com cefaléia.

Data on the use of pain relieving drugs in 339 patients who used medication to relieve their headache are presented. One hundred sixty eight (49%) of them were considered as abusers based on Diamond and Dalessio's criteria modified by Saper. The most common form of abuse was the daily use of PRD, observed in 90 (54%) of the patients (criterion A) followed by: abuse by criterion A plus use of more than 100 doses of analgesic/month (criterion B) observed in 18 (11%) and finally criterion A plus daily use of compounds containing barbiturates or other tranquilizing drugs, in 18 (11%) of the patients. The abuse by psychotropic drugs was observed in 11 (7%) of the patients. The data suggest that the abuse of PRD is high and must be regarded as a public health problem.