Epidemio-clinical and CT-scan profile of adult headache disorders in a sub-Saharan Africa country

Objective: Given the little availability of MRI in sub-Saharan Africa, we carried out this study focusing on CT-scan in adult headache disorder, in order to determine epidemiological and clinical profile of adult patients undergoing CT-scan for headache disorder, and the organic pathologies discovered in sub-Saharan Africa.Method: We carried out a multicentric prospective cross-sectional study in medical imaging departments of Yaounde Central Hospital and Douala Laquintinie Hospital, which are two teaching hospitals in Cameroon. We consecutively and non-exhaustively included all consenting patients aged eighteen years or above, referred to radiology department to undergo a head CT-scan as aetiological workup of headache disorder, from either traumatic or non-traumatic mechanism. Patients with a Glasgow coma scale less than thirteen were excluded. We interviewed eligible patients, and performed a neurological examination and a complete physical examination before they underwent head CT-scan. The scanning was performed using a brand HITACHI ECLOS 16 slices CT-scan, in helical mode with or without contrast enhancement according to the clinical context. The reading was done by experimented radiologists

Prevalência de cefaleia em uma unidade de diálise / Prevalence of headache in a dialysis clinic

Introdução: De acordo com a Sociedade Internacional de Cefaleia, a cefaleia é uma dor localizada acima da linha orbitomeatal, classificada como primária e secundária. A cefaleia da diálise consiste em uma dor de cabeça inespecífica que ocorre no período da diálise, podendo persistir após o término da sessão. Apesar de ser um sintoma comum em pacientes submetidos à hemodiálise, a cefaleia decorrente da terapia dialítica é pobremente estudada. Não se tem a sua etiologia precisa, porém infere-se que a gênese da cefaleia seja multifatorial. Objetivo: Avaliar a prevalência da cefaleia em pacientes submetidos à hemodiálise. Além disso, classificar as cefaleias apresentadas pelos pacientes estudados, inclusive as que não são decorrentes da diálise. Métodos: Trata-se de um estudo constituído por pacientes submetidos à terapia dialítica em uma clínica, de uma cidade brasileira, no período de maio a agosto de 2014. Este foi composto por 152 pacientes. Resultados: Foram analisados 77 (50,7%) pacientes do sexo masculino e 75 (49,3%) do sexo feminino. Dos 61 pacientes (40,1%) que afirmaram apresentar episódios de cefaleia, os tipos mais prevalentes foram cefaleia do tipo tensional ­ CTT (41%) e cefaleia da diálise (37,7%), sendo outros tipos menos frequentes. Ou seja, 23 (15,1%) dos 152 pacientes foram diagnosticados com cefaleia da diálise, isolada ou associada a outros tipos de cefaleia. Conclusão: Diante da elevada prevalência de tal condição, elaborar planos de ação para melhoria da qualidade de vida desses pacientes é uma medida relevante.

Introduction: According to the International Society of Headache, headache is a pain located above the orbitomeatal line, classified as primary and secondary. The dialysis headache isclassified as secondary and consists of a nonspecific headache that occurs during the period of dialysis and may persist after the end of the session. Despite being a common symptom in patients undergoing hemodialysis, headache resulting from dialysis is poorly studied. It does not have a precise etiology, however it appears that the genesis of the headache is multifactorial. Background. Evaluate the prevalence of headache in patients submitted to hemodialysis. Besides classify headaches evidenced by patient studied, including those which are not decurrent from dialysis. Methods. It´s a study consists of patients who had dialysis performed at a clinic, in a brazilian city, from May to August, 2014. This was composed of 152 patients. Results. 77 (50,7%) patients were males and 75 (49,3%) were females. Of the 61 (40,1%) affirmed evince headache episodes, the most prevalence types were tension type headache ­ CTT (41%) and headache from dialysis (37,7%), and other less common types. So, 23 (15,1%) of 152 patients were diagnosed with headache from dialysis, irrespective of being or not being associated with other types of headache. Conclusion. Such high prevalence of this condition, draw up action plans to improve the quality of life of these patients is a relevant measure.

Headache-related disability among medical students in Amazon: a cross-sectional study / Incapacidade relacionada à cefaleia em estudantes de medicina no Amazonas: um estudo transversal

ABSTRACT Objective To evaluate the prevalence of headache in medical students, and quantify the degree of disability through HIT-6 and MIDAS scale. Method The criteria established by International Headache Society were used and the HIT-6 and MIDAS, to asses disability. Results 140 medical students from UFAM were evaluated. 16.43% cases of migraine headache, 6.43% of probable migraine, and 23.57% of tension headaches were detected. 6.42% reported an absence of headache; and another 11.42% had secondary headache. According to the HIT-6 questionnaire, in 7.14% and 18.57% of the students, headaches were classified as having substantial to severe impact, respectively. Conclusion Migraine and probable migraine had higher scores than the other types of headache and, therefore, led to higher levels of disability. The present study did not find a significant correlation between student semester, age or extracurricular activities on the impact generated by headache.

RESUMO Objetivo Avaliar a prevalência de cefaleia em estudantes médicos e quantificar o grau de incapacidade através das escalas HIT-6 e MIDAS. Método Os critérios da Sociedade Internacional de Cefaleia foram usados e as escalas Hit-6 e MIDAS foram usadas para medir a incapacidade. Resultados 140 estudantes de medicina da UFAM foram avaliados. 16.43% eram migrânea, 6.43% de provável migrânea e 23.57% de cefaleia tipo tensional. 6,42% relataram ausência de cefaleia e 11.42% possuíam cefaleia secundária. De acordo com o questionário HIT-6 em 7,14% e 18,57% dos estudantes, a cefaleia foram classificadas como impacto substancial e grave respectivamente. Conclusão Migrânea e provável migrânea tiveram escores mais elevados do que os outros tipos de cefaleia e maiores níveis de incapacidade. O estudo não encontrou uma associação significante entre o período de graduação, idade ou das atividades extracurriculares com o impacto gerado pela cefaleia.

Screening for acromegaly in adult patients not reporting enlargement of the extremities, but with arterial hypertension associated with another comorbidity of the disease / Rastreamento de acromegalia em pacientes adultos não relatando crescimento de extremidades, mas com hipertensão arterial associada a outra comorbidade da doença

Objective To determine the value of acromegaly screening in adult patients not reporting enlargement of the extremities, but who present arterial hypertension associated with at least one other comorbidity of the disease. Subjects and methods Patients seen by general practitioners at primary health care units were evaluated. Among the patients without extremity enlargement, those with recently diagnosed arterial hypertension associated with at least one other comorbidity were selected. Results A total of 1,209 patients were submitted to laboratory investigation. Elevated IGF‐1 was observed in 22 patients. Eighteen patients had adequate suppression of growth hormone (GH). No GH suppression was observed in four women with confirmed elevated IGF‐1. In the latter, IGF‐1 and nadir GH were only slightly elevated, magnetic resonance showed a normal pituitary, and chest and abdominal computed tomography revealed no tumor, and no intervention was performed. Conclusion In patients with arterial hypertension without known pituitary disease, acromegaly is unlikely in the absence of enlargement of the extremities. .

Objetivo Determinar o valor do rastreamento de acromegalia em pacientes adultos sem aumento de extremidades, mas com hipertensão arterial associada a pelo menos uma outra comorbidade da doença. Sujeitos e métodos Pacientes vistos por clínicos em unidades primárias de saúde foram avaliados. Entre pacientes sem aumento de extremidades, aqueles com hipertensão arterial diagnosticada recentemente e associada a pelo menos uma outra comorbidade foram selecionados. Resultados Um total de 1.209 pacientes foi submetido à investigação laboratorial. IGF‐1 foi elevado em 22 pacientes. Dezoito pacientes apresentavam supressão adequada do hormônio do crescimento (GH). Ausência de supressão do GH foi vista em quatro mulheres com IGF‐1 repetidamente elevado. Nestas, IGF‐1 e nadir do GH foram apenas discretamente aumentados, ressonância magnética revelou hipófise normal, tomografia computadorizada de tórax e abdome não revelaram tumor, e nenhuma intervenção foi realizada. Conclusão Em pacientes com hipertensão arterial sem doença hipofisária conhecida, acromegalia é improvável na ausência de aumento de extremidades. .

Frequência dos tipos de cefaleia no centro de atendimento terciário do Hospital das Clínicas da Universidade Federal de Minas Gerais / Frequency of types of headache in the tertiary care center of the Hospital das Clínicas of the Universidade Federal de Minas Gerais, MG, Brazil

OBJETIVO: Avaliar a frequência dos diferentes diagnósticos de cefaleias do Ambulatório de Cefaleias do Hospital das Clínicas da Universidade Federal de Minas Gerais (AmbCef-UFMG). MÉTODOS: Estudo transversal e descritivo com 289 pacientes atendidos consecutivamente no AmbCef-UFMG. O diagnóstico da cefaleia baseou-se nos critérios da Classificação Internacional das Cefaleias (ICDH-2004). RESULTADOS: A idade média dos pacientes foi 42,6 anos, sendo a maioria do sexo feminino (86,9%) e com menos de nove anos de escolaridade. As cefaleias primárias foram as mais comuns, sendo a migrânea encontrada em 79,8% dos casos e a cefaleia do tipo tensional (CTT), em 20,4%. Entre as secundárias, o tipo mais comum foi a cefaleia por uso excessivo de analgésicos (16,6%), seguido de casos menos comuns como a hipertensão intracraniana idiopática. A cefaleia crônica diária (CCD) esteve presente em 31,8% dos casos. CONCLUSÃO: Este estudo confirma dados da literatura que mostram a migrânea como a cefaleia mais comum em centros terciários. O número expressivo de casos de CCD e de uso excessivo de analgésicos indica que, desde o nível primário de atenção, os pacientes deveriam ser orientados a evitar o uso abusivo de medicação sintomática.

OBJECTIVE: To assess the frequency of different diagnoses of headaches in the Headache Outpatient Clinic of the Hospital das Clínicas of the Universidade Federal de Minas Gerais (AmbCef-UFMG). METHODS: Cross sectional study with 289 patients consecutively attended to at AmbCef-UFMG. Headaches were diagnosed based on the criteria established by the International Classification of Headache Disorders (ICDH-2004). RESULTS: The average age of patients was 42.6 years, mostly women (86.9%) with less than nine years of education. Primary headaches were the most common type, with migraine found in 79.8% of cases, and tension-type headache (TTH) in 20.4%. Among the secondary types, the most common was headache caused by overuse of analgesics (16.6%), followed by less common types, such as idiopathic intracranial hypertension. Chronic daily headache (CDH) was found in 31.8% of cases. CONCLUSION: This study confirms literature data showing migraine as the most common headache in tertiary care centers. The expressive number of cases of CDH and headaches caused by overuse of analgesics indicates that, starting at the primary care level, patients should be advised to avoid the abuse of symptomatic drugs.

Comorbidities associated with epilepsy and headaches / Comorbidades associadas às epilepsias e cefaleias

Comorbidities are often associated with chronic neurological diseases, such as headache and epilepsy. OBJECTIVES: To identify comorbidities associated with epilepsy and headaches, and to determine possible drug interactions. METHODS: A standardized questionnaire with information about type of epilepsy/headache, medical history, and medication was administered to 80 adult subjects (40 with epilepsy and 40 with chronic headache). RESULTS: Patients with epilepsy had an average of two comorbidities and those with headache of three. For both groups, hypertension was the most prevalent. On average, patients with epilepsy were taking two antiepileptic medications and those with headache were taking only one prophylactic medication. Regarding concomitant medications, patients with epilepsy were in use, on average, of one drug and patients with headache of two. CONCLUSIONS: Patients with chronic neurological diseases, such as epilepsy and headaches, have a high number of comorbidities and they use many medications. This may contribute to poor adherence and interactions between different medications.

As comorbidades geralmente estão associadas a doenças neurológicas crônicas, tais como cefaleia e epilepsia. OBJETIVOS: Identificar comorbidades associadas à epilepsia e cefaleia e determinar as possíveis interações de drogas. MÉTODOS: Questionário padronizado com informações sobre o tipo de epilepsia/cefaleia, os antecedentes médicos e as medicações foi aplicado a 80 indivíduos adultos (40 com epilepsia e 40 com cefaleia crônica). RESULTADOS: Pacientes com epilepsia e cefaleia apresentaram uma média de duas e três comorbidades, respectivamente, sendo, para ambos, hipertensão arterial sistêmica a mais prevalente. Em média, os pacientes com epilepsia estavam em uso de duas medicações antiepilépticas; aqueles com cefaleia, uma medicação profilática. Em relação às medicações concomitantes, os pacientes com epilepsia estavam em uso, em média, de uma droga e os pacientes com cefaleia de duas. CONCLUSÕES: Pacientes com doenças neurológicas crônicas, como epilepsia e cefaleia, apresentam elevado número de comorbidades e utilizam grande número de medicações. Isso pode contribuir para diminuir a aderência ao tratamento e facilitar interações entre diversas medicações.

Prevalence and impact of headache in undergraduate students in Southern Brazil / Prevalência e impacto da cefaléia em estudantes do sul do Brasil

OBJECTIVE: To determine the prevalence, characteristics and impact of headache among university students. METHOD: The criteria established by the International Headache Society were used to define the primary headache subtypes and the Migraine Disability Assessment Questionnaire (MIDAS), to assess the disability. The students were then grouped into six categories: [1] migraine; [2] probable migraine; [3] tension-type headache; [4] probable tension-type headache; [5] non-classifiable headache; [6] no headache. RESULTS: Of all undergraduate students interviewed, 74.5 percent had at least one headache episode in the last three months. Regarding disability, there was a significant difference between the headache types (p<0.0001). In the post-hoc analysis, migraine was the headache type with most reported disability. CONCLUSION: Headache is a highly prevalent condition among the students at the University of Caxias do Sul. This disease may have a major impact on the students' lives and in some cases, ultimately lead to educational failure.

OBJETIVO: Determinar a prevalência, características e impacto da cefaléia entre estudantes universitários. MÉTODO: Foram utilizados os critérios estabelecidos pela Sociedade Internacional de Cefaléia para definir os subtipos de cefaléia e o Migraine Disability Assessment Questionnaire (MIDAS), para avaliar a incapacidade associada. Os estudantes foram classificados em seis categorias: [1] migrânea; [2] provável migrânea; [4] cefaléia do tipo tensional; [4] provável cefaléia do tipo tensional; [5] cefaléia não classificável; [6] sem cefaléia. RESULTADOS: De todos os estudantes entrevistados, 74,5 por cento tiveram pelo menos um episódio de cefaléia nos últimos três meses. Em relação à incapacidade, foi encontrada uma diferença significativa entre os tipos de cefaléia (p<0,0001). Na análise post-hoc, a migrânea foi o tipo de cefaléia mais relacionada à incapacidade. CONCLUSÃO: A cefaléia é uma condição de grande prevalência entre estudantes da Universidade de Caxias do Sul. Esta doença pode ter um grande impacto na vida dos estudantes e, em alguns casos, levar a um pior desempenho acadêmico.

Prevalence of parafunctional habits and temporomandibular dysfunction symptoms in patients attending a tertiary headache clinic / Prevalência de hábitos parafuncionais e de sintomas de disfunção temporomandibular em pacientes atendidos em um ambulatório terciário de cefaléias

OBJETIVE: To investigate the most prevalent forms of headache in a tertiary outpatient service, and to assess the frequency of associated parafunctional habits and temporomandibular dysfunction symptoms (TMD). METHOD: All new patients referred to the Headache Outpatient Service in UNIMES during 2008 were prospectively assessed by the neurologist and the dental surgeon. RESULTS: Eighty new patients were assessed; chronic migraine and episodic migraine without aura were the most prevalent conditions, accounting for 66.3 percent of all cases. There was significantly higher use of analgesics/days for the chronic migraine patients. The prevalence of parafunctional habits was 47.5 percent and the prevalence of TMD symptoms was 35 percent. CONCLUSION: The high prevalence of primary headaches, parafunctional habits and TMD symptoms and the inadequate use of analgesic drugs suggest that primary healthcare units need further training in the field of headache and orofacial pain.

OBJETIVO: Investigar as formas prevalentes de cefaléia em um ambulatório terciário e analisar a frequência de hábitos parafuncionais e de sintomas de disfunção temporomandibular (DTM) associados. MÉTODO: Todos os pacientes novos encaminhados ao Serviço de Cefaléias da UNIMES durante 2008 foram avaliados de forma prospectiva pelo neurologista e pelo cirurgião dentista. RESULTADOS: Oitenta pacientes novos foram avaliados; enxaqueca crônica e enxaqueca episódica sem aura foram as condições mais prevalentes, perfazendo 66,3 por cento de todos os casos. Houve uso significativamente alto de analgésicos/dias pelos pacientes com enxaqueca crônica. A prevalência de hábitos parafuncionais foi 47,5 por cento e a prevalência de sintomas de DTM foi 35 por cento. CONCLUSÃO: A alta prevalência de cefaléias primárias, hábitos parafuncionais, sintomas de DTM e o uso inadequado de drogas analgésicas sugerem que as unidades básicas de saúde necessitam maior treinamento no campo da cefaléia e da dor orofacial.

Childhood headache syndromes [part II]

Headache is one of the most common reason that children are referred to the Pecliatric Neurology Services. It is said that ten percent of children aged 5 to 15 years have migraine. Subsequently, it is essential for clinician to have a through, comprehensive and systematic approach to the evaluation and management of the child or adolescent who complains of headache. This writing aims to explore the symptoms of headache, its epidemiology, classification, appropriate evaluation, differential diagnosis and management. Headaches are divided into primary and secondary categories. Migraine and tension type headaches are prototype of primary headaches without underlying pathology. On the other hand, the type of headache which stems from organic diseases such as: brain tumor, increased intracranial pressure, systemic disease, drug toxicity, ear-nose and throat problems are considered secondary. On the whole, the majority of children with primary headache have two patterns of headache. One is a chronic low-grade and the other is an intermittent disabling headache. The cause of the former is either caffeine or analgesic abuse, and the latter is predominantly migraine. Traditionally, if a child presents himself with chief complain of headache, care taker physician begins with history taking followed by thorough physical and neurological examinations. In the majority of the cases, this initial process leads to a diagnosis or indicate the need for further testing. Once the diagnosis is made, a management program can be put into place

Dolor crónico en hemodializados: prevalencia, severidad y estrategias de afrontamiento / Chronic pain in hemodialysis patients: prevalence, severity and coping strategies

El dolor es un aspecto relevante y escasamente estudiado en los pacientes hemodializados. Las estrategias de afrontamiento son vitales para enfrentar el dolor. Se evaluó la prevalencia y severidad del dolor crónico, comorbilidad y estrategias de afrontamiento en pacientes en Hemodiálisis del Hospital Clínico de la Pontificia Universidad Católica de Chile. Para ello, se aplicó la Versión Corta de McGill para dolor(SF-MPQ), con Escala Analógica Visual (VAS) y el Cuestionario para Estrategias de Afrontamiento al Dolor (CAD) a 39 mujeres y 51 hombres, conformándose tres grupos según percentiles de edad. Para el análisis se empleó el SPSS versión 16 para Windows. La prevalencia de dolor crónico fue de 70 por ciento, la causa más frecuente fue el musculoesquelético, con 60,31 por ciento. La severidad no tuvo relación con las causas. Para VAS, el promedio fue 6,92 cms y presentó correlaciones altas con las dimensiones sensorial, afectiva y total. El 39,68 por ciento experimentó dolor moderado y el 53,96 por ciento, severo. La media para Pain Rating Index (PRI) fue 16,68 (Dt. 8,949) y para el Present PAin Intensive (PPI) 0,81 (Dt. 0,998). Las mujeres presentaron puntuaciones superiores para ambas dimensiones, más altas en el grupo entre 45-70 años. El análisis multivariado para dolor y comorbilidad mostró independencia con hipertensión y no significación para diabetes. La estrategia de afrontamiento mas empleada fue autoafirmación (media 16,82 por ciento), seguida de búsqueda de información (14,42 por ciento) y distracción (11,77 por ciento). La catarsis es la menos utilizada. En conjunto, las dimensiones del afrontaiento, hombres y mujeres se comportan diferente, básicamente en religión y catarsis, con valores superiores en mujeres, pero no en cuanto a grupos de edad. Por la elevada prevalencia, severidad y el tipo de afrontamiento, el dolor y la psicoterapia para su enfrentamiento deben incluirse en el manejo de pacientes hemdializados.

Prevalence of migraine and non-migraine headache among high school students at the National Guard Housing in Riyadh, Saudi Arabia

To determine the prevalence of headache and migraine, to identify symptoms that accompany headache attack, and to determine the possible effect of headache on school attendance, among high school students. A cross-sectional, questionnaire-based study of secondary school students of the National Guard Housing in Riyadh, Kingdom of Saudi Arabia, was executed during the academic year of 2002 and 2003. A sample of 1750 students was included from 4 schools by systemic random sampling for each school. The questionnaire included demographic data. The second part includes specific questions on headache, and whether there had been headache in the year preceding the survey, type of headache, and its diagnosis according to International Headache Society IHS criteria. Possible effect of headache on school attendance was recorded. Approximately one-third of the entire study sample had recurrent headache episodes not related to febrile illness in the year preceding the survey. Female students showed a significantly higher prevalence than males of migraine, as well as non-migraine headache, with the least prevalence among the younger students of ages 16-17 years. More than one-third of all students were absent from school due to headache. Recurrent headache is prevalent among the high school students, and more among female students. These prevalence rates are comparable with those reported elsewhere. Health education sessions at schools, primary care clinics, and the society in general are recommended to increase awareness for this common adolescent-s neurological problem

Chronic daily headache: medications overuse and psychiatric morbidity

The objectives of the study were: [i] To assess the frequency of different chronic daily headaches in patients using ICHD-2 criteria [ii] To find out the frequency and type of medication overuse and psychiatric morbidity in chronic daily headache subjects. Cross sectional observational study. The study was conducted in the psychiatry outpatient department of a teaching medical institution during January to September 2005. Subjects suffering from chronic daily headache were recruited from a specialized headache clinic in a tertiary care hospital's Psychiatry department. The diagnoses were made according to ICHD-2. Medication overuse was defined according to ICHD-2 criteria and psychiatric illness was diagnosed following ICD-10 criteria in CDH patients. In subjects fulfilling the criteria for 'medication overuse', the culprit drug was stopped immediately and prophylactic therapy was started. Frequency of chronic daily headache was 37% in this sample. Females outnumbered males [1:1.52] and formed higher number of migraine cases [p=0.02]. Tension Type Headache [TTH] was most frequent headache [48.5%]. According to ICHD-2 criteria, probable medication overuse headache could be diagnosed in all patients, which precluded the diagnosis of chronic migraine and chronic TTH. Psychiatric morbidity was seen in 70.3% subjects and mild to moderate depression was the most common illness [53%]. TTH subjects showed predisposition for anxiety disorders [OR= 6.41; p= 0.004]. TTH is the most common subtype of CDH when ICHD-2 is followed. Medication overuse is common in this group of patients and these probably should be discontinued according to substance dependence de-addiction model for better compliance, and even more slowly in subjects with chronic migraine headache. Psychiatric morbidity is prevalent in CDH patients and requires special attention

Headaches during pregnancy in women with a prior history of menstrual headaches

OBJETIVO: Avaliar a presença de cefaléia relacionada ao ciclo menstrual, antes da gestação, classificá-las, segundo os critérios da Sociedade Internacional de Cefaleia (SIC) de 2004, e estudar o comportamento (freqüência e intensidade) dessas cefaléias pré-existentes à gestação durante os trimestres gestacionais.MÉTODO: Foram estudados 1101 mulheres grávidas (12 a 45 anos) entrevistadas através de questionário semi-estruturado durante o primeiro, o segundo e o terceiro trimestres gestacionais e imediatamente após o parto. Todas as entrevistas foram conduzidas por um dos autores, usando a classificação da SIC, 2004. RESULTADOS: De 1101 mulheres, 1029 apresentavam cefaléia antes da gestação, sendo possível estudar o comportamento das cefaléias durante os trimestres gestacionais em 993. Apresentaram cefaléia relacionada à menstruação 360/993 mulheres. Encontramos migrânea em, 332/360 (92,22%) mulheres com cefaléia menstrual e em 516/633 (81,51%) mulheres com cefaléia não menstrual antes da gestação. A maioria das mulheres com migrânea menstrual apresentou melhora da cefaléia durante a gestação (62,22% no primeiro trimestre; 74,17% no segundo trimestre; 77.78% no terceiro trimestre). CONCLUSÃO: A maioria das mulheres grávidas, com cefaléia tanto menstrual quanto não menstrual, antes da gestação, apresentou migrânea, sendo que a mesma melhora ou desaparece durante a gestação. Mulheres com cefaléia não menstrual antes da gestação melhoram em proporção menor do que aquelas com cefaléia menstrual.