Relación entre oclusión, bruxismo y cefalea tensional en niños: Reporte de casos / Relation between occlusion, bruxism and tension headache in children: Case report

La cefalea es uno de los motivos de consulta más frecuente en nuestros pacientes, presentando una alta prevalencia en niños en edades escolares y adolescentes. El objetivo de este reporte de casos es describir casos de niños entre 6 y 13 años, quienes presentan cefalea tensional crónica. Al examen clínico se observa maloclusión, dolor a la palpación de músculos masticatorios y bruxismo. Todos los pacientes tenían características comunes en su personalidad, siendo perfeccionistas, estudiosos y preocupados. La terapia que se les realizó fue la confección de una férula oclusal orgánica, construida en relación céntrica, y se controlaron cada 15 días. Luego de un mes de tratamiento los pacientes mostraron una remisión total de las cefaleas y de la contractura muscular, llegando a la conclusión de que los planos de relajación sirven para aliviar la cefalea tensional en niños con bruxismo y maloclusión, siempre realizando un correcto diagnóstico previo.

Headache is one of the most frequent reasons for consultation in our patients, with a high prevalence in school-age children of and adolescents. The objective of this case report is to present cases of children between 6 and 13 years old, who have chronic tension headache. On clinical examination, malocclusion, palpation of masticatory muscles and bruxism were observed. All the patients had common characteristics in their personality, being perfectionists, studious and concerned. The therapy consisted of the preparation of an occlusal splint, with partial or total coverage depending on the case, and they were monitored every 15 days. After one month of treatment, the patients showed a total remission of headaches and muscle contracture, concluding that occlusal splints can relieve tension headache in children with bruxism and malocclusion, always with a correct previous diagnosis.

Primary headache and myofascial pain: a data based study / Cefaleia primária e dor miofascial: um estudo baseado em dados

Aim: This study aimed to evaluate the relationship be-tween the presence of primary headaches and myofascial pain in orofacial patients. Materials and methods: Six hundred and ninety-nine records of patients seeking treatment in a specialized orofacial pain clinic were assessed. The primary diagnostic categories of heada-che and myofascial pain were recorded. Data analyses were carried out by Pearson Chi-square and Logistic Regression, with a p-value of 0.05. Results: Average age of patients was 34.6 years. Females constituted 82.8% of the sample. A relationship between the presence of tension-type headache and myofascial pain was found (p=0.00); however, this relationship was not found for the presence of migraine and myofascial pain (p>0.05). Discussion: Tension-type headaches may be triggered or perpetuated by trigger points in orofacial structures. Conclusion: It can be concluded that trigger points in myofascial pain patients can play an important role in the genesis of tension-type headache.

Objetivo: Este estudo avaliou a relação entre a presença de cefaleia primária e dor miofascial em pacientes orofaciais. Materiais e métodos: Foram avaliados 699 prontuários de pacientes que buscavam atendimento em clínica especiali-zada em dor orofacial. As categorias diagnósticas primárias de cefaleia e dor miofascial foram registradas. A análise dos dados foi realizada pelo Qui-quadrado de Pearson e Regressão Logística, com valor de p=0,05. Resultados: A idade média dos pacientes foi de 34,6 anos. O sexo feminino constituiu 82,8% da amostra. Foi encontrada relação entre a presença de cefaleia do tipo tensional e dor miofascial (p = 0,00); en-tretanto, essa relação não foi encontrada para a presença de enxaqueca e dor miofascial (p> 0,05). Discussão: As cefaleias primárias do tipo tensionais podem ser desencadeadas ou perpetuadas por pontos-gatilhos nas estruturas orofaciais. Conclusão: Pode-se concluir que os pontos-gatilhos em pacientes com dor miofascial podem desempenhar um papel importante na gênese da cefaleia do tipo tensional.

Comparando o efeito da liberação miofascial e técnica de energia muscular no ângulo craniovertebral e cefaleia em pacientes com cefaleia tensional / Comparing the effect of myofascial release and muscle energy technique on craniovertebral angle and headache in tension-type headache patients

INTRODUÇÃO: Cefaleias tensionais podem ser induzidas pela postura da cabeça para frente, e há uma grande quantidade de evidências disponíveis para o manejo de cefaleias crônicas. Os dados corroboram uso de abordagens de terapia manual para gerenciar dores de cabeça do tipo tensional. Devido à postura anterior da cabeça, a região do músculo suboccipital torna-se curta, resultando em aumento da lordose e dor no pescoço. Pacientes com uma postura de cabeça ainda mais para frente têm um ângulo craniovertebral menor, o que, por sua vez, causa cefaleia do tipo tensional. OBJETIVO: O objetivo deste estudo é comparar os efeitos da terapia de liberação miofascial (LMF) e da técnica de energia muscular (TEM) com exercícios gerais do pescoço no ângulo crânio-vertebral e na cefaleia em pacientes com cefaleia do tipo tensional. MÉTODOS: No total, 75 indivíduos com cefaleia tensional e sensibilidade muscular suboccipital foram recrutados e randomizados cegamente em três grupos: o grupo LMF, o grupo TEM e o grupo controle (25 indivíduos em cada grupo). Um ângulo pré-crânio vertebral foi obtido por método fotográfico e um questionário de índice de incapacidade pré-cefaleia foi preenchido. O grupo LMF recebeu liberação crânio-basal na região suboccipital com exercícios de pescoço; o grupo TEM recebeu relaxamento pós-isométrico na região suboccipital com exercícios, e o grupo controle recebeu apenas exercícios por 2 semanas. Após duas semanas, o ângulo pós-craniano e o questionário de cefaleia foram coletados e medidos. RESULTADOS: O ângulo crânio-vertebral e o índice de cefaleia mostraram melhora significativa nos grupos TEM e LMF. Não houve diferença significativa quando os grupos TEM e LMF foram comparados. Quando comparados com o grupo controle, tanto o TEM quanto o LMF apresentaram aumento significativo do ângulo crânio-vertebral. Houve melhora significativa no índice de cefaleia após TEM, LMF ou exercício de rotina no pescoço. CONCLUSÃO: Comparado ao grupo controle, o LMF apresenta melhores resultados do que o TEM no ângulo crânio-vertebral e cefaleia.

INTRODUCTION: Tension headaches can be induced by forward head posture, and there is a wealth of evidence available for managing chronic headaches. The data support the use of manual therapy approaches to manage tension-type headaches. Because of the forward head posture, the suboccipital muscle region becomes short, resulting in an increase in lordosis and neck pain. Patients with an even more forward head posture have a smaller craniovertebral angle, which in turn causes tension-type headache. OBJECTIVE: This study aims to compare the effects of Myofascial release therapy (MFR) and Muscle energy technique (MET) with general neck exercises on the craniovertebral angle and headache in tension-type headache patients. METHODS: In total, 75 subjects with tension-type headache and suboccipital muscle tenderness were recruited and randomized blindly into three groups: the MFR group, the MET group, and the control group (25 subjects in each group). A pre-craniovertebral angle was taken by photographic method, and a pre-headache disability index questionnaire was filled in. The MFR group receives cranio-basal release in the suboccipital region with neck exercises, the MET group receives post­isometric relaxation in the suboccipital region with exercises, and the control group receives only exercises for two weeks. After two weeks, the postcranial angle and the headache questionnaire were taken and measured. RESULTS: Craniovertebral angle and headache index showed significant improvement in both the MET and MFR groups. There was no significant difference when MET and MFR groups were compared. When compared with the control group, both MET and MFR showed a significant increase in craniovertebral angle. There was a significant improvement in the headache index following MET, MFR, or routine neck exercise. CONCLUSION: Compared to the control group, MFR shows better results than MET on craniovertebral angle and headache.

Falta de rigor científico de dos investigaciones de series de casos sobre diplomáticos estadounidenses en La Habana / Lack of scientific consistency in two investigations of case series of United States diplomats in Havana

Introducción: Con el propósito de justificar la decisión diplomática de los Estados Unidos, se publicaron dos artículos científicos en revistas médicas que intentan sostener la idea de que en La Habana hubo un ataque dirigido a personal de la embajada estadounidense. Objetivo: Demostrar la falta de rigor científico en dos investigaciones de series de casos no independientes sobre los síntomas de salud de diplomáticos de los Estados Unidos en La Habana. Método: Se realiza un análisis documental de dos publicaciones de series de casos. Se evalúan hipótesis diagnósticas. Resultados: Existe superposición amplia entre las dos series en cuanto a pacientes compartidos y en contraste se presentan algunas diferencias en los datos clínicos que superan lo esperado. Conclusiones: En ambas publicaciones se desaprovecha la riqueza semiográfica de síntomas y la información psicosocial. Se enfatiza más en argumentos asociados al fetichismo de la tecnología expresado en la interpretación de hallazgos inespecíficos. El análisis de datos clínicos permitió ver que se trata de un grupo heterogéneo de personas cuyas quejas de salud han sido reunidas por la interacción de otros factores psicosociales contextuales(AU)

Introduction: In order to justify the diplomatic decision of the United States, two scientific articles were published in medical journals that attempt to support the idea that, in Havana, there was an attack aimed at US embassy personnel. Objective: To prove the lack of scientific consistency in two investigations of non-independent case series on the health symptoms of United States diplomats in Havana. Method: A documentary analysis of two publications of case series is carried out. Diagnostic hypotheses are evaluated. Results: There is wide overlap between the two series in terms of shared patients and in contrast there are some differences in the clinical data that exceed what was expected. Conclusions: In both publications the semiographic wealth of symptoms and psychosocial information are wasted. More emphasis is placed on arguments associated with the fetishism of technology expressed in the interpretation of nonspecific findings. The analysis of clinical data allowed us to see that it is a heterogeneous group of people whose health complaints have been brought together by the interaction of other contextual psychosocial factors(AU)

Valoración del trabajo, exigencias y daños a la salud en académicos universitarios argentinos / Assessment of jobs, job demands and health damage in Argentine university

El objetivo de este estudio fue analizar la relación que hay entre la manera en que los académicos de la Universidad Nacional de Mar del Plata perciben el contenido del trabajo, las exigencias que demandan las actividades que deben realizar y las consecuencias de éstas sobre su salud física y mental. Se realizó un estudio transversal y observacional, con una muestra aleatoria de 151 profesores de 9 unidades académicas de la Universidad de Mar del Plata, en Argentina. Se utilizó una encuesta de tipo epidemiológico para recabar información demográfica, condiciones y valoración del trabajo, exigencias y daños a la salud. Los datos se analizaron con el programa estadístico Jump statistical program, versión 9, y se controló edad, género y antigüedad; estableciendo el nivel de significancia en p<0.05 y un intervalo de confianza del 95%.La percepción sobre el trabajo es muy satisfactoria y las exigencias más importantes fueron realizar trabajo pendiente en horas o días de descanso (79%), cubrir cursos, clases, artículos y conferencias (75%), permanecer sentado la mayor parte del tiempo (65%) y realizar tareas minuciosas (64%). Se identificó que casi la mitad de la población sufre de fatiga (46%) y trastornos musculoesqueléticos (45%), mientras que alrededor del 40% padece estrés, trastornos del sueño, cefalea, disfonía y ansiedad(AU)

The objective of this study was to evaluate how academic staff at the Mar del Plata National University in Argentina perceive the content, demands and activities of their jobs, and the consequences on their physical and mental health. A cross-sectional, observational study was carried out on a random sample of 151 professors from 9 academic units at this university. An epidemiological survey was used to collect self- reported information on demographics, job characteristics and demands and adverse health effects. The data were analyzed with the Jump™ Version 9 statistical package, controlling for age, gender and seniority. The significance level was set at p < 0.05, and 95% confidence intervals were calculated. Overall, respondents were very satisfied with their jobs. The most common job demands were working in off hours or off days, (79%), teaching courses and classes, writing articles and attending talks (75%), remaining seated most of the time (65%) and carrying out detailed tasks (64%). Almost half of the respondents reported suffering from fatigue (46%) and musculoskeletal disorders (45%), while around 40% suffered from stress, sleep disorders, headaches, dysphonia or anxiety(AU)

The Effect of Body Awareness Therapy on Pain, Fatigue and Health-related Quality of Life in Female Patients with Tension-type Headaches and Migraine

ABSTRACT Objective: To examine the effect of body awareness therapy on pain, fatigue and quality of life in women with tension-type headaches (TTH) and migraine. Methods: Socio-demographic features of patients who are included in the study were recorded. Visual analogue scale was used for pain and fatigue severity scale was used for fatigue, Nottingham health profile (NHP) was used for life quality related to health. Following the first evaluation, body awareness therapy (BAT) was applied to patients for six weeks per 60 minutes in three sessions. Results: Among patients with TTH, there was statistical difference between visual analogue scale, fatigue severity scale and total NHP score before and after BAT (p < 0.05). Among patients with migraine, there was statistical difference between total NHP score before and after BAT (p < 0.05). Conclusion: Body awareness therapy is an effective method that can be used in order to increase life quality related to health among female patients with TTH and migraine.

Análise da terapia craniossacral na disfunção temporomandibular associada a cefaleia tensional / Analysis of craniosacral therapy in temporomandibular dysfunction associated with tensional headache

Resumo Introdução Ocorrendo de forma branda e não invasiva, a terapia craniossacral é uma técnica de manipulação na qual o terapeuta exerce leve pressão sobre estrutura óssea, sendo utilizada como tratamento para diversos problemas de saúde, como cefaleias e DTM. Objetivo Analisar os efeitos da terapia craniossacral em indivíduos com disfunção temporomandibular associada a cefaleia do tipo tensional. Material e método Estudo descritivo, intervencionista com abordagem quantitativa, realizado no núcleo de atenção médica integrado, no período de fevereiro a setembro de 2018. Foram inclusos no estudo indivíduos com disfunção temporomandibular e que apresentaram cefaleia dentre os sintomas. Foram exclusos aqueles que não compareceram ao atendimento ou não apresentaram a sintomatologia. Previamente, foi realizada uma avaliação para identificar a dor na crise de cefaleia, a mensuração da amplitude de movimento mandibular e a palpação dos músculos da mastigação, para classificar a dor em leve, moderada ou forte. Após oito atendimentos, sendo duas vezes por semana com duração de 15 minutos cada, todos foram reavaliados. Resultado Participaram do estudo 31 indivíduos, sendo 90,3% do sexo feminino. Na classificação do RDC/TMD, houve prevalência dos grupos G1 e G1G3. Quanto a mobilidade mandibular, houve ganho para os movimentos de abertura, com 45,6 mm (±7,5) antes da terapia e, na reavaliação, 47,4 mm (±8,4); desvios laterais antes da terapia (lado direito - 7,0 ±2,8) e (lado esquerdo - 7,7±3,0), e após a terapia (8,0±3,0) e (8,6±2,9), respectivamente; o movimento de protusão, antes com média 5,03 ±2,5 e, na reavaliação, com 4,8 ±1,9. Na palpação muscular, destacamos redução do quadro álgico no músculo pterigoideo medial com média 2,2 (±1,05) antes da terapia e 1,5 (±1,02) após a terapia. Conclusão Concluímos que a terapia se mostrou eficaz no tratamento de pacientes com disfunção temporomandibular associada a cefaleia do tipo tensional.

Abstract Introduction Occurring in a mild and non-invasive way, craniosacra therapy is a manipulation technique that the therapist exerts light pressure on the bone structure, being used as a treatment for several health problems, such as headaches and TMD. Objective To analyze the effects of craniosacra therapy in individuals with temporomandibular disorders associated with tension-type headache. Material and method Descriptive, interventional study with a quantitative approach, carried out in the integrated medical care center from February to September 2018. Individuals with temporomandibular disorder and who presented headache among the symptoms were included in the study. And those who did not attend the service or did not present symptoms were excluded. Previously, an assessment was carried out to identify pain during headache attacks, measurement of mandibular range of motion and palpation of mastication muscles, to quantify pain as mild, moderate and severe. After 8 consultations, twice a week lasting 15 minutes each, all were reassessed. Result 31 individuals participated in the study, being 90.3% female. In the classification of the RDC/TMD, there was a prevalence of groups G1 and G1G3. Regarding mandibular mobility, there was a gain for opening movements with 45.6mm (±7.5) before therapy and 47.4mm (±8.4) in the reassessment; lateral deviations before therapy (right side - 7.0 ±2.8) and (left side - 7.7±3.0) and after (8.0±3.0) and (8.6±2.9); and the protrusion movement before with an average of 5.03 ± 2.5 and in the reassessment with 4.8 ± 1.9. And in muscle palpation, we highlight a reduction in pain in the medial pterygoid muscle with a mean of 2.2 (±1.05) before therapy and 1.5 (±1.02) after. Conclusion We conclude that the therapy has been shown to be effective in treating patients with temporomandibular disorders associated with tension-type headache.

Evidence mapping of clinical research on 28 Chinese patent medicines for tension-type headache / 中国中药杂志

In this study, the evidence mapping methodology was used to systematically retrieve and sort out the clinical research evidence of Chinese patent medicines in the treatment of tension-type headache(TTH), and to understand the distribution of evidence in this field and the basis and quality of evidence. Chinese and English articles on the 28 Chinese patent medicines for TTH, which were recorded in National Essential Medicines List(2018), Medicine Catalogue for National Basic Medical Insurance, Work Injury Insurance, and Maternity Insurance(2020), and Chinese Pharmacopoeia(2020), were retrieved from China National Knowledge Infrastructure(CNKI), Wanfang, VIP, China Biology Medicine disc(CBMdisc), PubMed, EMbase, and Cochrane Library from the establishment to June 2021, followed by descriptive analysis. Then, tables and bubble charts were plotted to analyze the distribution characteristics of evidence. A total of 129 eligible articles were yielded: 126 randomized/non-randomized controlled trials, and 3 systematic reviews. The functions, indications, and composition of the 28 medicines, as well as the proportion of related articles, publication trends, intervention measures, and outcome indicators were compared and analyzed. The results showed that the 28 Chinese patent medicines, composed of 128 Chinese medicinals, can be classified into six categories in terms of function: reinforcing healthy Qi, tranquilizing mind, dispelling stasis, regulating Qi, treating wind, and resuscitating. There are ongoing efforts to study the treatment of TTH with Chinese patent medicine in China, despite of little evidence. The clinical positioning of Chinese patent medicine for TTH is not clear, and clinical research fails to highlight the advantages of Chinese medicine. In addition, the outcome indicators have not been standardized and unified, and there is a lack of evidence on the long-term efficacy of Chinese patent medicine for TTH. This study is the first exploratory application of evidence maps to compare the characteristics and clinical research progress of 28 Chinese patent medicines for TTH, which can provide a reference for research on the optimization of Chinese medicine strategies for TTH.

Systematic review and Meta-analysis of efficacy and safety of Toutongning Capsules in treatment of tension-type headache / 中国中药杂志

This study aims to systematically evaluate the clinical efficacy and safety of Toutongning Capsules in the treatment of tension-type headache(TTH), so as to provide a corresponding basis for clinical treatment. Eight commonly used medical research databases and two clinical trial registration systems were retrieved with the time interval from the establishment of the database or system to November 2020. The randomized controlled trials of Toutongning Capsules in the treatment of TTH were screened out according to the pre-set criteria. The quality of the included papers was evaluated by the bias risk assessment tool in Cochrane Reviewers Handbook 6.1 and the data were statistically analyzed by RevMan v5.4 provided by Cochrane collaboration. A total of 13 studies were included and the quality of methodology was generally low. Meta-analysis showed that Toutongning Capsules assisted with western medicine therapy can effectively reduce the pain intensity(MD_(VAS)=-1.94,95%CI[-2.50,-1.38],P<0.000 01;MD_(NRS)=-0.83,95%CI[-0.86,-0.80],P<0.000 01), headache duration(SMD=-0.98,95%CI[-1.17,-0.79],P<0.000 01), headache frequency(MD=-1.01,95%CI[-1.16,-0.85],P<0.000 01), headache index(MD=-11.13,95%CI[-12.10,-10.16],P<0.000 01), anxiety and depression scale score(MD_(HAMA)=-4.02,95%CI[-6.58,-1.46],P=0.002;MD_(HAMD)=-2.67,95%CI[-4.04,-1.29],P=0.000 1), while Toutongning Capsules as monotherapy only reduced the headache score(MD=-2.24,95%CI[-2.97,-1.51],P<0.000 01). The available clinical studies demonstrate that Toutongning Capsules combined with western medicine in the treatment of TTH can improve the related outcome indicators, but the clinical safety and efficacy of Toutongning Capsules alone remain unclear. Due to the small number and low quality of the included studies, large-sample, multi-center, high-quality and strictly designed randomized controlled trials are still needed to verify the clinical efficacy in the future.

Systematic review and Meta-analysis of efficacy and safety of gastrodin in treatment of tension-type headache / 中国中药杂志

The efficacy of gastrodin as a Chinese herbal medicine extract in the treatment of tension-type headache has been confirmed. This paper systematically reviewed the efficacy and safety of gastrodin in the treatment of tension-type headache, aiming to provide a new choice for the treatment of this disease. In this study, four Chinese databases, four English databases and two trial registries were searched from the date of establishment to September 2020. The related randomized controlled trials(RCTs) were screened out according to the predetermined criteria. The bias risk assessment tool developed by Cochrane collaboration was used to evaluate the quality of the reports. RevMan 5.4.1 was used for Meta-analysis, and GRADE system for the evidence-based evaluation on the quality of outcome indicators. A total of 177 articles were retrieved and 8 articles were finally included for analysis, with a total sample size of 1 091 cases, which included 565 cases in the treatment group and 526 cases in the control group. The overall quality of included stu-dies was not high. The results of Meta-analysis are as follows:(1)In terms of headache frequency, gastrodin group was better than wes-tern medicine group(MD=-2.90, 95%CI[-3.76,-2.03], P<0.000 01).(2)In terms of number of abnormal blood vessels in TCD, gastrodin group was better than western medicine group(MD=-88.96, 95%CI[-102.36,-75.55], P<0.000 01).(3)In terms of effective rate, gastrodin group was better than western medicine group(RR=1.47, 95%CI[1.29, 1.68], P<0.000 01). The results of subgroup analysis are as follows:(1)Effective rate based on age, for the patients upper age limit 40-46 years old, gastro-din group was better than western medicine group(RR=1.69, 95%CI[1.50, 1.90], P<0.000 01); for the patients upper age limit 55-60 years old, gastrodin group was better than western medicine group(RR=1.27, 95%CI[1.16, 1.38], P<0.000 01).(2)Effective rate based on dosage form, both the gastrodin capsules and injection groups were better than western medicine group(RR_(capsules)=1.42, 95%CI[1.08, 1.88], P=0.01; RR_(injection)=1.50, 95%CI[1.26, 1.77], P<0.000 01). GRADE evaluation showed that the above outcomes had low quality of evidence. Only one article detailed the occurrence of adverse reactions and thus the present study cannot make a positive conclusion on the safety of gastrodin in the treatment of tension-type headache. The small number and low quality of the included reports affected the reliability of the results. In the future, more high-quality randomized controlled trails are needed to improve the evaluation on the efficacy and safety of gastrodin in the treatment of tension-type headache.

Outcome indicators in randomized controlled trials on traditional Chinese medicine intervention for tension-type headache in recent five years / 中国中药杂志

To evaluate the application of outcome indicators in randomized controlled trials(RCTs) concerning the treatment of tension-type headache(TTH) with traditional Chinese medicine(TCM) in recent five years, so as to provide a basis for the study of core outcome set(COS) for TCM intervention in TTH. The RCTs on TCM treatment of TTH in recent five years were systematically retrieved from CNKI, Wanfang, VIP, CBM, EMbase, PubMed, Cochrane Library, Web of Science, ClinicalTrials.gov and China Clinical Trial Registry. After literature screening, data extraction and evaluation of the risk of bias, the outcome indicators in the included RCTs were subjected to qualitative analysis. The preliminary search yielded 19 042 articles, and 10 983 were left after the elimination of duplication. Finally, 52 RCTs(48 in Chinese and 4 in English) were included for qualitative analysis. The outcome indicators of RCTs included in this study were classified into seven domains: TCM syndrome, symptom and sign, physical and chemical detection, quality of life, long-term prognosis, economic evaluation, and safety event. The findings demonstrated that headache characteristic index in the symptom and sign domain was the index with the highest reporting frequency and reporting rate. Seventeen RCTs used TCM syndrome score as the outcome indicator. Further analysis revealed that there existed such problems in research design as non-distinction between primary and secondary outcome indicators, great difference in the adopted measurement tools for outcome indicators, and the neglect of measurement time of outcome indicators. Moreover, the syndrome indicators reflecting TCM advantages, objective evaluation indicators, safety and health-economic indicators were lacking. These limitations have affected the quality and reliability of RCTs on TTH treatment with TCM. It is suggested that the efficacy and characteristics of TCM should be combined into current clinical research, and the COS in RCTs regarding TCM treatment of TTH should be established according to internationally recognized standard procedures.

Primary headache subtypes and thyroid dysfunction: Is there any association? / Subtipos de cefaleia primária e disfunção tireoidiana: existe alguma associação?

ABSTRACT Background: Primary headaches, and particularly migraine and tension-type headache (TTH) as well as hypothyroidism are common medical conditions. To date, numerous studies have suggested a possible bidirectional relationship between migraine and hypothyroidism, although certain studies had contradictory results. Objective: To investigate whether there is any association between primary headache subtypes and thyroid disorders. Methods: A retrospective study of consecutive patients aged ≥18 years referred to the Headache Outpatient Clinic of Aeginition Hospital and diagnosed with primary headache and any thyroid disorder. Results: Out of 427 patients (males/females=76/351), 253 (59.3%) were diagnosed with migraine without aura, 53 (12.4%) with TTH, 49 (11.5%) with migraine with aura, 29 (6.8%) with medication-overuse headache, 23 (5.4%) with mixed-type headache (migraine with/without aura and TTH), nine (2.1%) with cluster headache, and 11 (2.6%) with other types of primary headaches. The prevalence of any type of thyroid disorder was 20.8% (89/427 patients). In the total sample, 27 patients (6.3%) reported hypothyroidism, 18 (4.2%) unspecified thyroidopathy, 14 (3.3%) thyroid nodules, 12 (2.8%) Hashimoto thyroiditis, 12 (2.8%) thyroidectomy, three (0.7%) thyroid goiter, and three (0.7%) hyperthyroidism. Further statistical analysis between categorical variables did not reveal any significant association between headache subtypes and thyroid dysfunction. Conclusions: No specific association was found between primary headache subtypes and specific thyroid disorder. However, a high prevalence of thyroid dysfunction in general and specifically hypothyroidism was demonstrated among patients with primary headaches, which lays the foundation for further clarification in prospective longitudinal studies.

RESUMO Introdução: Cefaleias primárias e, particularmente, enxaqueca e cefaleia do tipo tensional (CTT), bem como hipotiroidismo, constituem condições médicas comuns. Até o momento, vários estudos sugeriram uma possível relação bidirecional entre enxaqueca e hipotireoidismo, embora alguns estudos tenham resultados contraditórios. Objetivo: Investigar se existe associação entre subtipos de cefaleia primária e distúrbios da tireoide. Métodos: Estudo retrospectivo de pacientes consecutivos com idade ≥18 anos encaminhados ao Ambulatório de Cefaleia do Hospital Aeginition, com diagnóstico de cefaleia primária e qualquer distúrbio da tireoide. Resultados: De 427 pacientes (homens/mulheres=76/351), 253 pacientes (59,3%) foram diagnosticados com enxaqueca sem aura, 53 (12,4%) com CTT, 49 (11,5%) com enxaqueca com aura, 29 (6,8 %) com cefaleia por uso excessivo de medicamentos, 23 (5,4%) com cefaleia mista (enxaqueca com/sem aura e CTT), nove (2,1%) com cefaleia em salvas e 11 (2,6%) com outros tipos de cefaleias primárias. A prevalência de qualquer tipo de distúrbio tireoidiano foi de 20,8% (89/427 pacientes). Na amostra total, 27 pacientes (6,3%) relataram hipotireoidismo, 18 (4,2%) tireoidopatia não especificada, 14 (3,3%) nódulos de tireoide, 12 (2,8%) tireoidite de Hashimoto, 12 (2,8%) tireoidectomia, três (0,7%) bócio da tireoide e três (0,7%) hipertireoidismo. Uma análise estatística posterior entre as variáveis categóricas não revelou qualquer associação significativa entre os subtipos de cefaleia e disfunção tireoidiana. Conclusões: Não encontramos associação entre subtipos de cefaleia primária e distúrbio específico da tireoide. No entanto, foi observada prevalência elevada de disfunção tireoidiana em geral e especificamente hipotireoidismo entre pacientes com cefaleia primária, o que estabelece base para maiores esclarecimentos em estudos longitudinais prospectivos.

Efeitos da reeducação postural global na intensidade dos sintomas álgicos e equilíbrio postural em mulheres jovens com cefaleia do tipo tensional / Effects of global posture reeducation on pain and postural balance in young women with tension-type headache

Introdução: Fatores emocionais, nocicepção miofascial pericraniana e ineficácia da regulação central da dor são mecanismos relacionados à cefaleia tensional, destacando os fatores psicossociais e a sobrecarga muscular decorrente de uma postura não adequada. Objetivo: Descrever os efeitos da Reeducação Postural Global (RPG) na cefaleia tensional. Métodos: Seis mulheres (28,16 ± 7,57 anos), com classificação 2 da International Classification of Headache Disorders 3rd edition (ICHD-3) e pontuação ≥ a 50 no Headache Impact Test (HIT-6) receberam uma sessão semanal de RPG, durante 40 minutos, em 4 semanas. A avaliação estabilométrica e baropodométrica foi realizada com plataforma de pressão e avaliação da dor com a escala visual analógica. Resultados: Foi observado redução da dor (6,8 ± 1,3 vs 3 ± 0,6; p = 0,000) e do impacto da cefaleia (58,5 ± 5,2 vs 47,3 ± 6,0; p = 0,002), aumento da oscilação do centro de pressão (COP) médio lateral (0,08 ± 0,33 vs 1,50 ± 0,32 mm2; p= 0,026) e antero-posterior (0,8 ± 0,2 vs 1,3 ± 0,3 mm2; p = 0,014) e maior contato com o solo em retropé em comparação ao antepé (65,33 ± 6,37%; vs 34,66 ± 6,37 p = 0,002), que foi mantido após as atendimentos (63,0 ± 6,38% vs 37,0 ± 6,38%; p = 0,004). Conclusão: A RPG promoveu redução do impacto da cefaleia e dor e mostrou-se eficaz como um método de correção postural, visualizado pelo aumento da oscilação do centro de pressão. (AU)

Introduction: Emotional factors, pericranial myofascial nociception and ineffectiveness of central regulation of pain are mechanisms related to tension type-headache, with emphasis on psychosocial factors and muscle overload due inadequate posture. Objectives: To describe the use of Global Postural Reeducation (GPR) in tension type-headache. Methods: Six women (28.16 ± 7.57 years), classification 2 in International Classification of Headache Disorders 3rd edition (ICHD-3) and score ≥ 50 in the Headache Impact Test (HIT-6) participated in 4 sessions of GPR, for 40 minutes, once a week. Pain was evaluated by the Visual Analog Scale of Pain (VAS) and stabilometric and baropodometric evaluation were performed with pressure platform. Results: Reduction of pain (6.8 ±1,3 vs 3 ± 0.6; p = 0.000) and headache impact (58.5 ± 5.2 vs 47.3 ±6.0; p = 0.002), increase in the oscillation of the center of standardized pressure, both as sagittal (0.8 ± 0.2 vs 1.3 ± 0.3 mm2 ; p = 0.014) and frontal plane (0.08 ± 0.33 vs 1.50 ± 0.32 mm2 ; p = 0.026) were observed, as well as more hindfoot ground contact compared to forefoot (65.33 ± 6.37% vs 34.66 ± 6.37%; p = 0.002), which was maintained after the sessions (63.0 ± 6.38% vs 37.0 ± 6.38%; p = 0.004). Conclusion: The GPR technique promoted reduction on impact of headache and pain and showed to be effective as a method of postural correction, visualized by increased pressure center oscillation. (AU)

Comparison of patients with migraine and tension-type headache in terms of somatosensory amplification and health anxiety / Estudo comparativo de pacientes com enxaqueca e cefaleia do tipo tensional em relação à amplificação somatossensorial e à ansiedade associada à saúde

ABSTRACT Although it is known that anxiety and depressive disorders frequently accompany migraine and TTH, the role of somatic amplification (SSA) and health anxiety in these diseases is not adequately known. Objective: The aim of this study is to compare SSA and health anxiety in patients with migraine or TTH, and healthy controls and to investigate the relationships between SSA, health anxiety, headache characteristics, anxiety and depressive symptoms. Methods: Fifty-four migraine, 50 TTH patients from the outpatient unit of the neurology department and 53 healthy volunteers were recruited for the study. The somatosensory amplification scale (SSAS), health anxiety inventory, Beck depression (BDI) and anxiety inventory (BAI) were administered to all participants. Results: The SSAS scores were significantly higher in migraineurs compared with the healthy controls. The health anxiety scores were significantly higher in both migraine and TTH groups. The BDI and BAI scores were also significantly higher in migraine and TTH groups compared with the controls. A significant positive correlation was found between headache frequency and BAI scores, the visual analogue scale scores and SSAS and BDI scores in migraineurs. The SSAS scores were also significantly correlated with the BDI and BAI scores in both of the headache groups. A similar correlation was determined with the health anxiety scores. Conclusions: While patients with migraine and TTH evalute, taking into account the SSA and health anxiety may contribute to the prognosis and treatment of these diseases.

RESUMO Embora se saiba que os distúrbios de ansiedade e depressão frequentemente acompanhem a enxaqueca e a TTH, o papel da amplificação somatossensorial (somatosensory amplification, SSA) e da hipocondria nessas doenças ainda não é bem conhecido. Objetivo: O presente estudo faz uma comparação entre pacientes que sofrem de enxaqueca e TTH com um grupo de controle saudável em termos de SSA e hipocondria e investiga a relação entre os achados e as características da cefaleia, a ansiedade e os sintomas depressivos. Métodos: O estudo incluiu 54 pacientes com enxaqueca, 50 pacientes com TTH e 53 voluntários saudáveis que se cadastraram na clínica de neurologia. A escala de amplificação somatossensorial (somatosensory amplification scale, SSAS), o inventário de hipocondria, o Inventário de Depressão de Beck (Beck Depression Inventory, BDI) e o Inventário de Ansiedade de Beck (Beck Anxiety Inventory, BAI) foram aplicados aos participantes. Resultados: Quando comparados com os controles saudáveis, as pontuações da SSAS dos pacientes com enxaqueca foram significativamente maiores, enquanto as pontuações de hipocondria foram significativamente maiores em ambos os grupos de enxaqueca e TTH. As pontuações do BAI e do BDI foram significativamente maiores em ambos os grupos de pacientes que no grupo de controle. No grupo da enxaqueca, foi identificada uma correlação positiva entre frequência de cefaleia e ansiedade, bem como entre a Escala Analógica Visual (EVA), a SSAS e a depressão. Em ambos os grupos de pacientes, a SSA foi correlacionada positivamente com a depressão e a ansiedade, e uma correlação semelhante foi encontrada entre a SSA e a hipocondria. Conclusão: Em avaliações dessas doenças, a hipocondria e a SSA devem ser levadas em consideração, pois se acredita que essa abordagem possa contribuir positivamente para o prognóstico e tratamento da doença.

Association of bruxism and anxiety symptoms among military firefighters with frequent episodic tension type headache and temporomandibular disorders / Associação de bruxismo e sintomas de ansiedade em bombeiros militares com cefaleia do tipo tensional episódica frequente e desordens temporomandibulares

ABSTRACT Objective To assess the presence of bruxism and anxiety among military firefighters with frequent episodic tension-type headache and painful temporomandibular disorders (TMDs). Methods The sample consisted of 162 individuals aged 18 to 55 years divided into four groups. Headache was diagnosed in accordance with the International Classification of Headache Disorders-III. The Research Diagnostic Criteria for Temporomandibular Disorders questionnaire was used to classify TMDs and awake bruxism; sleep bruxism was diagnosed in accordance with the International Classification of Sleep Disorders-3; and anxiety was classified using the Beck Anxiety Inventory. In statistical models, a significance level of 95% was used. The chi-square test was used to assess anxiety. Results Associations were found among frequent episodic tension-type headache, painful TMDs, awake bruxism and anxiety (p < 0.0005). Sleep bruxism was not a risk factor (p = 0.119) except when associated with awake bruxism (p = 0.011). Conclusion Anxiety and awake bruxism were independent risk factors for developing frequent episodic tension-type headache associated with painful TMDs; only awake bruxism was a risk factor for frequent episodic tension-type headache with non-painful TMDs.

RESUMO Objetivo Avaliar a presença de bruxismo e sintomas de ansiedade entre bombeiros militares com cefaleia do tipo tensional episódica frequente (CTTEF) e desordens temporomandibulares Dolorosas (DTMs). Métodos A amostra foi composta por 162 indivíduos com idade entre 18 e 55 anos divididos em quatro grupos. A CTTEF foi diagnosticada de acordo com o ICHD-III. O RDC / TMD foi usado para classificar as DTMs e o bruxismo acordado; o bruxismo do sono foi diagnosticado de acordo com o ICSD-3; e a ansiedade foi classificada usando o Inventário de Ansiedade de Beck. Nos modelos estatísticos, utilizou-se um nível de significância de 95%. O teste Qui-quadrado avaliou a ansiedade. Resultados Associações foram encontradas entre CTTEF, DTMs dolorosas, bruxismo diurno e ansiedade (p < 0,0005). O bruxismo do sono não foi fator de risco (p = 0,119), mas quando associado à atividade diurna (p = 0,011). Conclusão Ansiedade e bruxismo diurno foram fatores de risco independentes para o desenvolvimento de CTTEF associado a DTMs dolorosas. Apenas o bruxismo diurno foi fator de risco para CTTEF com DTMs não dolorosas.

Constipation is associated with tension type headache in women / Constipação está associada à cefaleia do tipo tensional em mulheres

ABSTRACT Tension-type headaches (TTH) and irritable bowel syndrome (IBS) are comorbid diseases affecting, especially, women. One of the underlying mechanisms for both is autonomic dysfunction in the brain-gut axis. We aimed to evaluate the factors accompanying TTH and their relation to functional gastrointestinal disorders. Methods: Women diagnosed with TTH were questioned about headache pattern and severity, and accompanying factors, as well as being screened for IBS according to the Rome III criteria. The participants were divided into two groups: constipation-dominant IBS (IBS-C) group and "others", with a total of 115 individuals included in the study. Results: Of the 115 patients; 48 (41.8%) of the women had IBS-C criteria while 67 (58.2%) described mixed-type IBS or diarrhea-dominant IBS. There were no significant differences in terms of mean age (p = 0.290), body mass index (p = 0.212), visual analog scale (p = 0.965), duration of attacks (p = 0.692), and episodic/chronic type (p = 0.553). Osmophobia was seen in 43.5%; phonophobia in 68.7%, and photophobia in 47.0% of the patients, and only osmophobia was significantly associated in women in the IBS-C group (p = 0.001). Conclusion: In female patients with TTH, a higher level of constipation was detected. The relationship of these two diseases suggests that they may share common mechanisms. This is the first study showing the relationship of osmophobia with constipation.

RESUMO As cefaléias do tipo tensional (TTH) e a síndrome do intestino irritável (IBS) são comorbidades que afetam especialmente as mulheres. O mecanismo subjacente para ambas é a disfunção autonômica no eixo cérebro-intestino. Nosso objetivo foi avaliar os fatores que acompanham as TTH e sua relação com distúrbios gastrointestinais funcionais (FGID). Métodos: Mulheres com diagnóstico de TTH foram questionadas quanto ao padrão e gravidade da cefaleia, fatores acompanhantes e triadas para IBS de acordo com os critérios de Roma III e foram divididas em dois grupos: grupo com IBS com predominância de constipação (IBS-C) e as demais. Um total de 115 mulheres foram incluídas no estudo. Resultados: Do total de 115 pacientes; 48 (41,8%) das mulheres tiveram os critérios da IBS-C, enquanto 67 (58,2%) tiveram IBS do tipo misto ou IBS com predominância de diarreia. Não houve diferenças significativas em termos de idade média (p = 0,290), índice de massa corporal (IMC) (p = 0,212), escala visual analógica (VAS) (p = 0,965), duração dos ataques (p = 0,692), e tipo episódico / crônico (p = 0,553). Osmofobia foi observada em 43,5% das pacientes; fonofobia em 68,7% e fotofobia em 47,0%, e apenas osmofobia foi significativamente associada no grupo de mulheres com predominância de constipação (p = 0,001). Conclusão: Em pacientes do sexo feminino com TTH, encontra-se uma maior constipação. A relação dessas duas doenças sugere que elas podem compartilhar mecanismos comuns. Além disso, este é o primeiro estudo mostrando a relação da osmofobia com a constipação.

The Development of Evidence-Based Guideline for Diagnosis and Management of Headache in Korea

OBJECTIVE: We aimed to develop the clinical guideline for headache by the systematic review and synthesis of existing evidence-based guidelines. The purpose of developing the guideline was to improve the appropriateness of diagnosis and treatment of headache disorder, and consequently, to improve patients’ pain control and quality of life. The guideline broadly covers the differential diagnosis and treatment of tension-type headache, migraine, cluster headache, and medication-overuse headache. METHODS: This is a methodological study based on the ADAPTE methodology, including a systematic review of the literature, quality assessment of the guidelines using the Appraisal of Clinical Guidelines for REsearch & Evaluation II (AGREE II) Instrument, as well as an external review using a Delphi technique. The inclusion criteria for systematic search were as follows: topic-relevant, up-to-date guidelines including evidence from within 5 years, evidence-based guidelines, guidelines written in English or Korean, and guidelines issued by academic institutions or government agencies. RESULTS: We selected five guidelines and conducted their quality assessment using the AGREE II Instrument. As a result, one guideline was found to be eligible for adaptation. For 13 key questions, a total of 39 recommendations were proposed with the grading system and revised using the nominal group technique. CONCLUSION: Recommendations should be applied to actual clinical sites to achieve the ultimate goal of this guideline; therefore, follow-up activities, such as monitoring of guideline usage and assessment of applicability of the recommendations, should be performed in the future. Further assessment of the effectiveness of the guideline in Korea is needed.