Correo electrónico de una consulta monográfica de cefaleas: experiencia durante cinco años / Email in a dedicated headache clinic: experience gained over a five-year period

Introducción. El correo electrónico puede facilitar la comunicación entre niveles. Nuestros médicos de atención primaria disponen del correo de la consulta monográfica de cefaleas (CMC) desde noviembre de 2009, por lo que se pretende analizar la utilización del correo electrónico durante cinco años. Pacientes y métodos. Recogimos prospectivamente datos de los correos enviados hasta octubre de 2014. Las preguntas se clasificaron en necesidad de derivación a la CMC (grupo 1), evolución de casos atendidos en la CMC (grupo 2), formación en cefaleas (grupo 3) o tratamiento de la cefalea padecida por el propio médico de atención primaria como paciente (grupo 4). Resultados. Analizamos 274 correos. Las consultas mensuales se han incrementado (de 1,5 al mes durante el primer año a 7,5 al mes durante el quinto). El 10,2% de los correos provenía de centros de salud rurales y el 89,8% de centros de salud urbanos. Se contestaron en 2 ± 2,8 días (rango: 0-24 días). En el grupo 1 se encuadraron 130 consultas (47,4%), y en 60 se recomendó (46,2%) la derivación por vía normal, en 47 (36,2%) la preferente y en 23 (17,6%) la no derivación. En el grupo 2 se incluyeron 125 correos (45,7%), y en 80 no fue necesaria nueva cita o adelanto de la prevista (64%). Trece consultas (4,7%) se clasificaron en el grupo 3 y seis (2,2%) en el grupo 4. Conclusiones. Nuestros médicos de atención primaria manejan cada vez más el correo electrónico de la CMC. Permite detectar pacientes en los que procede un adelanto de cita, bien primera visita o revisión, o resolver cuestiones sin necesidad de derivación. Es eficaz para la atención del médico con cefalea y como herramienta de formación continuada (AU)

Introduction. The use of email can facilitate communication between the different levels of an organisation. Our primary care physicians have had an email service in the dedicated headache clinic (DHC) since November 2009, and our aim is therefore to analyse the use of email over that five-year period. Patients and methods. Data concerning the emails sent up until October 2014 were collected prospectively. The questions were classified as need for referral to the DHC (group 1), progress made by the cases seen in the DHC (group 2), training in headaches (group 3) or the treatment of the headaches suffered by primary care physicians themselves as patients (group 4). Results. A total of 274 email messages were analysed. Monthly consultations have increased (from 1.5 per month during the first year to 7.5 per month during the fifth). Findings showed that 10.2% of the email messages came from rural health centres and 89.8% were sent from urban health centres. Replies were sent within 2 ± 2.8 days (range: 0-24 days). Altogether 130 consultations were classified as belonging to group 1 (47.4%), in which referral through the normal channel was recommended in 60 cases (46.2%), via the preferential channel in 47 (36.2%) and non-referral was suggested in 23 cases (17.6%). Group 2 included 125 emails (45.7%) and in 80 cases there was no need to make a new appointment or to bring forward the existing one (64%). Thirteen visits (4.7%) were classified into group 3 and six (2.2%) in group 4. Conclusions. Our primary care physicians are using the email of the DHC on an increasingly more frequent basis. Its use makes it possible to detect patients whose appointment –whether the first or a follow-up– needs to be brought forward, as well as allowing issues to be solved without the need for referral. It is effective for the treatment of physicians who themselves have headaches and as a tool for continuing education (AU)

Cefalea en racimos ascendente: presentación de tres casos y revisión de la bibliografía / Ascending cluster headache: a description of three cases and a review of the literature

Introducción. Se sabe que la cefalea en racimos (CR) puede afectar a regiones extratrigeminales. En varios pacientes se ha descrito dolor occipital, incluso en el inicio de los ataques; sin embargo, las propuestas sobre variaciones topográficas de la CR sólo se han centrado, hasta el momento, en la distinción de localizaciones supra e infraorbitarias. Casos clínicos. Presentamos a tres pacientes que cumplían criterios diagnósticos de CR de la Clasificación Internacional de las Cefaleas, cuyos ataques se iniciaban con dolor leve o moderado en la región occipital. En los 10-30 minutos siguientes el dolor se desplazaba hacia delante de forma gradual, para instalarse finalmente en la región orbitaria. Una vez localizada en la región periocular, la cefalea adquiría características típicas de CR, con dolor intenso y síntomas autonómicos acompañantes. Conclusiones. La CR puede adoptar un patrón de progresión ascendente desde la región occipital. Es probable que este patrón clínico sea la expresión de ciertos mecanismos fisiopatológicos que implican al complejo trigémino-cervical. Estos mismos mecanismos podrían justificar la eficacia de determinados procedimientos terapéuticos en la CR, como el bloqueo del nervio occipital mayor o la neuroestimulación occipital (AU)

Introduction. It has been previously shown that cluster headache (CH) can involve some extratrigeminal areas. Occipital pain has been recognized in several patients, even as the origin of the attacks. Nevertheless, the proposals of topographic variations of CH have been mainly focused on the location of pain in either supraorbital or infraorbital regions. Case reports. We report three patients fulfilling International Classification of Headache Disorders criteria for CH whose attacks started with mild or moderate headache at the occipital region and gradually moved forward over 10 to 30 minutes, finally reaching the ipsilateral orbital area. There the pain acquired typical CH features, with severe intensity and ipsilateral autonomic accompaniments. Conclusions. These descriptions of ascending CH probably reflect pathophysiological mechanisms involving the trigeminocervical complex, and also offer theoretical support for some new therapeutic approaches such as great occipital nerve blockades or occipital neurostimulation (AU)

[Neurology in Byzantine medicine. An analysis of Alexander of Tralles' Medici libri duodecim]. / La neurología en la medicina bizantina. Análisis del Medici libri duodecim de Alejandro de Tralles.

INTRODUCTION: Byzantium continued Greek and Roman habit of texts compilation, and so, preserved medical knowledge. In addition, assimilating the influence of Monastic and Arabic medicine, Byzantine physicians transmitted original contributions including references to neurological diseases. Alexander of Tralles was one of major exponents of Byzantine medicine. He received his early medical training with his father, and in extensive travels, gathered medical knowledge and experience. AIM: Medici libri duodecim is a treatise on pathology and therapeutics of internal diseases, in twelve books. It comprises views from observation of different diseases. Its influence was prolonged and it was translated and edited until Renaissance. We analyze grecolatin edition by Henricum Petrum (1556), with special interest in neurological disease citations. DEVELOPMENT. First of twelve books is dedicated to head and brain diseases. When considering headache, he classifies them, following Aretaeus of Cappadocia, in cephalalgia, cephalea and hemicrania, suggesting different pathogenic mechanisms and therapies. Headache is included among symptoms conducting, as well as memory or sleep disturbances, to delirium. Medici libri duodecim considers memory complaints among systemic diseases, mainly with cardiac involvement. Alexander distinguishes between paralysis (privation of sensibility and mobility concerning half of the body), and apoplexy (including main soul functions loss, even conducting to death). Regarding epilepsy, Medici libri duodecim considers that its origin can be outside the head, mainly in the stomach, and offers us descriptions of epileptic auras. CONCLUSION: Analysis of Alexander of Tralles' Medici libri duodecim shows how byzantine physicians understood neurological diseases. Therapeutics was based on venesection, medicinal plants and avoidance of noxious substances.

[De secretis mulierum, de chirurgia et de modo medendi libri septem. Neurology and women in mediaeval medical literature]. / De secretis mulierum, de chirurgia et de modo medendi libri septem. Neurología y mujer en la literatura médica medieval.

INTRODUCTION AND AIMS: The School of Salerno stood as a landmark in the teaching and practice of medicine in the Western mediaeval world. Women could be both teachers and students and made significant contributions to its abundant scientific production. One of the most important of such women was Trotula of Salerno, the 12th century author of the Passionibus mulierum curandorum. De secretis mulierum, de chirurgia et de modo medendi libri septem is an anonymous medical poem from the School of Salerno, which was discovered in a manuscript from the 13th century. It consists of seven books and 7280 dactylic hexameters. The first book is specifically devoted to women's diseases and the second is a treaty on cosmetics. Books III and IV deal with surgery and follow the classical a capite ad calcem formula. The seventh book, De modo medendi, deals with therapeutics. We review the references to neurological diseases, using a critical translation of this text to carry out our study. DEVELOPMENT: The poem proposes therapies to treat epilepsy, headache or tinnitus. The treatment to be prescribed for headache differs depending on its origin. It puts forward pathophysiological explanations for the different types of headache, it relates engorged blood vessels with hemicranial headache, and suggests an excess of phlegm as the origin of mild occipital headache. CONCLUSIONS: Neurological pathology is well represented in this mediaeval monograph on women's diseases. Furthermore, it also shows us the vision that the Salerno physician has of these conditions and the therapeutic arsenal (based mainly on medicinal plants) that was available for use.

De secretis mulierum, de chirurgia et de modo medendi libri septem. Neurología y mujer en la literatura médica medieval / De secretis mulierum, de chirurgia et de modo medendi libri septem. Neurology and women in mediaeval medical literature

Introducción y objetivo. La Escuela de Salerno supuso un hito en la enseñanza y la práctica de la medicina en el Occidente medieval. Las mujeres podían ser tanto profesoras como estudiantes, y contribuyeron a su abundante producción científica, destacando Trótula de Salerno, autora, en el siglo xii, del Passionibus mulierum curandorum. De secretis mulierum, de chirurgia et de modo medendi libri septem es un poema médico anónimo de la Escuela de Salerno, descubierto en un manuscrito del siglo xiii. Consta de siete libros y 7.280 hexámetros dactílicos. El primer libro está dedicado a enfermedadesespecíficamente femeninas y el segundo es un tratado de cosmética. Los libros III al VI tratan de cirugía y siguen el esquema clásico a capite ad calcem. El séptimo libro, De modo medendi, se ocupa de la terapéutica. Reseñamos las citas referentes a enfermedades neurológicas, trabajando sobre una traducción crítica de este texto. Desarrollo. El poema propone terapias contra la epilepsia, la cefalea o los acúfenos. El tratamiento que se debe prescribir contra la cefalea es diferente en función de su origen. Propone explicaciones fisiopatológicas para las distintas cefaleas; relaciona la plétora sanguínea con la cefalea hemicraneal, y sugiere un exceso de flema como origen de la cefalea occipital leve. Conclusiones. La patología neurológica está bien representada en esta monografía medieval sobre enfermedades de la mujer. Nos muestra, además, la visión que el médico de Salerno tiene de estos cuadros y el arsenal terapéutico del que dispone, basado fundamentalmente en plantas medicinales (AU)

Introduction and aims. The School of Salerno stood as a landmark in the teaching and practice of medicine in the Western mediaeval world. Women could be both teachers and students and made significant contributions to its abundant scientific production. One of the most important of such women was Trotula of Salerno, the 12th century author of the Passionibus mulierum curandorum. De secretis mulierum, de chirurgia et de modo medendi libri septem is an anonymous medical poem from the School of Salerno, which was discovered in a manuscript from the 13th century. It consists of seven books and 7280 dactylic hexameters. The first book is specifically devoted to women’s diseases and the second is a treaty on cosmetics. Books III and IV deal with surgery and follow the classical a capite ad calcem formula. The seventh book, De modo medendi, deals with therapeutics. We review the references to neurological diseases, using a critical translation of this text to carry out our study. Development. The poem proposes therapies to treat epilepsy, headache or tinnitus. The treatment to be prescribed for headache differs depending on its origin. It puts forward pathophysiological explanations for the different types of headache, it relates engorged blood vessels with hemicranial headache, and suggests an excess of phlegm as the origin of mild occipital headache. Conclusions. Neurological pathology is well represented in this mediaeval monograph on women’s diseases. Furthermore, it also shows us the vision that the Salerno physician has of these conditions and the therapeutic arsenal (based mainly on medicinal plants) that was available for use (AU)