Cervical muscle parameters and allodynia in migraine and cervical pain-A controlled study.

BACKGROUND: Neck pain is common among individuals with migraine, but there is a lack of information of how this comorbidity can be associated with cervical muscle function. This controlled cross-sectional study aimed to compare cervical muscle function, activity, and sensitization in women with migraine, neck pain, both, and neither. METHODS: This study included women, between 18 and 55 years old, with either episodic migraine with or without aura, without any concomitant headache diagnosis; chronic neck pain, with at least moderate intensity and mild disability; or neither headache nor neck pain. Pain pressure threshold, allodynia, muscle strength, and endurance and cervical muscles activity were evaluated. RESULTS: One hundred subjects, with mean age of 30.4 years old, were stratified by diagnosis (n = 25 per group) and by self-reported pain during tests. Lower endurance during flexion was observed for migraine and neck pain (34s) relative to neck pain alone (45s), migraine (40s), and controls (58s) (p = 0.04). For extensor endurance, means were 142s, 166s, 215s, and 270s, respectively (p < 0.001). Endurance times were impacted by the presence of test-induced pain decreasing about 40%-53% of the performance. Diagnostic groups did not differ significantly in strength (p > 0.05), but all pain groups presented significantly higher proportion of test-induced pain, lower muscle activity during the maximal isometric voluntary contractions, and lower pressure pain thresholds. CONCLUSION: Patients with migraine, chronic neck pain, and the association of both present altered cervical muscle function and activity. Also, test-induced pain impacts significantly on neck muscles endurance. SIGNIFICANCE: The diagnosis of migraine and chronic neck pain is associated with altered function and activity of the cervical muscles. However, the test-induced pain had an important contribution to worse cervical muscle endurance. This suggests that the therapeutic approach should focus on de-sensitization of the trigeminal-cervical complex when dealing with the comorbidity of migraine and cervical pain.

Do patients with migraine experience an increased prevalence of falls and fear of falling? A cross-sectional study.

OBJECTIVE: To assess the prevalence of falls and fear of falling in patients with migraine compared with controls. DESIGN: Cross-sectional. SETTING: Tertiary headache clinic. PARTICIPANTS: This study consisted of 105 controls and 105 consecutive patients diagnosed with migraine with aura (MA, n=35), migraine without aura (MO, n=35) and chronic migraine (CM, n=35). MAIN OUTCOME MEASURES: Patients were interviewed using a questionnaire containing questions about the history of falls and impairment in balance, and completed the International Falls Efficacy Scale (FES-I). Groups were contrasted using Student's t-test and analysis of variance, and prevalence ratios were estimated. RESULTS: Falls and self-reported impairment in balance are more prevalent in patients with migraine (54% and 69%, respectively) than in controls (2% and 2%, respectively). In particular, patients with CM and MA reported a greater mean number of falls during the previous year {CM 1.4 [standard deviation (SD) 2.2]; MA 2.2 (SD 2.3)} compared with patients with MO [0.5 (SD 1.0); P <0.04] and controls [0.05 (SD 0.2); P <0.002]. The prevalence ratio of falls was greater in patients with MA (7.2; P <0.002) and CM (4.5; P <0.002) compared with controls. Patients with migraine experienced a high level of concern about falls during their daily activities compared with controls (29.8 vs 20.1 points in the FES-I questionnaire; P<0.0001). CONCLUSIONS: The balance impairment of patients with migraine may have a functional impact. Migraine is associated with risk of falling, and patients exhibit a higher prevalence of impairment in balance, falls and fear of falling.

Reduced thermal threshold in patients with Temporomandibular Disorders.

BACKGROUND: Many studies have demonstrated the presence of somatosensory modulation changes at different sites in patients with temporomandibular disorders (TMDs) using different modalities. However, the neck area, a well-know condition related to TMD, remains unexplored. OBJECTIVE: To assess the thermal pain threshold in patients with TMD and controls at cephalic and extra-cephalic areas, including the neck. METHODS: Twenty female patients with TMDs diagnosed by the Research Diagnostic Criteria for TMD (RDC/TMD) and twenty age-matched controls underwent a first interview about neck pain and disability (NDI questionnaire). A blinded evaluator assessed the thermal pain threshold for cold (CPT) and heat (HPT) stimuli in accordance with an ascending method of limits of the Quantitative Sensory Testing at the following sites: periorbital, masseter, cervical posterior and ventral forearm. The groups were compared using a t-test with α = 5%. RESULTS: Patients with TMDs reported pain at higher temperature for cold stimuli in all sites (P < 0·05) and at lower temperature for heat stimuli in the right periorbital site (P < 0·05) than controls. Pain and disability due tothis symptom were reported more often in the TMD group (P < 0·05). CONCLUSION: Patients with TMD have pain modulation changes in the neck area as well, especially for cold stimuli, associated with higher disability and a higher report of neck pain than controls. These findings reinforce the evidence regarding the relationship between TMDs and neck pain.

Prevalence of restless legs syndrome in patients with chronic pain in Maputo, Mozambique.

OBJECTIVES: Because there is only one study to our knowledge on the prevalence of restless legs syndrome (RLS) in sub-Saharan Africa and RLS is more common in patients with some pain syndromes, we aimed to determine the prevalence of RLS in a population with chronic pain in Maputo, Mozambique. METHODS: Our study was conducted in the Pain Unit of the Central Hospital of Maputo, Mozambique. Patients were individually interviewed by a neurologist, and only those fulfilling the criteria were included. After collection of demographic data and pain features, the patients answered the screening questions regarding RLS. RESULTS: A total of 123 patients with pain were interviewed. Five individuals were excluded. RLS was found in eight (6.77%) of 118 patients. The mean age of the eight patients with RLS was 54.6years. Five patients (62.5%) were women and six (75%) were black individuals. Seven (87.5%) patients were diagnosed with neuropathic pain; one of them had AIDS and another one (12.5%) had orthopedic pain. The presence of hypertension and neuropathies was more frequent in the RLS group. CONCLUSION: Despite the secondary causes involved, we believe that it is relevant to report the RLS prevalence detected in our study.

[Complementary exams and headaches]. / Pruebas complementarias y cefaleas.

INTRODUCTION: In view of the high prevalence of headache in the general population, the availability of well defined criteria that will guide the physician regarding the request of complementary exams is highly desirable. AIM: To analyze the requests of complementary exams during the investigation of headache. PATIENTS AND METHODS: The data were obtained by reviewing medical records of all patients who had been scheduled to be seen in a tertiary Headache Outpatient Clinic in 2004. RESULTS: The exam most frequently requested was computed tomography of the head and the exams that most contributed to a change in clinical diagnosis or medical conduct were computed tomography of paranasal sinuses, simple radiography of paranasal sinuses, and magnetic resonance image of the brain. The exams that did not contribute to a change in diagnosis or medical conduct were computed tomography and simple radiography of the cervical spine. As expected, the most expensive exams for the institution were computed tomography and magnetic resonance image. CONCLUSION: The importance of complementary exams in the investigation of headache is indisputable in many cases. However, it is necessary the availability of more studies that evaluate the request of complementary exams for headache patients.

Pruebas complementarias y cefaleas / Complementary exams and headaches

Resumen. Introducción. En vista de la elevada prevalencia de cefaleas entre la población general, es muy conveniente disponer de criterios bien definidos que orienten al médico a la hora de solicitar pruebas complementarias. Objetivo. Analizar las peticiones de pruebas complementarias durante el estudio de las cefaleas. Pacientes y métodos. Los datos se obtuvieron al revisar las historias clínicas de todos los pacientes que estaba previsto que fueran visitados en una consulta externa de cefaleas terciaria en 2004. Resultados. La prueba solicitada con más frecuencia fue la tomografía computarizada (TC) craneal, y las exploraciones que más contribuyeron a un cambio del diagnóstico clínico o la conducta médica fueron la TC de los senos paranasales, la radiografía simple de los senos paranasales y la resonancia magnética (RM) del cerebro. Las pruebas que no contribuyeron a un cambio del diagnóstico clínico ni de la conducta médica fueron la TC y la radiografía simple de la columna cervical. Tal como era de esperar, las exploraciones más caras para la institución fueron la TC y la RM. Conclusión. La importancia de las pruebas complementarias en el estudio de las cefaleas es indiscutible en muchos casos. Sin embargo, es necesario disponer de más estudios que evalúen la petición de pruebas complementarias para los pacientes con cefalea (AU)

Summary. Introduction. In view of the high prevalence of headache in the general population, the availability of well defined criteria that will guide the physician regarding the request of complementary exams is highly desirable. Aim. To analyze the requests of complementary exams during the investigation of headache. Patients and methods. The data were obtained by reviewing medical records of all patients who had been scheduled to be seen in a tertiary Headache Outpatient Clinic in 2004. Results. The exam most frequently requested was computed tomography of the head and the exams that most contributed to a change in clinical diagnosis or medical conduct were computed tomography of paranasal sinuses, simple radiography of paranasal sinuses, and magnetic resonance image of the brain. The exams that did not contribute to a change in diagnosis or medical conduct were computed tomography and simple radiography of the cervical spine. As expected, the most expensive exams for the institution were computed tomography and magnetic resonance image. Conclusion. The importance of complementary exams in the investigation of headache is indisputable in many cases. However, it is necessary the availability of more studies that evaluate the request of complementary exams for headache patients (AU)

Nummular headache: three new cases.

Nummular headache is proposed as a distinct type of headache in the Appendix of the second edition of the International Classification of Headache Disorders (ICHD-II). It is a chronic condition, with the following characteristics: pain is felt on a small circumscribed cranial area; pain is of mild to moderate intensity; there is no evidence of a structural abnormality. Herein, three cases fulfilling the ICHD-II proposed criteria (code A13.7.1) for nummular headache are reported.

Acute treatments with GMP produce antidepressant-like effects in mice.

This study examined the effect of GMP in two models of depression in mice. The immobility times in the forced swimming test (FST) and in the tail suspension test (TST) were significantly reduced by GMP (dose range: 5-50 mg/kg and 5-100 mg/kg, i.p., respectively), without accompanying changes in ambulation in an open-field. I.c.v. injection of GMP (320-480 nmol/site) also reduced the immobility in the FST without affecting ambulation. The immobility of mice treated with MK-801 (0.01 mg/kg) + GMP (50 mg/kg) was not significantly different from the result obtained with MK-801 or GMP alone, but GMP (or MK-801) + imipramine (15 mg/kg) treatment induced a stronger effect in FST than administration of either drug alone. Pretreatment with p-chlorophenylalanine (100 mg/kg, 4 days) completely blocked the anti-immobility effect of GMP, MK-801 or fluoxetine (32 mg/kg), but only partially that of imipramine in the FST. The results suggest that the antidepressant-like effects produced by the administration of GMP, like MK-801, may be due to an indirect serotonin activation resulting from blockade of NMDA receptors.