High rates of (treated) hypothyroidism among chronic migraine patients consulting a specialized headache clinic: are we missing something?

BACKGROUND: Roughly three percent of episodic migraine patients evolve into the most burdensome chronic form of this condition every year. While some of the determinants behind this transformation are well established, others are still ill defined. Hypothyroidism is a prevalent endocrinological disorder that can both produce a secondary headache or aggravate a pre-existing primary headache disorder such as migraine. OBJECTIVE: We aimed to re-assess the association between hypothyroidism and chronic migraine controlling for factors such as hormone replacement treatment status and bodyweight. METHODS: We retrospectively analyzed the medical records of episodic and chronic migraine patients who consecutively consulted our headache clinic in order to determine the prevalence of adequately treated hypothyroidism in each group. Only patients receiving a stable dose regimen were included. The body mass index and other possibly confounding covariates were also collected. RESULTS: Data from 111 migraine patients was included for analysis. Most (88.6%) of chronic migraine sufferers were overusing acute medication. Treated hypothyroidism was significantly more prevalent in chronic migraine patients (29.55%) compared to episodic migraine patients (8.96%). This association was independent of the patients' body mass index or other variables. CONCLUSION: Alterations of neuronal metabolism, deficient calcitonin release, or focal inflammation causing local hormonal deactivation might explain why hypothyroidism, in spite of levothyroxine replacement therapy, is associated with migraine chronification. Further studies evaluating these factors are warranted.

[ELDERLY ADULTS IN NURSING HOMES IN THE PROVINCE OF CORDOBA: OBJECTS OF CARE OR LEGAL SUBJECTS?]. / Adultos mayores en establecimientos geriátricos en la provincia de Córdoba: objeto de cuidado o sujetos de derecho?

Argentina is among the Ibero-American countries with the greatest old age population, and is going through a process of advanced demographic transition. Elderly adults have long been considered a vulnerable group in need of care. The purpose of this work was to problematize the conceptions underlying the care given to the elderly in nursing homes, and the possible slides this involves from a human rights stance. An approach to this problem was built up by resorting to secondary documentary sources and interviews with key informants located in institutions for the elderly in the Province of Cordoba. This approach revealed a predominantly asylum-oriented conception centered on caring for others as objects, and a noticeable lack of consideration for the elderly as legal subjects, visible in numerous serious infringements of human rights, mostly silenced and rendered invisible. It seems that to overcome these situations it will be necessary not merely to review legal loopholes and current programs but also to reconsider the place given to the elderly in society. Regardless of their age and other social differences, the elderly require the same opportunities to claim full respect and exercise their human rights and fundamental freedoms.