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INTRODUCTION: Headache is common among patients diagnosed with pituitary adenoma (PA). There are still controversies regarding the headache presentation, pathophysiology and outcome after treatment in these patients. OBJECTIVES: To determine the prevalence of headache among patients with PA, describe their phenotypes and identify precipitating factors. Also, to evaluate prospectively if PA treatment leads to headache improvement. METHODS: Treatment-naïve adult patients with PA were included. A questionnaire based on the beta version of the International Classification of Headache Disorders 3rd edition was created to classify the headaches. Patients submitted to surgery or medical treatment were reevaluated at least three to six months after treatment. RESULTS: Headache during the previous 3 months was present in 62% of the 104 patients. The most prevalent phenotypes were migraine and tension-type headache. Trigeminal autonomic cephalalgias (TACs) were observed only in prolactinoma patients. Both genders presented headache at similar rates (64% in females and 58% in males) but patients with headache were younger (41.5 ± 13.8 vs. 56.8 ± 13.6 years). Tumor characteristics were not determinant of headache. Patients with acromegaly that presented headache had higher GH levels. Headache was more frequent in prolactinomas (83%) than in NFPA (52%). After disease remission or control, resolution of headache was observed in 83%, 50% and 33% of the NFPA, somatotropinomas and prolactinomas, respectively. CONCLUSIONS: Migraine and tension-type are the most common headache phenotypes in PA patients, and TACs were only observed in prolactinomas. Also, headache was more common in prolactinomas than in NFPA. GH levels were higher in patients with acromegaly that presented headache. Surgical and medical treatments completely resolve the headaches in 50% of the patients.
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Cefaleia , Neoplasias Hipofisárias , Humanos , Feminino , Masculino , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/terapia , Neoplasias Hipofisárias/epidemiologia , Pessoa de Meia-Idade , Adulto , Cefaleia/epidemiologia , Idoso , Resultado do Tratamento , Adenoma/epidemiologia , Adenoma/complicações , Adenoma/terapia , Prolactinoma/epidemiologia , Prolactinoma/complicações , Cefaleia do Tipo Tensional/epidemiologia , Transtornos de Enxaqueca/epidemiologia , Estudos ProspectivosRESUMO
A sellar spine is a rare midline osseous spur, which arises from the dorsum sellae and projects into the pituitary fossa. It can be found incidentally on imaging or may present with symptoms related to optic chiasm compression or hormonal disturbances.Herein, we present the case of an incidentally detected sellar spine in a patient presenting with sudden onset headaches.
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Sela Túrcica , Humanos , Sela Túrcica/diagnóstico por imagem , Sela Túrcica/patologia , Sela Túrcica/anormalidades , Imageamento por Ressonância Magnética , Osteófito/diagnóstico por imagem , Osteófito/complicações , Cefaleia/etiologia , Masculino , Achados Incidentais , Feminino , Tomografia Computadorizada por Raios X , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Headache is common in people with whiplash-associated disorders (WAD). Upper-cervical structures may be involved in the presence of headache, and the flexion-rotation test (FRT) has been widely studied to assess cervicogenic headaches. OBJECTIVES: To evaluate the diagnostic accuracy of the FRT for the presence of headache in people with WAD, and its cut-off value. METHODS: In this secondary analysis from a previously published study 47 people with WAD were consecutively recruited, 28 with and 19 without headache. FRT was assessed by a single blinded evaluator, with production of headache during the test as the reference standard. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were assessed through cross-tabulation. The cut-off value was calculated based on the Youden's Index. The positivity of the test was defined based on: a) range of motion (ROM) <32°; and ROM <32° combined with headache provocation. RESULTS: Differences between groups were significant for both most and least restricted sides of FRT in terms of ROM (p < 0.001). For the most restricted side, moderate sensitivity and specificity was found (82.1% [95%CI = 68.4%, 95.8%] and 63.2% [95%CI = 40.8%, 85.6%], respectively) when only ROM was considered. When headache provocation was included, sensitivity and specificity were 78.6% (95%CI = 63.1%, 93.7%) and 68.4% (95%CI = 47.5%, 88.5%), respectively. A cut-off value of 31.5° was found. CONCLUSION: Moderate diagnostic accuracy through both ways of assessing the FRT was found for this test to detect the presence of whiplash-associated headache from upper cervical origin. The FRT may be considered positive if ROM is less than 31.5°.
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Amplitude de Movimento Articular , Traumatismos em Chicotada , Humanos , Estudos Transversais , Traumatismos em Chicotada/fisiopatologia , Rotação , Cefaleia/fisiopatologia , Sensibilidade e EspecificidadeRESUMO
Chikungunya patients may develop chronic joint pain that can persist for months to years. This study aimed to determine the factors associated with Chikungunya chronicity. This case-control study involved data from patients with laboratory-confirmed Chikungunya reported from March 2016 to December 2020 in Vitória, Espírito Santo state, Brazil. The data were accessed from compulsory notification databases (SINAN and eSUS VS) and electronic medical reports (Rede Bem-Estar). For each patient who developed chronic symptoms, we included a control patient who did not develop chronic symptoms by random sampling. A total of 183 chronic and 183 non-chronic patients were included in the study. Most of them were female (73.2%), with a median age of 49.5 years (interquartile range = 37-61), and presented fever (89.6%), myalgia (89.6%), arthralgia (89.3%), and headache (82.0%). Chronic patients were older (median = 53; interquartile range = 41-61) than non-chronic cases (median = 46; interquartile age = 31-61) (OR = 0.979, 95% CI = 0.968-0.991) and more frequently presented nausea (58.5% vs. 40.4%; OR = 2.109, 95% CI = 1.374-3.238), and leukopenia (20.2% vs. 10.9%; OR = 2.060, 95% CI = 1.122-3.779). Therefore, these characteristics should be monitored for the better clinical management of cases prone to chronicity.
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Febre de Chikungunya , Humanos , Febre de Chikungunya/epidemiologia , Febre de Chikungunya/complicações , Brasil/epidemiologia , Feminino , Pessoa de Meia-Idade , Masculino , Adulto , Estudos de Casos e Controles , Doença Crônica , Artralgia/virologia , Vírus Chikungunya , Fatores de Risco , Idoso , Febre/virologia , Mialgia/epidemiologia , Mialgia/etiologia , Cefaleia/epidemiologia , Cefaleia/etiologiaRESUMO
OBJECTIVE: The purpose of this study was to describe the factors related to dizziness in workers with noise-induced hearing loss in Brazil. METHOD: A cross-sectional study was carried out with a sample from noise-induced hearing loss reports (2007-2019). The dependent variable in this study was dizziness, and the independent variables were sociodemographic characteristics, comorbidities, symptoms, and noise characteristics in the work environment. Logistic regression analysis was performed. RESULTS: A total of 3,824 individuals with noise-induced hearing loss in Brazil were analyzed. The prevalence of dizziness was 23.4% in the sample. Factors associated with dizziness were women (odds ratio [OR]: 2.10; 95% confidence interval [CI] [1.64, 2.69]), hypertension (OR: 1.68; 95% CI [1.38, 2.06]), headache (OR: 6.31; 95% CI [5.26, 7.57]), tinnitus (OR: 3.46; 95% CI [2.82, 4.25]), and continuous noise at the work environment (OR: 1.54; 95% CI [1.22, 1.94]). CONCLUSIONS: The factors associated with the outcome-dizziness-were gender (female), systemic arterial hypertension, headache, tinnitus, and continuous exposure to workplace noise. Such findings demonstrate the importance of promoting a multifactorial approach to understanding dizziness among workers exposed to occupational noise.
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Tontura , Perda Auditiva Provocada por Ruído , Ruído Ocupacional , Zumbido , Humanos , Feminino , Masculino , Brasil/epidemiologia , Tontura/epidemiologia , Perda Auditiva Provocada por Ruído/epidemiologia , Estudos Transversais , Adulto , Pessoa de Meia-Idade , Ruído Ocupacional/efeitos adversos , Prevalência , Zumbido/epidemiologia , Fatores de Risco , Doenças Profissionais/epidemiologia , Fatores Sexuais , Hipertensão/epidemiologia , Cefaleia/epidemiologia , Cefaleia/etiologia , Exposição Ocupacional/efeitos adversos , Exposição Ocupacional/estatística & dados numéricosRESUMO
BACKGROUND: Patients with immune-mediated rheumatic diseases (IMRDs) have been prioritized for COVID-19 vaccination to mitigate the infection severity risks. Patients with rheumatoid arthritis (RA) are at a high risk of severe COVID-19 outcomes, especially those under immunosuppression or with associated comorbidities. However, few studies have assessed the safety of the COVID-19 vaccine in patients with RA. OBJECTIVE: To evaluate the safety of vaccines against SARS-CoV-2 in patients with RA. METHODS: This data are from the study "Safety and Efficacy on COVID-19 Vaccine in Rheumatic Diseases," a Brazilian multicentric prospective phase IV study to evaluate COVID-19 vaccine in IMRDs in Brazil. Adverse events (AEs) in patients with RA of all centers were assessed after two doses of ChAdOx1 (Oxford/AstraZeneca) or CoronaVac (Sinovac/Butantan). Stratification of postvaccination AEs was performed using a diary, filled out daily and returned at the end of 28 days for each dose. RESULTS: A total of 188 patients with RA were include, 90% female. CoronaVac was used in 109 patients and ChAdOx1 in 79. Only mild AEs were observed, mainly after the first dose. The most common AEs after the first dose were pain at the injection (46,7%), headache (39,4%), arthralgia (39,4%), myalgia (30,5%) and fatigue (26,6%), and ChAdOx1 had a higher frequency of pain at the injection (66% vs 32 %, p < 0.001) arthralgia (62% vs 22%, p < 0.001) and myalgia (45% vs 20%, p < 0.001) compared to CoronaVac. The more common AEs after the second dose were pain at the injection (37%), arthralgia (31%), myalgia (23%), headache (21%) and fatigue (18%). Arthralgia (41,4% vs 25%, p = 0.02) and pain at injection (51,4% vs 27%, p = 0.001) were more common with ChAdOx1. No serious AEs were related. With Regard to RA activity level, no significant difference was observed between the three time periods for both COVID-19 vaccines. CONCLUSION: In the comparison between the two immunizers in patients with RA, local reactions and musculoskeletal symptoms were more frequent with ChAdOx1 than with CoronaVac, especially after the first dose. In summary, the AE occurred mainly after the first dose, and were mild, like previous data from others immunizing agents in patients with rheumatoid arthritis. Vaccination did not worsen the degree of disease activity.
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Artrite Reumatoide , Vacinas contra COVID-19 , COVID-19 , ChAdOx1 nCoV-19 , Humanos , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/complicações , Feminino , Masculino , Brasil/epidemiologia , Pessoa de Meia-Idade , COVID-19/prevenção & controle , COVID-19/complicações , Vacinas contra COVID-19/efeitos adversos , Vacinas contra COVID-19/administração & dosagem , ChAdOx1 nCoV-19/efeitos adversos , Estudos Prospectivos , Adulto , SARS-CoV-2/imunologia , Idoso , Cefaleia/induzido quimicamente , Cefaleia/etiologia , Mialgia/induzido quimicamente , Mialgia/etiologia , Artralgia/etiologia , Vacinas de Produtos InativadosRESUMO
BACKGROUND: Evidence indicates that physical activity reduces stress and promote a myriad of health-enhancing effects through anti-inflammatory mechanisms. However, it is unknown whether these mechanisms interfere in the association between psychosocial job stress and headache disorders. OBJECTIVE: To test whether physical activity and its interplay with the systemic inflammation biomarkers high-sensitivity C-reactive protein (hs-CRP) and acute phase glycoproteins (GlycA) would mediate the associations between job stress and headache disorders. METHODS: We cross-sectionally evaluated the baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) regarding job stress (higher demand and lower control and support subscales), migraine and tension-type headache (ICHD-2 criteria), self-reported leisure-time physical activity, and plasma hs-CRP and GlycA levels. Conditional process analyses with a sequential mediation approach were employed to compute path coefficients and 95 % confidence intervals (CI) around the indirect effects of physical activity and biomarkers on the job stress-headache relationship. Separate models were adjusted for sex, age, and depression and anxiety. Further adjustments added BMI smoking status, and socioeconomic factors. RESULTS: In total, 7,644 people were included in the study. The 1-year prevalence of migraine and tension-type headache were 13.1 % and 49.4 %, respectively. In models adjusted for sex, age, anxiety, and depression, the association between job stress (lower job control) and migraine was mediated by physical activity [effect = -0.039 (95 %CI: -0.074, -0.010)] but not hs-CRP or GlycA. TTH was associated with higher job control and lower job demand, which was mediated by the inverse associations between physical activity and GlycA [Job Control: effect = 0.0005 (95 %CI: 0.0001, 0.0010); Job Demand: effect = 0.0003 (95 %CI: 0.0001, 0.0007]. Only the mediating effect of physical activity in the job stress-migraine link remained after further adjustments including socioeconomic factors, BMI, smoking, and the exclusion of major chronic diseases. CONCLUSION: In the ELSA-Brasil study, physical activity reversed the link between job stress and migraine independently of systemic inflammation, while the LTPA-mediated downregulation of GlycA was associated with lower job stress-related TTH.
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Biomarcadores , Proteína C-Reativa , Exercício Físico , Inflamação , Análise de Mediação , Estresse Ocupacional , Humanos , Masculino , Feminino , Brasil/epidemiologia , Pessoa de Meia-Idade , Inflamação/metabolismo , Inflamação/sangue , Adulto , Proteína C-Reativa/metabolismo , Proteína C-Reativa/análise , Estudos Transversais , Exercício Físico/fisiologia , Biomarcadores/sangue , Estresse Ocupacional/epidemiologia , Estudos Longitudinais , Estresse Psicológico/metabolismo , Cefaleia do Tipo Tensional/epidemiologia , Cefaleia do Tipo Tensional/sangue , Transtornos de Enxaqueca/epidemiologia , Cefaleia/epidemiologia , Cefaleia/metabolismo , IdosoRESUMO
OBJETIVE: this study was to determine the relationship between acute febrile illness and bacterial pathogens with zoonotic potential that cause emerging and re-emerging diseases in a central-eastern region of Peru. RESULTS: Out of the 279 samples analyzed, 23 (8.2%) tested positive for infection by Rickettsia spp., while a total of 15 (5.4%) tested positive for Leptospira spp. Women had a higher frequency of infection by Rickettsia spp., with 13 cases (53.3%), while men had a higher frequency of infection by Leptospira spp., with 10 cases (66.7%). The most frequently reported general symptom was headache, with 100.0% (n = 23) of patients with Rickettsia (+) and 86.7% (n = 13) of patients with Leptospira (+) experiencing it. Arthralgia was the second most frequent symptom, reported by 95.6% (n = 22) and 60% (n = 9) of patients with Rickettsia (+) and Leptospira (+), respectively. Myalgia was reported by 91.3% (n = 21) and 66.7% (n = 10) of patients with Rickettsia (+) and Leptospira (+), respectively. Retroocular pain, low back pain, and skin rash were also present, but less frequently. Among the positives, no manifestation of bleeding was recorded, although only one positive case for Leptospira spp. presented a decrease in the number of platelets.
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Leptospira , Leptospirose , Infecções por Rickettsia , Rickettsia , Humanos , Peru/epidemiologia , Rickettsia/isolamento & purificação , Feminino , Masculino , Leptospira/isolamento & purificação , Leptospira/patogenicidade , Leptospirose/epidemiologia , Leptospirose/microbiologia , Leptospirose/complicações , Leptospirose/diagnóstico , Infecções por Rickettsia/epidemiologia , Infecções por Rickettsia/microbiologia , Infecções por Rickettsia/diagnóstico , Adulto , Animais , Febre/microbiologia , Zoonoses/microbiologia , Zoonoses/diagnóstico , Zoonoses/epidemiologia , Mialgia/microbiologia , Mialgia/epidemiologia , Pessoa de Meia-Idade , Adulto Jovem , Adolescente , Cefaleia/microbiologia , Cefaleia/etiologia , Cefaleia/epidemiologia , Artralgia/microbiologia , Artralgia/etiologiaRESUMO
INTRODUCTION: The novel coronavirus, dubbed SARS-CoV-2, which causes the COVID-19 disease, was detected on December 31, 2019, in Wuhan, China. OBJECTIVE: To perform a systematic review with a meta-analysis about the prevalence of headache and myalgia in patients with SARS-CoV-2. METHODS: High-sensitivity research was conducted on the main platforms (Medline by PubMed, Embase (Elsevier), and Cochrane Library). The entire versions of the manuscripts were analyzed by three independent researchers, and only observational studies describing the symptoms of the selected sample were included. RESULTS: 1,782 studies were identified, which were submitted to exclusion criteria, remaining only 62 manuscripts to do qualitative synthesis and metanalysis. Of the 28,412 patients diagnosed with SARS-CoV-2, 12% (95% CI 9% - 16%) presented headache and 19% (95% CI 14% - 24%) presented myalgia, both with statistical significance and high heterogeneity (I2=97.0%, p<0.01 and I2=98.0%, p<0.01, respectively). CONCLUSION: It was noticed that headache and myalgia were the most ordinary neurological symptoms, but it is important to emphasize the prevalence of symptoms in different degrees of severity of the patients.
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Humanos , Mialgia/epidemiologia , COVID-19 , Cefaleia/epidemiologiaRESUMO
Cerebrospinal fluid opening pressure values are associated with various neurologic diseases; however, numerous factors can modify this measurement. This study aims to describe factors related to modifications in opening pressure measurements in pediatric patients. Methods: A retrospective analysis of lumbar punctures in pediatric patients conducted by the neuropediatrics group with institutional standardization. Bivariate and linear regression analyses were performed to determine the association between opening pressure and variables included in the study. Results: 544 events, median age 107 months, median opening pressure 19.7â cm H2O. Bivariate analysis found no association with medication use; anesthetics that increased opening pressure were remifentanil (P = .02) and propofol (P = .05), along with a positive linear correlation between opening pressure and age (P < .0001). Multiple linear regression analysis revealed that age, BMI, male gender, and remifentanil use were associated with an increase in opening pressure, whereas corticosteroid withdrawal was associated with a reduction in opening pressure. There is an interaction between age and headache, with an association with increased opening pressure up to around 140 months. Conclusion: This study identifies factors associated with changes in opening pressure, crucial for estimating normal opening pressure values in children. Headaches, anesthetic use, and corticosteroid withdrawal are confirmed as significant factors.
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Pressão do Líquido Cefalorraquidiano , Cefaleia , Punção Espinal , Humanos , Masculino , Feminino , Criança , Estudos Retrospectivos , Pressão do Líquido Cefalorraquidiano/fisiologia , Pré-Escolar , Adolescente , Cefaleia/fisiopatologia , Lactente , Punção Espinal/métodos , Fatores EtáriosRESUMO
Studies focusing on the safety and common side effects of vaccines play a crucial role in enhancing public acceptance of vaccination. Research is scarce regarding the usage of COVID-19 vaccines and the side effects experienced by health professions students in India and other countries. This study aimed to document self-reported side effects associated with COVID-19 vaccination among medical and dental students of six medical and dental colleges and teaching hospitals in four states (Tamil Nadu, Madhya Pradesh, Gujarat, and West Bengal) of India. A cross-sectional survey using purposive sampling of medical and dental students was conducted from 26 April to 26 May 2021. Data was collected using a Google Forms questionnaire capturing information regarding receiving COVID-19 vaccines, side effects and symptoms, onset and duration of symptoms, use of treatment to alleviate symptoms, awareness of haematologic risks associated with vaccination, and side effects from previous (non-COVID-19) vaccinations. The majority (94.5%) of participants received both doses of the Covishield/AstraZeneca COVID-19 vaccine. Among participants (n = 492), 45.3% (n = 223) reported one or more side effects. The most frequently reported side effects were soreness of the injected arm (80.3%), tiredness (78.5%), fever (71.3%), headache (64.1%), and hypersomnia (58.7%). The two most common severe symptoms were fever (14.8%) and headache (13%). Most side effects appeared on the day of vaccination: soreness of the injection site (57%), fever (43.1%), and tiredness (42.6%). Most reported symptoms persisted for one to three days-soreness of the injection site (53%), fever (47.1%), and headache (42.6%). Logistic regression showed that women were almost 85% less likely to report side effects. The study's findings corroborate the safety of the Covishield/AstraZeneca vaccine's first dose, evidenced by the relatively minor and transient nature of the side effects. However, the study underscores the necessity for ongoing research to assess the long-term impacts of COVID-19 vaccines, especially in the context of booster doses, thereby contributing to the global understanding of vaccine safety and efficacy.
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COVID-19 , Estudantes de Ciências da Saúde , Feminino , Humanos , ChAdOx1 nCoV-19 , COVID-19/epidemiologia , Vacinas contra COVID-19/efeitos adversos , Estudos Transversais , Fadiga , Febre , Cefaleia , Ocupações em Saúde , Índia/epidemiologia , Dor , Autorrelato , MasculinoRESUMO
We present a case study of a 24-year-old man who reported mild balance and walking difficulties for 2 years. He had a history of recurrent fever, skin lesions, headache, and elbow pain, but most of these events resolved spontaneously. There was no significant family history. On examination, we observed frontal bossing, sensorineural hearing loss, and gait ataxia. This case underscores the significance of identifying clinical indicators in patients with neurologic symptoms, particularly recurrent fever, to establish a precise and thorough differential diagnosis.
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Surdez , Perda Auditiva Neurossensorial , Masculino , Humanos , Adulto Jovem , Adulto , Perda Auditiva Neurossensorial/complicações , Perda Auditiva Neurossensorial/diagnóstico , Cefaleia , Marcha , Raciocínio ClínicoRESUMO
BACKGROUND: The Global Campaign against Headache is conducting a series of population-based studies to fill the large geographical gaps in knowledge of headache prevalence and attributable burden. One major region not until now included is South America. Here we present a study from Peru, a country of 32.4 million inhabitants located at the west coast of South America, notable for its high Andes mountains. METHODS: The study was conducted in accordance with the standardized methodology used by the Global Campaign. It was a cross-sectional survey using cluster randomised sampling in five regions to derive a nationally representative sample, visiting households unannounced, and interviewing one randomly selected adult member (aged 18-65 years) of each using the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire translated into South American Spanish. The neutral screening question ("Have you had headache in the last year?") was followed by diagnostic questions based on ICHD-3 and demographic enquiry. RESULTS: The study included 2,149 participants from 2,385 eligible households (participating proportion 90.1%): 1,065 males and 1,084 females, mean age 42.0 ± 13.7 years. The observed 1-year prevalence of all headache was 64.6% [95% CI: 62.5-66.6], with age-, gender- and habitation-adjusted prevalences of 22.8% [21.0-24.6] for migraine (definite + probable), 38.9% [36.8-41.0] for tension-type headache (TTH: also definite + probable), 1.2% [0.8-1.8] for probable medication-overuse headache (pMOH) and 2.7% [2.1-3.5] for other headache on ≥ 15 days/month (H15+). One-day prevalence of headache (reported headache yesterday) was 12.1%. Migraine was almost twice as prevalent among females (28.2%) as males (16.4%; aOR = 2.1; p < 0.001), and strongly associated with living at very high altitude (aOR = 2.5 for > 3,500 versus < 350 m). CONCLUSION: The Global Campaign's first population-based study in South America found headache disorders to be common in Peru, with prevalence estimates for both migraine and TTH substantially exceeding global estimates. H15 + was also common, but with fewer than one third of cases diagnosed as pMOH. The association between migraine and altitude was confirmed, and found to be strengthened at very high altitude. This association demands further study.
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Transtornos da Cefaleia Primários , Transtornos da Cefaleia Secundários , Transtornos de Enxaqueca , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Estudos Transversais , Cefaleia/epidemiologia , Transtornos da Cefaleia Primários/diagnóstico , Transtornos da Cefaleia Secundários/epidemiologia , Transtornos de Enxaqueca/epidemiologia , Peru/epidemiologia , Prevalência , Distribuição Aleatória , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: Only a small proportion of patients presenting to an ED with headache have a serious cause. The SNNOOP10 criteria, which incorporates red and orange flags for serious causes, has been proposed but not well studied. This project aims to compare the proportion of patients with 10 commonly accepted red flag criteria (singly and in combination) between patients with and without a diagnosis of serious secondary headache in a large, multinational cohort of ED patients presenting with headache. METHODS: Secondary analysis of data obtained in the HEAD and HEAD-Colombia studies. The outcome of interest was serious secondary headache. The predictive performance of 10 red flag criteria from the SNNOOP10 criteria list was estimated individually and in combination. RESULTS: 5293 patients were included, of whom 6.1% (95% CI 5.5% to 6.8%) had a defined serious cause identified. New neurological deficit, history of neoplasm, older age (>50 years) and recent head trauma (2-7 days prior) were independent predictors of a serious secondary headache diagnosis. After adjusting for other predictors, sudden onset, onset during exertion, pregnancy and immune suppression were not associated with a serious headache diagnosis. The combined sensitivity of the red flag criteria overall was 96.5% (95% CI 93.2% to 98.3%) but specificity was low, 5.1% (95% CI 4.3% to 6.0%). Positive predictive value was 9.3% (95% CI 8.2% to 10.5%) with negative predictive value of 93.5% (95% CI 87.6% to 96.8%). CONCLUSION: The sensitivity and specificity of the red flag criteria in this study were lower than previously reported. Regarding clinical practice, this suggests that red flag criteria may be useful to identify patients at higher risk of a serious secondary headache cause, but their low specificity could result in increased rates of CT scanning. TRIAL REGISTRATION NUMBER: ANZCTR376695.
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Serviço Hospitalar de Emergência , Cefaleia , Valor Preditivo dos Testes , Humanos , Feminino , Serviço Hospitalar de Emergência/organização & administração , Masculino , Pessoa de Meia-Idade , Adulto , Cefaleia/etiologia , Cefaleia/diagnóstico , Sensibilidade e Especificidade , IdosoRESUMO
BACKGROUND: An increase in the workload and use of personal protective equipment by healthcare workers was observed during the COVID-19 pandemic. Due to the connections between craniocervical structures, symptoms such as neck pain and temporomandibular symptoms could be influenced by the use of PPE. AIMS: To assess the prevalence of craniocervical pain, sleep quality, physical activity, and depressive symptoms and relationship among craniocervical symptoms in healthcare workers before and during the COVID-19 pandemic in Brazil. DESIGN: Cross-sectional study. PARTICIPANTS: Healthcare workers. SETTINGS: An online questionnaire included a self-report of craniocervical pain intensity [orofacial pain, neck pain, and headache (Numerical Rating Scale)], sleep quality (Pittsburgh Sleep Quality Index), depressive symptoms (Patient Health Questionnaire two items) and physical activity (self-report). METHODS: The sample analysis was performed by descriptive statistics, the paired t-test was used to compare symptoms intensity before and during the pandemic. The relationship between dependent and independent samples was assessed through McNemar test, Pearson's chi-squared test, and Student's independent t-test. A value of p < .05 was adopted as statistical significance. RESULTS: Overall, 147 participants replied the questionnaires. Headache, neck pain, and orofacial pain complaints increased during the pandemic in healthcare workers (p < 0.001). Craniocervical pain was correlated with poor sleep quality, probable depression, and physical activity during the pandemic (p < 0.05). CONCLUSION: Healthcare workers self-reported more craniocervical pain during the COVID-19 pandemic compared to before the pandemic. In addition, poor sleep quality, depressive symptoms, and physical inactivity were associated with craniocervical symptoms during this period.
Assuntos
COVID-19 , Depressão , Exercício Físico , Pessoal de Saúde , Cervicalgia , Qualidade do Sono , Humanos , COVID-19/epidemiologia , COVID-19/psicologia , Masculino , Estudos Transversais , Feminino , Pessoal de Saúde/estatística & dados numéricos , Pessoal de Saúde/psicologia , Brasil/epidemiologia , Adulto , Depressão/epidemiologia , Depressão/psicologia , Cervicalgia/epidemiologia , Cervicalgia/psicologia , Inquéritos e Questionários , Exercício Físico/psicologia , Pessoa de Meia-Idade , Pandemias , Cefaleia/epidemiologia , Cefaleia/psicologia , Autorrelato , SARS-CoV-2 , Equipamento de Proteção Individual/estatística & dados numéricos , PrevalênciaRESUMO
OBJECTIVE: It has been suggested that diseases that may cause visual evoked potential abnormality, such as optic neuritis, may be associated with the coronavirus disease 2019. This study aimed to find out whether there are visual evoked potential abnormalities in coronavirus disease 2019 patients using pattern reversal visual evoked potential and flash visual evoked potential. METHODS: Patients with a history of coronavirus disease 2019 (coronavirus disease 2019 patients) and controls were included in this prospective case-control study. This study was conducted in the Clinical Neurophysiology Laboratory of Adana City Training and Research Hospital. Individuals without visual impairment were included. Coronavirus disease 2019 patients were required to have clinical features consistent with previous acute infection and a positive nose swab polymerase chain reaction test. Visual evoked potential was applied to coronavirus disease 2019 patients between July 2020 and July 2021. Controls consisted of patients without a history of chronic disease who underwent a visual evoked potential study between June 2017 and June 2018 due to headache or dizziness. Pattern reversal visual evoked potential and flash visual evoked potential were applied to all participants. N75, P100, and N135 waves obtained from pattern reversal visual evoked potential and P1, N1, P2, N2, P3, and N3 waves obtained from flash visual evoked potential were analyzed. RESULTS: A total of 44 coronavirus disease 2019 patients and 40 controls were included in the study. Age and gender were not different between the two groups. Pattern reversal visual evoked potential parameters were not different between the two groups. Right P2 latency was 114.4±21.1 and 105.5±14.7 ms in coronavirus disease 2019 patients and controls, respectively (p=0.031). Patients with P100 and P2 wave abnormalities were 6 (13.6%) and 13 (29.6%), respectively. CONCLUSION: This study showed that there may be visual evoked potential abnormalities in coronavirus disease 2019 patients.
Assuntos
COVID-19 , Potenciais Evocados Visuais , Humanos , Estudos de Casos e Controles , Cefaleia , HospitaisRESUMO
BACKGROUND: Studying biomarkers in children with temporomandibular disorders (TMD) such as epinephrine, norepinephrine, and dopamine may reveal factors like screen time or sleep loss that affect these biomarkers and predict TMD-related pain, offering new research opportunities. AIM: To determine the association between stress and catecholamines with myofascial pain and headache related to TMD in children. DESIGN: Sixty-six 9- to 11-year-old children assisting at the clinics of Pediatric Dentistry of Universidad CES participated in the study. Myofascial pain and headache attributed to TMD were determined according to the Diagnostic Criteria for TMD (DC/TMD) Axis I. Stress was evaluated with the Perceived Stress Scale-Children (PSS-C), and a 24-h urine sample was analyzed using liquid chromatography to assay catecholamines. Single and multiple regression analyses were performed. RESULTS: Children with a mean age of 10.3 years participated in the study. The mean score of stress was 29 ± 4. Perceived stress, dopamine, epinephrine, and norepinephrine were statistically significant predictors of myofascial pain and headache attributed to TMD in the single- and multiple variable logistic regression analyses. CONCLUSION: Stressful states and its biological biomarkers increase the probability of developing myofascial pain and headache attributed to TMD in children.