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1.
J Prev Med Public Health ; 55(4): 389-397, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35940194

RESUMO

OBJECTIVES: This study examined the effect of out-of-pocket (OOP) payment reduction on the potential utilization of low-value magnetic resonance imaging (MRI) across income groups. METHODS: We conducted an experimental vignette survey using a proportional quota-based sample of individuals in Korea (n=1229). In two hypothetical vignettes, participants were asked whether they would be willing to use MRI if they had uncomplicated headache and non-specific low back pain, each before and after OOP payment reduction. To account for the possible role of physician inducement, half of the participants were initially presented with vignettes that included a physician recommendation for low-value care. The predicted probability, slope index of inequality (SII), and relative index of inequality (RII) were calculated using logistic regression. RESULTS: Before OOP payment reduction, the lowest income quintile was least likely to use low-value MRI regardless of physician inducement (36.7-49.6% for low back pain; 30.5-39.3% for headache). After OOP payment reduction, almost all individuals in each income quintile were willing to use low-value MRI (89.8-98.0% for low back pain; 78.1-90.3% for headache). Absolute and relative inequalities concerning potential low-value MRI utilization decreased after OOP payments were reduced, even without physician inducement (SII: from 8.15 to 5.37%, RII: from 1.20 to 1.06 for low back pain; SII: from 6.99 to 0.83%, RII: from 1.20 to 1.01 for headache). CONCLUSIONS: OOP payment reduction for MRI has the potential to increase low-value care utilization among all income groups while decreasing inequality in low-value care utilization.


Assuntos
Gastos em Saúde , Dor Lombar , Cefaleia , Humanos , Renda , Dor Lombar/diagnóstico por imagem , Imageamento por Ressonância Magnética , República da Coreia
2.
J Headache Pain ; 23(1): 96, 2022 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-35941545

RESUMO

OBJECTIVE: To investigate whether persistent post-traumatic headache attributed to mild traumatic brain injury (TBI) is associated with more pronounced pericranial tenderness and lower pressure pain thresholds (PPTs) in the head and neck region, compared with healthy controls. METHODS: Patients with persistent post-traumatic headache (n = 100) and age- and gender-matched healthy controls (n = 100) were included between July 2018 and June 2019. Total tenderness score (TTS) was used to assess pericranial tenderness by bilateral manual palpation in eight muscles or tendon insertions. Summation was then used to calculate a TTS from 0 to 48 based on individual right- and left-sided scores; higher TTS score indicated more pronounced pericranial tenderness. PPTs were examined in m. temporalis and m. trapezius (upper and middle part) using an electronic pressure algometer that applies increasing blunt pressure at a constant rate. RESULTS: The TTS score was higher in patients with persistent post-traumatic headache (median, 21; IQR, 12-31), compared with healthy controls (median, 10; IQR, 6-17; P < .001). PPTs were lower in patients with persistent post-traumatic headache than in controls in both the left-sided m. temporalis (mean ± SD, 157.5 ± 59.9 vs. 201.1 ± 65.2; P < .001) and right-sided m. temporalis (mean ± SD, 159.5 ± 63.8 vs. 212.3 ± 61.9; P < .001). Furthermore, patients with persistent post-traumatic headache also had lower left- and right-sided PPTs in the upper as well as middle part of m. trapezius, compared with healthy controls; all P values were .05 or less. CONCLUSIONS: Among patients with persistent post-traumatic headache, pericranial tenderness was more pronounced and PPTs in the head and neck region were lower than in healthy controls free of headache and mild TBI. Further research is needed to better understand the involvement of pericranial myofascial nociceptors in the disease mechanisms underlying post-traumatic headache.


Assuntos
Concussão Encefálica , Cefaleia Pós-Traumática , Cefaleia do Tipo Tensional , Cefaleia/etiologia , Humanos , Dor , Limiar da Dor/fisiologia , Cefaleia Pós-Traumática/etiologia , Cefaleia do Tipo Tensional/complicações
3.
J Headache Pain ; 23(1): 97, 2022 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-35941572

RESUMO

BACKGROUND: Previous research has extensively documented the impact of migraine episodes ('ictal') on patients' health-related quality of life. Few studies have looked at the impact of migraine on migraine-free days ('interictal'). This study was designed to describe interictal burden of migraine in a mixed group of people affected by migraine and to explore patient characteristics associated with interictal burden. METHODS: People with migraine in the United States (US) and Germany were recruited for a cross-sectional online survey, including a subgroup treated with calcitonin gene-related peptide (CGRP) monoclonal antibody (mAb). The survey included the Migraine Interictal Burden Scale (MIBS-4), Headache Impact Test (HIT-6), and items measuring patient demographics, clinical and treatment background. Data were analyzed using descriptive statistics and linear regression. RESULTS: Five hundred six people with migraine completed the survey (US: n = 257; Germany: n = 249), of whom 195 had taken a CGRP mAb for three or more months. Participants had a mean of 8.5 (SD = 6.4) Monthly Migraine Days (MMD) and 10.4 (SD = 7.1) Monthly Headache Days (MHD). The mean MIBS-4 score was 6.3 (SD = 3.4), with 67% reporting severe interictal burden (MIBS-4: ≥5). The mean HIT-6 score was 65.3 (SD = 6.0), with 86% reporting severe migraine impact (HIT-6: ≥60). MIBS-4 was correlated with the HIT-6 (r = 0.37), MMD and MHD (both r = 0.27). The HIT-6, MMD, MHD, CGRP mAb treatment, and depression all had an independent positive association with the MIBS-4. CONCLUSION: Two-thirds of the study sample reported substantial interictal burden. Whilst interictal burden was associated with migraine frequency and impact of migraine attacks, study results also show it represented a distinct aspect of the overall disease burden. Study findings further indicate unique associations between interictal burden and depression. A unique positive association between interictal burden and CGRP mAb treatment suggests a remaining unmet need among people affected by migraine treated with CGRP mAb.


Assuntos
Peptídeo Relacionado com Gene de Calcitonina , Transtornos de Enxaqueca , Anticorpos Monoclonais/uso terapêutico , Peptídeo Relacionado com Gene de Calcitonina/uso terapêutico , Estudos Transversais , Cefaleia/tratamento farmacológico , Humanos , Transtornos de Enxaqueca/tratamento farmacológico , Qualidade de Vida , Estados Unidos
4.
Front Endocrinol (Lausanne) ; 13: 890853, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35937816

RESUMO

Introduction: Pituitary apoplexy (PA) is a rare, and potentially life-threatening condition, caused by hemorrhage or infarction into the pituitary gland with a rapid expansion of the contents of the sella turcica, associated with sudden intense headache, neurological and endocrinological deterioration. The identification of risk factors is crucial for prevention and optimal management. Herein we report a case of PA occurring 1 month after the initiation of anabolic androgenic steroid abuse for bodybuilding. Case Report: A 40-year-old male patient presents with abrupt onset headache associated with left partial third cranial nerve palsy. The MRI shows a sellar lesion involving left cavernous sinus with a heterogenous anterior aspect of the lesion with hemorrhagic zones in favor of PA. Endocrine work-up shows high testosterone level in patient who was using exogenous testosterone without a medical prescription for a month. Conclusion: We report a case of PA of a pituitary neuroendocrine tumor occurring shortly after AAS. The association between PA and AAS should be considered as a potential risk.


Assuntos
Apoplexia Hipofisária , Neoplasias Hipofisárias , Adulto , Cefaleia/complicações , Humanos , Masculino , Apoplexia Hipofisária/induzido quimicamente , Apoplexia Hipofisária/complicações , Apoplexia Hipofisária/diagnóstico , Neoplasias Hipofisárias/induzido quimicamente , Neoplasias Hipofisárias/complicações , Esteroides , Testosterona
5.
Zhongguo Zhen Jiu ; 42(8): 949-55, 2022 Aug 12.
Artigo em Chinês | MEDLINE | ID: mdl-35938341

RESUMO

Through collecting the prescriptions for headache treated with acupuncture in Huangdi Neijing (Yellow Emperor's Inner Classic) till the Qing Dynasty, the literature traceability research is undertaken to determine the extant literature documents with the earliest recorded acupuncture prescriptions and identify the repeated ones in later generations; and then, the acupoint use frequency in the earliest recorded literature of acupuncture prescriptions in the extant documents and acupuncture treatment verses is analyzed separately. It is found that the most of acupoints of high use frequency are overlapped between such two kinds of literature. By integrating and classifying the same or similar contents of acupuncture prescription articles between headache and migraine, the common characteristics and acupoint selections are extracted, the regularity of acupoint selection is explored in view of etiology, complication and affected location, and the attributed fourteen meridians are analyzed statistically in terms of the acupoints in the earliest recorded prescriptions. Finally, the experience of ancient medical masters in acupuncture treatment for headache is obtained.


Assuntos
Terapia por Acupuntura , Meridianos , Pontos de Acupuntura , Cefaleia/terapia , Humanos , Prescrições
6.
J Headache Pain ; 23(1): 93, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35915417

RESUMO

Headache is among the most frequent symptoms persisting or newly developing after coronavirus disease 2019 (COVID-19) as part of the so-called long COVID syndrome. The knowledge on long COVID headache is still limited, however growing evidence is defining the features of this novel condition, in particular regarding clinical characteristics, some pathophysiological mechanisms and first treatment recommendations. Long COVID headache can present in the form of worsening of a preexisting primary headache, or, more specifically, in the form of a new (intermittent or daily) headache starting during the acute infection or after a delay. It often presents together with other long COVID symptoms, most frequently with hyposmia. It can manifest with a migrainous or, more frequently, with a tension-type-like phenotype. Persistent activation of the immune system and trigeminovascular activation are thought to play a role. As there are virtually no treatment studies, treatment currently is largely guided by the existing guidelines for primary headaches with the corresponding phenotype. The present report, a collaborative work of the international group of the Junior Editorial Board of The Journal of Headache and Pain aims to summarize the most recent evidence about long COVID headache and suggests approaches to the diagnosis and treatment of this disorder.


Assuntos
COVID-19 , Transtornos de Enxaqueca , COVID-19/complicações , Cefaleia/diagnóstico , Cefaleia/etiologia , Cefaleia/terapia , Humanos , SARS-CoV-2
7.
Ideggyogy Sz ; 75(7-08): 253-263, 2022 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-35916612

RESUMO

Background and purpose: Previous studies using generic and disease specific instruments showed that both migraine and medication overuse headache are associated with lower health-related quality of life (HRQoL). The aim of our study was to assess HRQoL differences in migraineurs and in patients with MOH and to examine how headache characteristics such as years with headache, aura symptoms, triptan use, headache pain severity and headache frequency are related to HRQoL. Methods: In this cross-sectional study 334 participants were examined (248 were recruited from a tertiary headache centre and 86 via advertisements). The Comp-rehensive Headache-related Quality of life Questionnaire (CHQQ) was used to measure the participants' HRQoL. Data showed normal distribution, therefore beside Chi-squared test parametric tests (e.g. independent samples t-test) were used with a two-tailed p<0.05 threshold. Linear regression models were used to determine the independent effects of sex, age, recruitment method, headache type (migraine vs. MOH) and headache characteristics (presence of aura symptoms, years with headache, headache pain severity, headache frequency and triptan use) separately for each domain and for the total score of CHQQ. Significance threshold was adopted to p0.0125 (0.05/4) to correct for multiple testing and avoid Type I error. Results: Independent samples t-tests showed that patients with MOH had significantly lower scores on all CHQQ domains than migraineurs, except on the social subscale. Results of a series of regression analyses showed that triptan use was inversely related to all the domains of HRQoL after correction for multiple testing (p<0.0125). In addition, headache pain severity was associated with lower physical (p=0.001) and total scores (p=0.002) on CHQQ subscales. Conclusion: Based on the results, different headache characteristics (but not the headache type, namely migraine or MOH) were associated with lower levels of HRQoL in patients with headache. Determining which factors play significant role in the deterioration of HRQoL is important to adequately manage different patient populations and to guide public health policies regarding health service utilization and health-care costs.


Assuntos
Transtornos da Cefaleia Secundários , Transtornos de Enxaqueca , Estudos Transversais , Cefaleia , Transtornos da Cefaleia Secundários/tratamento farmacológico , Humanos , Hungria , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/tratamento farmacológico , Qualidade de Vida , Triptaminas/uso terapêutico
8.
R I Med J (2013) ; 105(7): 23-26, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-35930486

RESUMO

Neurological symptoms of post-acute sequelae of COVID-19 (PASC), also known as Long COVID, are recognized. Four neurological syndromes (transverse myelitis, ischemic stroke, headache, and Guillain-Barré syndrome) associated with PASC are reviewed here, with a particular focus on issues related to rehabilitation.


Assuntos
COVID-19 , Síndrome de Guillain-Barré , COVID-19/complicações , Síndrome de Guillain-Barré/complicações , Cefaleia , Humanos
9.
10.
Comput Math Methods Med ; 2022: 8101099, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35915771

RESUMO

Objective: Roflumilast is a novel therapeutic drug for chronic obstructive pulmonary disease (COPD). This study was designed to evaluate the efficacy and safety of roflumilast combining inhaled corticosteroid (ICS)/long-acting ß2 agonist (LABA) in treating COPD patients through the meta-analysis. Methods: Randomized controlled trials of roflumilast combining ICS/LABA in treating patients with severe and profound COPD were searched from PubMed, Cochrane Library, and Embase databases from their establishment to February 2022. The quality of included studies was assessed by Cochrane risk bias assessment tool. The main outcomes of these studies should include at least one of the following clinical outcome indicators: forced expiratory volume in one second (FEV1), exacerbation rate, and adverse events (AEs) such as diarrhea, nasopharyngitis, and headache. Results: Six articles were included in the study, including 9,715 patients. Meta-analysis revealed that compared with placebo, roflumilast gained superiority for severe COPD patients treated with ICS/LABA combinations in FEV1 before bronchodilator administration (MD = 46.62, 95% CI (30.69, 62.55), P < 0.00001), FEV1 after bronchodilator administration (MD = 45.62, 95% CI (34.95, 56.28), P < 0.00001), and COPD exacerbation rate (RR = 0.90, 95% CI (0.87, 0.94), P = 0.001). In terms of safety, the incidence of diarrhea, headache, nausea, weight loss, back pain, loss of appetite, and insomnia was notably higher in the roflumilast group than in the placebo group. Conclusion: Roflumilast is suggested to be significantly effective for severe COPD patients with ICS/LABA combination therapy, which reduces the exacerbation rate but also leads to PDE4 inhibitor-related adverse reactions.


Assuntos
Broncodilatadores , Doença Pulmonar Obstrutiva Crônica , Corticosteroides/efeitos adversos , Agonistas de Receptores Adrenérgicos beta 2/efeitos adversos , Aminopiridinas , Benzamidas , Broncodilatadores/efeitos adversos , Ciclopropanos , Diarreia/induzido quimicamente , Diarreia/tratamento farmacológico , Progressão da Doença , Cefaleia/induzido quimicamente , Cefaleia/tratamento farmacológico , Humanos , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico
11.
J Headache Pain ; 23(1): 95, 2022 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-35927625

RESUMO

BACKGROUND: The diagnosis of migraine is mainly clinical and self-reported, which makes additional examinations unnecessary in most cases. Migraine can be subtyped into chronic (CM) and episodic (EM). Despite the very high prevalence of migraine, there are no evidence-based guidelines for differentiating between these subtypes other than the number of days of migraine headache per month. Thus, we consider it timely to perform a systematic review to search for physiological evidence from functional activity (as opposed to anatomical structure) for the differentiation between CM and EM, as well as potential functional biomarkers. For this purpose, Web of Science (WoS), Scopus, and PubMed databases were screened. FINDINGS: Among the 24 studies included in this review, most of them (22) reported statistically significant differences between the groups of CM and EM. This finding is consistent regardless of brain activity acquisition modality, ictal stage, and recording condition for a wide variety of analyses. That speaks for a supramodal and domain-general differences between CM and EM that goes beyond a differentiation based on the days of migraine per month. Together, the reviewed studies demonstrates that electro- and magneto-physiological brain activity (M/EEG), as well as neurovascular and metabolic recordings from functional magnetic resonance imaging (fMRI) and positron emission tomography (PET), show characteristic patterns that allow to differentiate between CM and EM groups. CONCLUSIONS: Although a clear brain activity-based biomarker has not yet been identified to distinguish these subtypes of migraine, research is approaching headache specialists to a migraine diagnosis based not only on symptoms and signs reported by patients. Future studies based on M/EEG should pay special attention to the brain activity in medium and fast frequency bands, mainly the beta band. On the other hand, fMRI and PET studies should focus on neural circuits and regions related to pain and emotional processing.


Assuntos
Transtornos de Enxaqueca , Biomarcadores , Doença Crônica , Eletroencefalografia , Cefaleia , Humanos , Imageamento por Ressonância Magnética , Transtornos de Enxaqueca/diagnóstico por imagem , Transtornos de Enxaqueca/epidemiologia , Tomografia por Emissão de Pósitrons
12.
Rev Med Liege ; 77(7-8): 477-480, 2022 Jul.
Artigo em Francês | MEDLINE | ID: mdl-35924507

RESUMO

Sphenopalatine ganglion block (SPGB) is a well-known technique of anesthesia used for the treatment of many types of facial pain syndromes. Its utility in the treatment of headaches due to cerebrospinal fluid hypotension, caused by dural breach or not, seems established but the lack of strong studies proving its efficacy or its superiority compared to epidural blood patch doesn't allow it, for now, to be a part of the official treatment algorithm. We report the case of a patient presenting idiopathic cerebrospinal hypotension (Schaltenbrand syndrome) treated effectively with a sphenopalatine ganglion block using the intranasal approach.


Le bloc du ganglion sphénopalatin (BGSP) est une technique d'anesthésie connue de longue date et utilisée comme proposition de traitement dans de nombreux types de syndromes d'algie de la face. Son utilité dans le traitement des céphalées sur hypotension de liquide céphalorachidien, causées ou non par une brèche durale, semble établie. Cependant, l'absence d'études solides démontrant son efficacité ou sa supériorité par rapport au «blood patch¼ épidural ne permet pas, à l'heure actuelle, de lui donner une place précise dans l'algorithme de prise en charge. Nous rapportons le cas d'un patient présentant un syndrome d'hypotension intracrânienne idiopathique ou spontanée (syndrome de Schaltenbrand) ayant bénéficié d'un traitement efficace par bloc du ganglion sphénopalatin par voie intra-nasale.


Assuntos
Transtornos da Cefaleia , Hipotensão , Bloqueio do Gânglio Esfenopalatino , Cefaleia/etiologia , Cefaleia/terapia , Humanos , Bloqueio do Gânglio Esfenopalatino/métodos
14.
J Med Case Rep ; 16(1): 260, 2022 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-35786211

RESUMO

BACKGROUND: Cerebral vein thrombosis is increasing in young adults. Although oral contraceptive pills increase the risk of cerebral vein thrombosis, relatively high brain venous involvement is rare when oral contraceptive pills are consumed for a short duration. CASE PRESENTATION: A 31-year-old Asian woman was referred to Imam Reza Hospital with a headache complaint on 11 November 2020. The woman, who had a headache for the previous 11 days, went to the hospital. Owing to endometriosis involvement, she consumed Diane tablets. According to the imaging findings, three vein involvements were diagnosed. Anticoagulant therapy was started, and the symptoms disappeared. CONCLUSIONS: All cerebral vein thrombosis symptoms are variable, but new presentation of headache could be an early symptom of cerebral vein thrombosis.


Assuntos
Veias Cerebrais , Trombose Intracraniana , Trombose , Adulto , Anticoncepcionais Orais/efeitos adversos , Feminino , Cefaleia/induzido quimicamente , Humanos , Trombose Intracraniana/induzido quimicamente , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/tratamento farmacológico , Adulto Jovem
15.
MMW Fortschr Med ; 164(13): 22-23, 2022 07.
Artigo em Alemão | MEDLINE | ID: mdl-35817903
16.
Sci Rep ; 12(1): 11647, 2022 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-35804058

RESUMO

People who have COVID-19 can experience symptoms for months. Studies on long COVID in the population lack representative samples and longitudinal data focusing on new-onset symptoms occurring with COVID while accounting for pre-infection symptoms. We use a sample representing the U.S. community population from the Understanding America Study COVID-19 Survey, which surveyed around 8000 respondents bi-weekly from March 2020 to March 2021. Our final sample includes 308 infected individuals who were interviewed one month before, around the time of, and 12 weeks after infection. About 23% of the sample experienced new-onset symptoms during infection which lasted for more than 12 weeks, and thus can be considered as having long COVID. The most common new-onset persistent symptoms among those included in the study were headache (22%), runny or stuffy nose (19%), abdominal discomfort (18%), fatigue (17%), and diarrhea (13%). Long COVID was more likely among obese individuals (OR = 5.44, 95% CI 2.12-13.96) and those who experienced hair loss (OR = 6.94, 95% CI 1.03-46.92), headache (OR = 3.37, 95% CI 1.18-9.60), and sore throat (OR = 3.56, 95% CI 1.21-10.46) during infection. There was a lack of evidence relating risk to age, gender, race/ethnicity, education, current smoking status, or comorbid chronic conditions. This work provides national estimates of long COVID in a representative sample after accounting for pre-infection symptoms.


Assuntos
COVID-19 , Pandemias , COVID-19/complicações , COVID-19/epidemiologia , Cefaleia/epidemiologia , Humanos , SARS-CoV-2
17.
BMC Neurol ; 22(1): 251, 2022 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-35804294

RESUMO

BACKGROUND: Eptinezumab is an anti-calcitonin gene-related peptide humanized monoclonal antibody approved for the preventive treatment of migraine in adults. The PREVAIL study demonstrated a favorable safety profile with sustained reductions in overall migraine-related burden in patients with chronic migraine (CM). This post hoc analysis aimed to examine item-level changes in the Migraine Disability Assessment (MIDAS) questionnaire over 2 years in participants with CM on eptinezumab treatment. METHODS: PREVAIL was an open-label, phase 3 trial that included 96 weeks of treatment where 128 adults received intravenous eptinezumab administered over 30 min every 12 weeks (wks) for up to 8 doses of 300 mg. MIDAS was administered at baseline, Wk12, and every 12wks thereafter. Two supplementary MIDAS items not included in the total score calculation assessed number of headache days in the past 3 months (MIDAS headache) and average headache pain severity (from 0 [none] to 10 [worst]). MIDAS total scores were summed from 5 items, each quantifying the number of days in the past 3 months with migraine-related disability. Items 1, 3, and 5 assessed absenteeism, namely how many days the patient missed work/school (Q1), household work (Q3), or family/social/leisure activities (Q5). Items 2 and 4 were measures of presenteeism, namely how many days the patient had reduced productivity in work/school (Q2) or household work (Q4). RESULTS: Mean MIDAS headache days decreased from 47.4 (baseline) to 17.1 (Wk12) and 16.3 (Wk104). The average headache pain severity score (0‒10) decreased from a mean of 7.3 (baseline) to 5.5 (Wk12) to 4.5 (Wk104). Mean MIDAS scores measuring absenteeism (Q1, 3, 5) changed from 9.7 days at baseline to 3.2 days (Wk12) and to 3.9 days (Wk104). Mean MIDAS scores measuring presenteeism (Q2, 4) at Wk12 decreased from 14.2 days at baseline to 5.2 days (Wk12, 104). Patients categorized with very severe MIDAS disability had a mean total MIDAS score of 84.8, with an average reduction of 56.7 days (Wk12), which was maintained at 32 days at Wk104. CONCLUSIONS: Long-term treatment with eptinezumab in patients with CM suggested sustained reductions in MIDAS-quantified disability, consistent with the sustained reductions in headache frequency and pain severity. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02985398 .


Assuntos
Transtornos de Enxaqueca , Adulto , Anticorpos Monoclonais Humanizados/uso terapêutico , Doença Crônica , Avaliação da Deficiência , Método Duplo-Cego , Cefaleia , Humanos , Transtornos de Enxaqueca/tratamento farmacológico , Transtornos de Enxaqueca/prevenção & controle , Resultado do Tratamento
18.
Artigo em Inglês | MEDLINE | ID: mdl-35805650

RESUMO

Temporomandibular disorders (TMD) and headache are complex. This study aims to assess the association between TMD, headache, and psychological dimensions such as psychological inflexibility and pain acceptance. The sample consisted of 120 participants following a non-probabilistic convenience sampling strategy through a direct invitation to the patients attending our facilities and their relatives (n = 61 diagnosed with headache, n = 34 diagnosed with TMD-headache, n = 25 control group). Diagnostic Criteria for Temporomandibular Disorders (DC-TMD), International Classification of Headache Disorders (ICHD-3 beta version), Chronic Pain Acceptance Questionnaire (CPAQ-8), and Psychological Inflexibility in Pain Scale (PIPS) were used as assessment tools. One-way ANOVA, multiple regression analysis (MRA), and the Johnson-Neyman approach were run by IBM SPSS, version 27 (IBM® Company, Chicago, IL, USA). The significance level was 0.05. One third of our sample presented with headache with TMD. Females were predominant. Males with headache, no systemic disease, less pain severity but higher frequency, living longer with the disease and having sensitive changes, showed higher pain acceptance. When headache occurs with TMD, women with higher education, no headache family history, less pain, and no motor changes showed higher pain acceptance. Patients with both conditions are more liable to have chronic pain and pain inflexibility. Pain intensity and willingness explain 50% of the psychological inflexibility in the headache group. In our sample, individuals suffering from both conditions show greater pain inflexibility, implicating more vivid suffering experiences, leading to altered daily decisions and actions. However, further studies are needed to highlight this possible association.


Assuntos
Dor Crônica , Transtornos da Articulação Temporomandibular , Dor Facial , Feminino , Cefaleia/epidemiologia , Cefaleia/etiologia , Humanos , Masculino , Medição da Dor , Inquéritos e Questionários , Transtornos da Articulação Temporomandibular/complicações , Transtornos da Articulação Temporomandibular/epidemiologia
19.
Emergencias ; 34(4): 275-281, 2022 Aug.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-35833766

RESUMO

OBJECTIVES: To study whether there are age-related differences in the clinical effects of cannabis poisoning and whether any age differences found are also related to sex or coingestion of alcohol. MATERIAL AND METHODS: Descriptive observational study of patients treated in 11 emergency departments for symptoms related to cannabis use. We collected data on 11 clinical manifestations and used a restricted cubic spline model to analyze their relative frequency according to age. We also looked for any interactions between the findings and patient sex or alcohol coingestion. RESULTS: A total of 949 patients were studied. The mean age was 29 years, 74% were males, and 39% had also consumed alcohol. We identified 3 symptom patterns related to age. One set of symptoms (vomiting, headache, convulsions, and hypotension) remained stable across all ages. Manifestations that increased in the middle of the age range studied were agitation and aggressivity, psychosis, palpitations and hallucinations. Chest pain and hypertension increased in older-aged patients. The frequencies of palpitations, vomiting, and headache differed according to sex. These manifestations held constant in males but were markedly higher in young-adult females. Coingestion of alcohol was associated with agitation and aggressivity (in 34.0% vs 23.4%, P .001), fewer reports of palpitations (in 9.8% vs 15.6%, P = .01), less anxiety (in 20.7% vs 27.8%, P = .01), less psychosis (in 10.3% vs 16.6%, P = .007), and less chest pain (in 3.8% vs 9.5%, P = .001). The only significant interaction between age and alcohol coingestion occurred with respect to vomiting and psychosis. CONCLUSION: There are age-related differences in the acute clinical manifestations of cannabis poisoning requiring emergency hospital care. Sex and coingestion of alcohol modify the relationship between age and frequency of some manifestations.


OBJETIVO: Investigar si existen diferencias en las manifestaciones clínicas por consumo de cannabis según la edad, y si estas se modifican en función del sexo o el consumo de etanol. METODO: Estudio observacional descriptivo de pacientes atendidos en 11 servicios de urgencias con consumo de cannabis como motivo de consulta. Se recogieron 11 manifestaciones clínicas y se analizó su frecuencia relativa en función de la edad mediante curvas spline cúbicas restringidas. Se analizó si existía interacción en el comportamiento etario de cada uno de los síntomas en función del sexo y del consumo de etanol. RESULTADOS: Se analizaron 949 pacientes, edad media 29 años, 74% varones y 39% con coingesta de etanol. Se identificaron tres patrones de síntomas según la edad: estable (vómitos, cefalea, convulsiones, hipotensión), incrementada en edades medias (agresividad-agitación, ansiedad, psicosis, palpitaciones, alucinaciones) y con aumento progresivo con la edad (dolor torácico e hipertensión). En la relación síntoma-edad, la frecuencia de palpitaciones, vómitos y cefalea tuvo un comportamiento significativamente diferente según el sexo, más constante en hombres y con un incremento marcado en edades medias en mujeres. La coingesta de etanol se asoció con más agitación-agresividad (34,0%/23,4%, p 0,001) y menos palpitaciones (9,8%/15,6%, p = 0,01), ansiedad (20,7%/27,8%, p = 0,01), psicosis (10,3%/16,6%, p = 0,007) y dolor torácico (3,8%/9,5%, p = 0,001). En cuanto a la relación síntoma-edad, el etanol solo modificó significativamente la frecuencia de vómitos y de psicosis. CONCLUSIONES: La edad condiciona efectos clínicos diferenciales en algunas manifestaciones agudas de la intoxicación por cannabis que precisa asistencia hospitalaria, y el sexo y el consumo simultáneo de alcohol modifican esta relación entre edad y frecuencia de algunos síntomas.


Assuntos
Cannabis , Transtornos Psicóticos , Adulto , Dor no Peito/diagnóstico , Feminino , Cefaleia/epidemiologia , Cefaleia/etiologia , Humanos , Masculino , Vômito/epidemiologia , Vômito/etiologia
20.
BMC Neurol ; 22(1): 261, 2022 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-35836140

RESUMO

BACKGROUND: Lumbar puncture (LP) is a common and relatively safe neurological procedure. It can be complicated by post-dural puncture headache (PDPH) after both diagnostic and therapeutic procedures. The aim of this study is to identify the incidence, risk factors and clinical characterization of PDPH in the inpatient setting of the main tertiary neurology hospital in Kuwait. METHODS: We conducted a prospective observational cohort study that included patients who were admitted to neurology department at Ibn Sina hospital, Kuwait, from January 1, 2019 to December 31, 2020, on whom, LP was performed for diagnostic and/or therapeutic reasons. Multivariate logistic regression analysis was performed to evaluate the association between PDPH and different clinical parameters. RESULTS: A total of 285 patients were included; 225 females (78.9%), mean age of 32.9 ± 11.7 years. PDPH was reported by 84 patients (29.5%), with mean headache onset of 1.7 ± 0.8 days, and mean duration of 2.4 ± 2.1 days. The commonest headache type was dull aching in 49 patients (58.3%). Headache severity was mild to moderate in 64 patients (76.2%), with mean NRS of 4.1 ± 0.9. Most PDPH (99.3%) resolved with conservative medical management, with only 2 patients (0.7%) requiring epidural blood patch. In multivariate logistic regression model, there was a statistically significant correlation between development of PDPH and young age (p = 0.001), female gender (p = 0 .001), low BMI (p < 0 .001), pre-LP headache (p = 0.001), history of previous PDPH (p = 0.001), and number of LP attempts (p < 0.001). PDPH was statistically significantly higher in patients with optic neuritis (p = 0.009), and cerebral venous thrombosis (p = 0.007), and lower in patients with peripheral neuropathy (p = 0.011) and spinal muscular atrophy (p = 0.042). CONCLUSIONS: Findings from clinical practice in the main tertiary neurology hospital in Kuwait were in line with literature findings. Younger age, female gender, lower BMI, pre-procedural headache, previous history of PDPH, and number of LP attempts were found to be independent risk factors for developing PDPH. To our knowledge, this study represents the first comprehensive description of PDPH in a population from the Arabian Gulf Region.


Assuntos
Cefaleia Pós-Punção Dural , Adulto , Feminino , Cefaleia/etiologia , Humanos , Incidência , Cefaleia Pós-Punção Dural/epidemiologia , Estudos Prospectivos , Fatores de Risco , Punção Espinal/efeitos adversos , Adulto Jovem
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