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1.
J Evid Based Med ; 13(1): 70-80, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32073239

RESUMO

Headache is one of the most common clinical complaints and is listed as one of the top 10 disability disorders by the World Health Organization (WHO). For standardizing the diagnosis and treatment of headache and improve the level of clinical diagnosis and treatment of traditional Chinese medicine (TCM), on 30 January 2019, China Association of Chinese Medicine officially issued the Guidelines for Diagnosis and Treatment of Common Internal Diseases in Chinese Medicine-Headache (T/CACM 1271-2019). The Guidelines were developed following the method process recommended by Technical Requirements for the Revision of TCM Clinical Diagnosis and Treatment Guidelines (pilot edition), and also referring to WHO Handbook for Guideline Development. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was also followed. The protocol was formulated by the guideline project team, which comprised of specialists of TCM encephalopathy, guideline methodologist, patient representative, etc. Question regarding the treatment of headaches in TCM were formulated and 18 most important ones were chosen as PICOs (population, intervention, comparison, outcomes). Comprehensive search and review of the literature were performed and the quality of the evidence was assessed and rated based on certain criteria. Twenty-five recommendations were put forward in the Guidelines through three rounds of expert consensus based on their quality of evidence, in addition to the balance of pros and cons of these interventions, patient preferences and values, and economic factors. It is the first and the only clinical practice guide for Chinese medicine accepted by National Guidelines Clearinghouse in the world.


Assuntos
Cefaleia , Medicina Tradicional Chinesa , China , Cefaleia/diagnóstico , Cefaleia/terapia , Humanos , Guias de Prática Clínica como Assunto
2.
J Headache Pain ; 20(1): 100, 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31690261

RESUMO

BACKGROUND AND AIM: Headache is very often the cause for seeking an emergency department (ED). However, less is known about the different diagnosis of headache disorders in the ED, their management and treatment. The aim of this survey is to analyse the management of headache patients in two different ED in Europe. METHODS: This retrospective survey was performed from September 2018 until January 2019. Patients were collected from the San Luca Hospital, Milan, Italy and the Ordensklinikum Barmherzige Schwestern, Linz, Austria. Only patients with a non-traumatic headache, as the primary reason for medical clarification, were included. Patients were analysed for their complexity and range of examination, their diagnoses, acute treatment and overall efficacy rate. RESULTS: The survey consists of 415 patients, with a mean age of 43.32 (SD ±17.72); 65% were female. Technical investigation was performed in 57.8% of patients. For acute treatment non-steroidal-anti-inflammatory drugs (NSAIDs) were the most used, whereas triptans were not given. A primary headache disorder was diagnosed in 45.3% of patients, being migraine the most common, but in 32% of cases the diagnosis was not further specified. Life-threatening secondary headaches accounted for less than 2% of cases. CONCLUSIONS: The vast majority of patients attending an ED because of headache are suffering from a primary headache disorder. Life-threatening secondary headaches are rare but seek attention. NSAIDs are by far the most common drugs for treating headaches in the ED, but not triptans.


Assuntos
Serviço Hospitalar de Emergência , Cefaleia/diagnóstico , Transtornos de Enxaqueca/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios não Esteroides/uso terapêutico , Áustria , Feminino , Cefaleia/tratamento farmacológico , Transtornos da Cefaleia Primários/diagnóstico , Transtornos da Cefaleia Primários/tratamento farmacológico , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/tratamento farmacológico , Estudos Retrospectivos , Inquéritos e Questionários , Triptaminas/uso terapêutico , Adulto Jovem
3.
J Stroke Cerebrovasc Dis ; 28(12): 104443, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31611169

RESUMO

We herein report the case of a 45-year-old woman who developed a continuous hemicranial headache subsequent to vertebral artery dissection (VAD). After remission of VAD, the patient repeatedly experienced right forehead and temporal region throbbing headache, accompanied by nausea, ocular hyperemia and lacrimation of the right eye, nasal congestion, and rhinorrhea. Magnetic resonance angiography did not reveal the recurrence of dissection. Daily use of indomethacin (190.8 mg/day) showed an excellent effect on the headache, suggesting that the patient had developed hemicrania continua subsequent to VAD.


Assuntos
Cefaleia/etiologia , Dissecação da Artéria Vertebral/complicações , Inibidores de Ciclo-Oxigenase/uso terapêutico , Feminino , Cefaleia/diagnóstico , Cefaleia/tratamento farmacológico , Humanos , Indometacina/uso terapêutico , Pessoa de Meia-Idade , Resultado do Tratamento , Dissecação da Artéria Vertebral/diagnóstico por imagem
4.
BMJ Case Rep ; 12(9)2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31537596

RESUMO

We present an unusual case of skull base osteomyelitis in an 88-year-old woman. She presented with gradual onset unilateral headache and diplopia. On examination, there was evidence of a left-sided Horner's and ipsilateral sixth nerve palsy. In addition to persistent raised inflammatory markers, an MRI neck identified signal change in the petrous bone confirming a diagnosis of skull base osteomyelitis. Skull base osteomyelitis should be considered in presentations of subacute raised inflammatory markers in the context of ipsilateral cranial nerve signs.


Assuntos
Síndrome de Horner/diagnóstico , Osteomielite/complicações , Osso Petroso/microbiologia , Base do Crânio/microbiologia , Doenças do Nervo Abducente/diagnóstico , Doenças do Nervo Abducente/etiologia , Administração Intravenosa , Idoso de 80 Anos ou mais , Carbapenêmicos/administração & dosagem , Carbapenêmicos/uso terapêutico , Diplopia/diagnóstico , Diplopia/etiologia , Feminino , Cefaleia/diagnóstico , Cefaleia/etiologia , Humanos , Imagem por Ressonância Magnética/métodos , Osteomielite/tratamento farmacológico , Osso Petroso/diagnóstico por imagem , Osso Petroso/patologia , Base do Crânio/diagnóstico por imagem , Base do Crânio/patologia , Resultado do Tratamento
5.
J Headache Pain ; 20(1): 94, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481015

RESUMO

Migraine is a complex brain disorder and initiating events for acute attacks still remain unclear. It seems difficult to explain the development of migraine headache with one mechanism and/or a single anatomical location. Cortical spreading depression (CSD) is recognized as the biological substrate of migraine aura and experimental animal studies have provided mechanisms that possibly link CSD to the activation of trigeminal neurons mediating lateralized head pain. However, some CSD features do not match the clinical features of migraine headache and there are gaps in translating CSD to migraine with aura. Clinical features of migraine headache and results from research are critically evaluated; and consistent and inconsistent findings are discussed according to the known basic features of canonical CSD: typical SD limited to the cerebral cortex as it was originally defined. Alternatively, arguments related to the emergence of SD in other brain structures in addition to the cerebral cortex or CSD initiated dysfunction in the thalamocortical network are proposed. Accordingly, including thalamus, particularly reticular nucleus and higher order thalamic nuclei, which functions as a hub connecting the visual, somatosensory, language and motor cortical areas and subjects to modulation by brain stem projections into the CSD theory, would greatly improve our current understanding of migraine.


Assuntos
Depressão Alastrante da Atividade Elétrica Cortical/fisiologia , Cefaleia/fisiopatologia , Enxaqueca com Aura/fisiopatologia , Pesquisa Médica Translacional/métodos , Animais , Córtex Cerebral/fisiopatologia , Cefaleia/diagnóstico , Humanos , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/fisiopatologia , Enxaqueca com Aura/diagnóstico , Núcleos Talâmicos/fisiopatologia
6.
Rinsho Shinkeigaku ; 59(9): 596-599, 2019 Sep 25.
Artigo em Japonês | MEDLINE | ID: mdl-31474640

RESUMO

BACKGROUND AND PURPOSE: The purpose of this study was to elucidate the association between aseptic meningitis and jolt accentuation of headache (JAH) in adults. SUBJECTS AND METHOD: 87 patients with meningeal irritation (age; 35.6 ± 13.3 years old, 45 males) who were admitted to our hospital from 1st August 2013 to 31st August 2018 were included. The diagnosis was determined according to the following criteria:, aseptic meningitis was defined as cerebrospinal fluids (CSF) pleocytosis with no evidence of bacterial infection, fungal infection or carcinomatous findings; meningism was defined as the absence of CSF pleocytosis. None of these patients had consciousness disturbance and focal neurological abnormalities. The blood and CSF data were reviewed for analysis. RESULTS: 61 patients were in aseptic meningitis group, 26 patients were in meningism group. Multiple logistic regression analysis showed older age (OR 1.059, 95% Confidence interval (CI) 1.012-1.108, P = 0.013), lower CRP (OR 0.803, 95%CI 0.697-0.925, P = 0.002) and absence of JAH (OR 0.048, 95%CI 0.004-0.554, P = 0.015) were significantly associated with aseptic meningitis. The sensitivity and specificity of JAH in aseptic meningitis were 68.9%, 3.8%.


Assuntos
Cefaleia/diagnóstico , Cefaleia/etiologia , Meningite Asséptica/complicações , Doença Aguda , Adolescente , Adulto , Fatores Etários , Proteína C-Reativa , Líquido Cefalorraquidiano/citologia , Criança , Pré-Escolar , Feminino , Humanos , Leucocitose , Modelos Logísticos , Masculino , Meningite Asséptica/diagnóstico , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Fatores de Tempo , Adulto Jovem
7.
BMJ Case Rep ; 12(9)2019 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-31540922

RESUMO

We report a case that illustrates how chronic migraine headaches and multiple dental pathologies caused severe and long-standing cranial pain that affected the quality of life of a man for more than 35 years. His case was investigated at several settings including the neurology outpatient clinic of the hospital without a definitive diagnosis or resolution. After investigations, multiple oral pathologies including two occult dental abscesses were diagnosed. Once both affected teeth and associated abscesses were surgically removed, with subsequent antibiotic therapy the headaches resolved.


Assuntos
Antibacterianos/uso terapêutico , Cefaleia/diagnóstico , Transtornos de Enxaqueca/diagnóstico , Abscesso Periapical/diagnóstico , Qualidade de Vida/psicologia , Odontalgia/diagnóstico , Cefaleia/etiologia , Cefaleia/fisiopatologia , Cefaleia/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/etiologia , Transtornos de Enxaqueca/fisiopatologia , Transtornos de Enxaqueca/psicologia , Saúde Bucal , Abscesso Periapical/complicações , Abscesso Periapical/fisiopatologia , Abscesso Periapical/psicologia , Radiografia Dentária , Fatores de Tempo , Extração Dentária , Odontalgia/complicações , Odontalgia/fisiopatologia , Odontalgia/psicologia , Resultado do Tratamento
8.
Neurology ; 93(11): 487-499, 2019 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-31413171

RESUMO

OBJECTIVE: To provide evidence-based recommendations for the acute symptomatic treatment of children and adolescents with migraine. METHODS: We performed a systematic review of the literature and rated risk of bias of included studies according to the American Academy of Neurology classification of evidence criteria. A multidisciplinary panel developed practice recommendations, integrating findings from the systematic review and following an Institute of Medicine-compliant process to ensure transparency and patient engagement. Recommendations were supported by structured rationales, integrating evidence from the systematic review, related evidence, principles of care, and inferences from evidence. RESULTS: There is evidence to support the efficacy of the use of ibuprofen, acetaminophen (in children and adolescents), and triptans (mainly in adolescents) for the relief of migraine pain, although confidence in the evidence varies between agents. There is high confidence that adolescents receiving oral sumatriptan/naproxen and zolmitriptan nasal spray are more likely to be headache-free at 2 hours than those receiving placebo. No acute treatments were effective for migraine-related nausea or vomiting; some triptans were effective for migraine-related phonophobia and photophobia. RECOMMENDATIONS: Recommendations for the treatment of acute migraine in children and adolescents focus on the importance of early treatment, choosing the route of administration best suited to the characteristics of the individual migraine attack, and providing counseling on lifestyle factors that can exacerbate migraine, including trigger avoidance and medication overuse.


Assuntos
Academias e Institutos/normas , Transtornos de Enxaqueca/tratamento farmacológico , Neurologia/normas , Guias de Prática Clínica como Assunto/normas , Sociedades Médicas/normas , Adolescente , Criança , Combinação de Medicamentos , Cefaleia/diagnóstico , Cefaleia/tratamento farmacológico , Cefaleia/epidemiologia , Humanos , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/epidemiologia , Naproxeno/administração & dosagem , Relatório de Pesquisa/normas , Sumatriptana/administração & dosagem , Resultado do Tratamento , Estados Unidos/epidemiologia
9.
BMJ Case Rep ; 12(8)2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31451471

RESUMO

A 68-year-old man, with a history of non-Hodgkin's lymphoma in remission, was admitted for homonymous hemianopsia, headaches and subacute progressive cognitive decline. Imaging revealed brain infarcts and angiography suggested vasculitis. A brain biopsy, however, revealed an intravascular large B-cell lymphoma (IVLBL). Central nervous system (CNS) vasculitis and IVLBL of the brain are extremely rare diseases that can have an almost identical clinical presentation. Angiographic findings are very similar but usually are reported as compatible with vasculitis. Brain biopsy or a random skin biopsy are crucial in diagnosing IVLBL as the accuracy of angiographic findings for CNS vasculitis is low.


Assuntos
Neoplasias Encefálicas , Encéfalo , Linfoma Difuso de Grandes Células B , Vasculite do Sistema Nervoso Central/diagnóstico , Idoso , Biópsia/métodos , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/fisiopatologia , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Diagnóstico Diferencial , Cefaleia/diagnóstico , Cefaleia/etiologia , Hemianopsia/diagnóstico , Hemianopsia/etiologia , Humanos , Linfoma Difuso de Grandes Células B/diagnóstico , Linfoma Difuso de Grandes Células B/patologia , Linfoma Difuso de Grandes Células B/fisiopatologia , Masculino
10.
BMJ Case Rep ; 12(7)2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31289153

RESUMO

Sarcomatoid carcinoma is a rare clinical entity, especially when presenting in the nasopharynx. We describe the first documented case of nasopharyngeal sarcomatoid carcinoma with intracranial extension in a 59-year-old Caucasian man presenting with severe bifrontal headache and diplopia, secondary to left abducens nerve palsy. We highlight some of the major diagnostic challenges and describe its unusual histological appearance. We outline the importance of a multidisciplinary approach to his management, which includes input from the medicine, neurosurgery, Ear, Nose and Throat (ENT), pathology, radiology, oncology and respiratory teams. In the context of limited evidence, we then describe the rationale to proceed with induction chemotherapy followed by concurrent chemoradiotherapy. Although there was a partial response to treatment, it was not sufficient enough to allow subsequent surgical clearance. The plan going forward is to palliate with chemotherapy as and when the disease progresses.


Assuntos
Quimiorradioterapia/métodos , Quimioterapia de Indução/métodos , Carcinoma Nasofaríngeo/patologia , Sarcoma/patologia , Doenças do Nervo Abducente/complicações , Doenças do Nervo Abducente/etiologia , Diplopia/etiologia , Cefaleia/diagnóstico , Cefaleia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma Nasofaríngeo/diagnóstico por imagem , Carcinoma Nasofaríngeo/terapia , Neoplasias Nasofaríngeas/patologia , Invasividade Neoplásica , Equipe de Assistência ao Paciente/normas , Sarcoma/terapia , Tomografia Computadorizada por Raios X , Conduta Expectante
11.
Acta Neurol Scand ; 140(4): 290-295, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31269227

RESUMO

OBJECTIVES: To identify possible risk factors influencing the incidence of intravenous immunoglobulin (IVIg) treatment-related cephalalgia in neurological diseases. MATERIALS & METHODS: Retrospective chart review of neurological patients receiving IVIg treatment between July 13, 2017, and August 14, 2017. Patients with MS receiving natalizumab in the same setting were observed as a reference group. RESULTS: Patients with headache after IVIg infusion (n = 22 infusions) showed a reduced heart rate (by 6.0 ± 8.5 beats per minute [bpm]), but no significant difference in blood pressure. Patients without headache after IVIg infusion (n = 69 infusions) showed a higher systolic blood pressure increase and a stronger reduction in the heart rate (by 5.7 ± 8.6 bpm), compared to patients with headache after IVIg infusion. The infusion rate was significantly slower and age significantly lower in patients developing headache after IVIg infusion. Body temperature was unchanged in both groups. Binary logistic regression analysis revealed that blood pressure at baseline and age significantly influence the occurrence of cephalalgia. In reference, patients receiving natalizumab (ie, shorter infusions/smaller infusion volume), systolic blood pressure, and heart rate decreased, while body temperature increased. Here, one patient developed headache. CONCLUSIONS: Intravenous immunoglobulin-associated headache is not associated with an increased blood pressure after infusion but with a reduced heart rate, a slower infusion rate, female sex and seems to be influenced by baseline systolic blood pressure and age. A reaction to immunoglobulin aggregates, stabilizers, or vasoactive mediators are possible explanations. The absence of an association with body temperature does not suggest a systemic immune response as a cause for headache.


Assuntos
Cefaleia/induzido quimicamente , Cefaleia/fisiopatologia , Imunoglobulinas Intravenosas/administração & dosagem , Imunoglobulinas Intravenosas/efeitos adversos , Doenças do Sistema Nervoso/tratamento farmacológico , Doenças do Sistema Nervoso/fisiopatologia , Adulto , Idoso , Pressão Sanguínea/efeitos dos fármacos , Pressão Sanguínea/fisiologia , Feminino , Cefaleia/diagnóstico , Frequência Cardíaca/efeitos dos fármacos , Frequência Cardíaca/fisiologia , Humanos , Infusões Intravenosas/efeitos adversos , Infusões Intravenosas/métodos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Fatores de Tempo , Resultado do Tratamento
12.
BMJ Case Rep ; 12(7)2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31340940

RESUMO

A 30-year-old nulliparous woman at 38 5/7 weeks of gestation developed a sudden, severe headache at work and subsequent loss of consciousness. She underwent evaluation in the emergency department. CT and CT angiogram head revealed a large intraparenchymal haematoma with intraventricular extension secondary to ruptured cerebral arteriovenous malformation (cAVM). She was intubated and transferred to a tertiary care centre. The patient underwent caesarean section followed by partial embolisation of the cAVM with planned second embolisation and resection 1 week later. Due to drowsiness and headache, the planned repeat embolisation and cAVM resection were performed 3 days earlier. The patient had a full recovery. Emergency medicine physicians and obstetrician-gynaecologists should be familiar with differential diagnosis of sudden headache in pregnancy and signs of a ruptured cAVM to facilitate early diagnosis, multidisciplinary team approach and timely treatment. Early diagnosis and management of ruptured cAVM are important due to associated morbidity and mortality.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Embolização Terapêutica/métodos , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/terapia , Ruptura Espontânea/terapia , Adulto , Cesárea , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Idade Gestacional , Cefaleia/diagnóstico , Cefaleia/etiologia , Humanos , Malformações Arteriovenosas Intracranianas/fisiopatologia , Gravidez , Resultado da Gravidez , Medição de Risco , Ruptura Espontânea/diagnóstico por imagem , Síncope/diagnóstico , Síncope/etiologia
15.
Med Hypotheses ; 128: 21-24, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31203903

RESUMO

Migraine is highly prevalent and disabling disorder, but despite that one of the main problems that remains in the clinical practice is delayed diagnosis and delayed specific treatment that has impact on patients' quality of life and productivity. There should be easy acceptable method to select those patients who might have migraine and who need to be referred to neurologist's consultation. We hypothesize that our created KAMST questionnaire is reliable method to select patients who might have migraine in primary care. To evaluate our hypothesis we made a research that consisted of two parts. Part A consisted of closed type questions made by The International Classification of Headache Disorders 3rd edition diagnostic criteria of migraine without aura. Part B was KAMST questionnaire. 298 patients were questioned. 209 (72%) of them were women and 89 (28%) - men. According to The International Classification of Headache Disorders 3rd edition migraine without aura diagnostic criteria, migraine was diagnosed for 42 (14,1%) patients, and according our KAMST questionnaire - 83 (27,9%). From 42 patients whom migraine was diagnosed with The International Classification of Headache Disorders 3rd edition criteria, 34 (81%) of these patients migraine was diagnosed with KAMST. From 256 patients whom migraine wasn't diagnosed with The International Classification of Headache Disorders 3rd edition criteria, 49 of them (19,1%) migraine was diagnosed with KAMST. We found statistically significant difference between questionnaires. KAMST sensitivity was - 81%, specificity - 81%, predictive positive value - 41%, predictive negative value - 96%, the Cronbach alpha for the total scale was 0,604. Our KAMST questionnaire of migraine is reliable and valid method for patients' screening but has some limitations.


Assuntos
Transtornos de Enxaqueca/diagnóstico , Neurologia/métodos , Neurologia/normas , Inquéritos e Questionários , Adolescente , Adulto , Idoso , Criança , Feminino , Cefaleia/diagnóstico , Transtornos da Cefaleia/diagnóstico , Humanos , Classificação Internacional de Doenças , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Atenção Primária à Saúde , Qualidade de Vida , Sensibilidade e Especificidade , Adulto Jovem
16.
J Headache Pain ; 20(1): 70, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31195960

RESUMO

BACKGROUND: Questionnaire-based headache diagnoses should be validated against diagnoses made by the gold standard, which is personal interview by a headache expert. The diagnostic algorithm with the best diagnostic accuracy should be used when later analysing the data. METHODS: The Nord-Trøndelag Health Study (HUNT4) was performed between 2017 and 2019. Among HUNT4 participants, a total of 232 (19.3%) out of 1201 randomly invited were interviewed by a headache expert to assess the sensitivity, specificity and kappa value of the questionnaire-based headache diagnoses. RESULTS: The median interval between answering the headache questions and the validation interview was 60 days (95% CI 56-62 days). The best agreements were found for self-reported lifetime migraine (sensitivity of 59%, specificity of 99%, and a kappa statistic of 0.65, 95% CI 0.55-0.75), self-reported active migraine (sensitivity of 50%, specificity of 97%, and a kappa statistic of 0.55, 95% 0.39-0.71), liberal criteria of migraine (sensitivity of 64%, specificity of 93%, and a kappa statistic of 0.58, 95% CI 0.43-0.73) and ICDH3-based migraine ≥1 days/month (sensitivity of 50%, specificity of 94%, and a kappa statistic of 0.49, 95% CI 0.30-0.68). For headache suffering ≥1 days/month a sensitivity of 90%, specificity 80%, and a kappa statistic of 0.55, 95% CI 0.41-0-69 were found. For tension-type headache (TTH) ≥ 1 days/month the agreement was 0.33 (95% CI 0.17-0.49). CONCLUSION: The HUNT4 questionnaire is a valid tool for identifying persons with lifetime migraine, self-reported active migraine and active migraine applying liberal modified criteria. The agreement for TTH was fair.


Assuntos
Cefaleia/diagnóstico , Transtornos de Enxaqueca/diagnóstico , Inquéritos e Questionários/normas , Cefaleia do Tipo Tensional/diagnóstico , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Autorrelato , Sensibilidade e Especificidade
17.
J Med Case Rep ; 13(1): 182, 2019 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-31200772

RESUMO

BACKGROUND: Development of neurological complications of varicella zoster virus reactivation is relatively uncommon, particularly in an immunocompetent child. CASE PRESENTATION: An 11-year-old Asian girl presented with headache and skin rash on her left chest. She was diagnosed with meningitis, and herpes zoster was confirmed by polymerase chain reaction using cerebrospinal fluid. Acyclovir was administered intravenously. Given the favorable evolution of the clinical course, she was discharged from the hospital on day 8 of her illness. She had no apparent sequelae or comorbidities at the time of the 6-week follow-up. CONCLUSIONS: Neurological complications such as meningitis due to varicella zoster virus reactivation are uncommon, especially in an immunocompetent child; no specific immune deficiency was identified in our patient. We conclude that, although rare, varicella zoster virus should be recognized as a potential cause of viral meningitis in immunocompetent children.


Assuntos
Aciclovir/administração & dosagem , Líquido Cefalorraquidiano/virologia , Herpes Zoster , Herpesvirus Humano 3/isolamento & purificação , Meningite Viral , Administração Intravenosa , Antivirais , Criança , Exantema/diagnóstico , Exantema/etiologia , Feminino , Cefaleia/diagnóstico , Cefaleia/etiologia , Herpes Zoster/complicações , Herpes Zoster/diagnóstico , Herpes Zoster/tratamento farmacológico , Herpes Zoster/fisiopatologia , Humanos , Imunocompetência , Meningite Viral/diagnóstico , Meningite Viral/tratamento farmacológico , Meningite Viral/etiologia , Meningite Viral/fisiopatologia , Resultado do Tratamento
18.
J Neurol ; 266(10): 2430-2433, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31201499

RESUMO

Traumatic brain injury (TBI) is the commonest cause of disability in under-40-year-olds. Vestibular features of dizziness (illusory self-motion) or imbalance which affects 50% of TBI patients at 5 years, increases unemployment threefold in TBI survivors. Unfortunately, vestibular diagnoses are cryptogenic in 25% of chronic TBI cases, impeding therapy. We hypothesized that chronic adaptive brain mechanisms uncouple vestibular symptoms from signs. This predicts a masking of vestibular diagnoses chronically but not acutely. Hence, defining the spectrum of vestibular diagnoses in acute TBI should clarify vestibular diagnoses in chronic TBI. There are, however, no relevant acute TBI data. Of 111 Major Trauma Ward adult admissions screened (median 38-years-old), 96 patients (87%) had subjective dizziness (illusory self-motion) and/or objective imbalance were referred to the senior author (BMS). Symptoms included: feeling unbalanced (58%), headache (50%) and dizziness (40%). In the 47 cases assessed by BMS, gait ataxia was the commonest sign (62%) with half of these cases denying imbalance when asked. Diagnoses included BPPV (38%), acute peripheral unilateral vestibular loss (19%), and migraine phenotype headache (34%), another potential source of vestibular symptoms. In acute TBI, vestibular signs are common, with gait ataxia being the most frequent one. However, patients underreport symptoms. The uncoupling of symptoms from signs likely arises from TBI affecting perceptual mechanisms. Hence, the cryptogenic nature of vestibular symptoms in TBI (acute or chronic) relates to a complex interaction between injury (to peripheral and central vestibular structures and perceptual mechanisms) and brain-adaptation, emphasizing the need for acute prospective, mechanistic studies.


Assuntos
Lesões Encefálicas Traumáticas , Marcha Atáxica , Cefaleia , Doenças Vestibulares , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/fisiopatologia , Feminino , Marcha Atáxica/diagnóstico , Marcha Atáxica/etiologia , Marcha Atáxica/fisiopatologia , Cefaleia/diagnóstico , Cefaleia/etiologia , Cefaleia/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Vestibulares/diagnóstico , Doenças Vestibulares/etiologia , Doenças Vestibulares/fisiopatologia , Adulto Jovem
19.
Curr Pain Headache Rep ; 23(7): 46, 2019 05 30.
Artigo em Inglês | MEDLINE | ID: mdl-31147799

RESUMO

This review will focus on the most recent information regarding the ICHD-3 definition of diving headache as well as other important causes of diving headache that are not listed in the ICHD-3 classification system. The paper will discuss etiology, diagnosis, and management of these disorders, focusing, when possible, on the newest research available. ICHD-3 diving headache is due to hypercapnia and is treated accordingly with oxygen. Other causes of diving headache range from decompression sickness to external compression headache to primary headache disorders, such as migraine. Correctly determining the underlying cause of the diving headache is critical to management and relies on history taking and physical exam. The pathophysiology of newly described types of diving headache, such as diving ascent headache, remains under investigation but may be related to other homeostatic headache causes, such as airplane headache. Further investigation may yield more information regarding management as well as possible insight into other headache disorders.


Assuntos
Barotrauma/fisiopatologia , Mergulho , Cefaleia/diagnóstico , Cefaleia/etiologia , Doença da Descompressão/fisiopatologia , Gerenciamento Clínico , Cefaleia/terapia , Humanos , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/fisiopatologia
20.
Curr Pain Headache Rep ; 23(7): 47, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31147848

RESUMO

PURPOSE OF REVIEW: Cerebral venous thrombosis (CVT) is a neurovascular disease caused by a thrombotic occlusion of either a dural sinus or cerebral vein. CVT results in a variety of neurological symptoms with the most common being headache. The purpose of this review is to characterize CVT, describe the headache pattern, and, finally, provide an update to date review of diagnostic and treatment options for this condition. RECENT FINDINGS: CVT is a very difficult disease to diagnose due to the variability in both patient presentation and imaging findings. Recent literature has attempted to standardize its risk factors, diagnosis, and treatment modalities. Additionally, new laboratory studies are being investigated for CVT patients who present with isolated headaches. CVT is a debilitating disease requiring immediate medical or surgical intervention. Because the disease can mask as a multitude of neurological deficits, patients are not properly diagnosed. Headache is the most common patient presentation. The quality of this headache is highly variable with no specific location or pattern. New literature has provided insight into potential diagnostic and treatment options for CVT patients. However, further large-scale cohort studies are necessary to standardize the care for this disease.


Assuntos
Encéfalo/fisiopatologia , Cefaleia , Trombose Intracraniana , Trombose Venosa , Encéfalo/irrigação sanguínea , Diagnóstico por Imagem/métodos , Cefaleia/diagnóstico , Cefaleia/terapia , Humanos , Trombose Intracraniana/diagnóstico , Trombose Intracraniana/terapia , Fatores de Risco , Trombose Venosa/diagnóstico , Trombose Venosa/terapia
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