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1.
Adv Exp Med Biol ; 1161: 193-217, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31562631

RESUMO

Headache is a common complaint after mild traumatic brain injury (mTBI). Changes in the CNS lipidome were previously associated with acrolein-induced headache in rodents. mTBI caused similar headache-like symptoms in rats; therefore, we tested the hypothesis that mTBI might likewise alter the lipidome. Using a stereotaxic impactor, rats were given either a single mTBI or a series of 4 mTBIs 48 h apart. 72 h later for single mTBI and 7 days later for repeated mTBI, the trigeminal ganglia (TG), trigeminal nucleus (TNC), and cerebellum (CER) were isolated. Using HPLC/MS/MS, ~80 lipids were measured in each tissue and compared to sham controls. mTBI drove widespread alterations in lipid levels. Single mTBI increased arachidonic acid and repeated mTBI increased prostaglandins in all 3 tissue types. mTBI affected multiple TRPV agonists, including N-arachidonoyl ethanolamine (AEA), which increased in the TNC and CER after single mTBI. After repeated mTBI, AEA increased in the TG, but decreased in the TNC. Common to all tissue types in single and repeated mTBI was an increase the AEA metabolite, N-arachidonoyl glycine, a potent activator of microglial migration. Changes in the CNS lipidome associated with mTBI likely play a role in headache and in long-term neurodegenerative effects of repeated mTBI.


Assuntos
Lesões Encefálicas Traumáticas , Sistema Nervoso Central , Cefaleia , Inflamação , Lipídeos , Neoplasias , Animais , Lesões Encefálicas Traumáticas/fisiopatologia , Sistema Nervoso Central/fisiopatologia , Cefaleia/fisiopatologia , Inflamação/fisiopatologia , Lipídeos/química , Lipídeos/genética , Lipídeos/fisiologia , Neoplasias/fisiopatologia , Ratos
2.
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
3.
J Headache Pain ; 20(1): 97, 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31492115

RESUMO

BACKGROUND: The International Classification of Headache Disorders diagnostic criteria for Headache Attributed to Transient Ischemic Attack (TIA) and many other secondary headaches are based primarily on the opinion of experts. The aim of this study was to field test, for the first time, the diagnostic criteria for headache attributed to TIA of the International Classification of Headache Disorders, 3rd edition (ICHD-3) and in case of their weaknesses to propose new diagnostic criteria. METHODS: Consecutive patients with Transient Ischemic Attack and a simultaneous control group were extensively interviewed soon after admission. Data were collected on previous headaches, headaches around the time of Transient Ischemic Attack and characteristics of the TIA using validated neurologist conducted semi-structured interview forms. The evidence of relevant infarction were excluded in patients with Transient Ischemic Attack using magnetic resonance imaging with diffusion-weighted imaging (n = 112) or computed tomography (n = 8). RESULTS: One hundred twenty patients with Transient Ischemic Attack and 192 controls were included. A new type of headache occurred within 24 h in 16 (13%) of patients with Transient Ischemic Attack and in no controls, a preexisting type of headache with altered characteristics occurred in 9 (7.5%) of patients with Transient Ischemic Attack and no in controls, headache without altered characteristics occurred in 8 (6.6%) of patients with Transient Ischemic Attack and in 9 (4.6%) controls. Only 24% of the headaches in patients with Transient Ischemic Attack (8 of 33 patients) fulfilled the diagnostic criteria of International Classification of Headache Disorders-3 and no control patients. We propose new criteria fulfilled by 94% of the headaches. Specificity remained excellent as only one of 192 controls had a headache fulfilling the proposed criterion C. CONCLUSIONS: Existing diagnostic criteria for headache attributed to TIA of the International Classification of Headache Disorders are too insensitive. We suggest new diagnostic criteria with high sensitivity and preserved specificity.


Assuntos
Cefaleia/diagnóstico por imagem , Cefaleia/etiologia , Ataque Isquêmico Transitório/complicações , Ataque Isquêmico Transitório/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética/métodos , Feminino , Cefaleia/fisiopatologia , Humanos , Ataque Isquêmico Transitório/fisiopatologia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tomografia Computadorizada por Raios X/métodos
4.
Am J Med ; 132(8): 984-991, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31402050

RESUMO

PURPOSE: We aimed to evaluate the role of caffeinated beverage intake as a potential trigger of migraine headaches on that day or on the following day. METHODS: In this prospective cohort study, 101 adults with episodic migraine completed electronic diaries every morning and evening. Ninety-eight participants completed at least 6 weeks of diaries in March 2016-October 2017. Every day, participants reported caffeinated beverage intake, other lifestyle factors, and the timing and characteristics of each migraine headache. We compared a participant's incidence of migraines on days with caffeinated beverage intake to the incidence of migraines among the same individual on days with no intake, accounting for day of week. We used conditional logistic regression to estimate odds ratios (OR) and 95% confidence intervals. RESULTS: Among 98 participants (86 women, 12 men) with mean age 35.1 years, 83% white, and 10% Hispanic or Latino, the average age when headaches started was 16.3 years. In total, the participants reported 825 migraines during 4467 days of observation. There was a statistically significant nonlinear association between the number of caffeinated beverages and the odds of migraine headache occurrence on that day (P-quadratic trend = .024), though estimates for each level of intake were not statistically significant. The associations varied according to habitual intake and oral contraceptive use. CONCLUSIONS: There was a nonlinear association between caffeinated beverage intake and the odds of migraine headache occurrence on that day. This suggests that high levels of caffeinated beverage intake may be a trigger of migraine headaches on that day.


Assuntos
Cafeína/efeitos adversos , Cefaleia/etiologia , Transtornos de Enxaqueca/etiologia , Adulto , Bebidas/efeitos adversos , Cafeína/metabolismo , Estudos de Coortes , Feminino , Cefaleia/fisiopatologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/fisiopatologia , Estudos Prospectivos , Fatores de Risco , Inquéritos e Questionários
5.
Biol Aujourdhui ; 213(1-2): 43-49, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31274102

RESUMO

A large body of clinical and pre-clinical evidence has shown complex interactions between bottom-up and top-down mechanisms that are essential for the discrimination of noxious information and pain perception. These endogenous systems, mainly originating from the brainstem, hypothalamus and cerebral cortex, are strongly influenced by behavioral, cognitive and emotional factors that are relevant for the survival of the individual. Under pathological conditions, however, dysfunctional engagement of these descending pathways certainly contributes to the transformation from acute into chronic pain states. In disorders such as primary headaches, dysfunctions affecting brain regulation mechanisms contribute to the generation of episodic painful states in susceptible individuals, and to the evolution from acute to chronic migraine or cluster headache. Taken together, these studies support the concept that CNS mechanisms that process trigemino-vascular pain do not consist only of a bottom-up process, whereby a painful focus modifies the inputs to the next higher level. Indeed, several CNS regions mediate subtle forms of plasticity by adjusting neural maps downstream and, consequently, altering all the modulatory mechanisms as a result of sensory, autonomic, endocrine, cognitive and emotional influences. Disturbances in normal sensory processing within these loops could lead to maladaptive changes and impaired craniofacial functions at the origin of primary headaches.


Assuntos
Encéfalo/fisiopatologia , Cefaleia/etiologia , Cefaleia/fisiopatologia , Rede Nervosa/fisiopatologia , Animais , Transtornos Cerebrovasculares/etiologia , Transtornos Cerebrovasculares/fisiopatologia , Cefaleia/psicologia , Humanos , Rede Nervosa/patologia , Dor/etiologia , Dor/fisiopatologia , Percepção da Dor/fisiologia , Ratos
6.
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
7.
Clin EEG Neurosci ; 50(5): 366-369, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31215229

RESUMO

Introduction. Posterior reversible encephalopathy syndrome (PRES) is a relatively common cause of encephalopathy in the hospital setting, and the EEG findings have not been well described. The purpose of this study was to review the EEG findings in a series of patients with PRES. Methods. We retrospectively reviewed our electronic medical record database to identify patients who received a diagnosis of PRES at Tampa General Hospital from January 2016 to October 2017. The diagnosis of PRES was suspected on clinical presentation and confirmed by magnetic resonance imaging. We selected patients with PRES who had received at least 1 EEG. EEGs were interpreted by 2 board-certified electroencephalographers. Results. From January 2016 to October 2017, 19 patients were diagnosed with PRES at Tampa General Hospital. Of those, 10 received at least 1 EEG. Four patients were male, 6 were female. The ages ranged from 21 to 87 (mean was 47). The patients had the following clinical presentations: 5 with encephalopathy, 8 with seizures, 2 with vision changes, and 3 with headache (some patients had more than 1 symptom). EEGs findings were as follows: 3 were normal; 3 showed intermittent generalized slowing; 2 showed continuous generalized slowing; 3 showed background slowing; 1 showed background suppression; 1 showed generalized rhythmic delta activity (GRDA); 1 showed GRDA, plus spike/sharp-wave discharges; 1 showed generalized periodic discharges. The etiologies were as follows: 9 from hypertension, 1 secondary to eclampsia, 3 due to posttransplant immunosuppression, and 1 patient was undergoing chemotherapy (some were multifactorial). Conclusion. EEG findings in PRES are diverse, with no specific or even predominant pattern, based on this small sample size.


Assuntos
Encefalopatias/fisiopatologia , Eletroencefalografia , Síndrome da Leucoencefalopatia Posterior/fisiopatologia , Convulsões/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Eletroencefalografia/métodos , Feminino , Cefaleia/fisiopatologia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Síndrome da Leucoencefalopatia Posterior/diagnóstico , Estudos Retrospectivos
9.
Auris Nasus Larynx ; 46(5): 724-733, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31054848

RESUMO

OBJECTIVE: The aim of the present study was to evaluate complaints in people with Ménière's disease (MD) with and without migraine and headache to study the association between MD and Vestibular Migraine (VM). We believe this will help us understand if these two disorders represent a disease continuum in that they may share a common aetiology. METHODS: The study used a retrospective design and included data of 911 patients with MD from the Finnish Ménière Federation database. The study participants had a mean age of 60.2 years, mean duration of disease of 12.6 years, and 78.7% of the participants were females. The questionnaire data comprised of both disease specific and impact related questions. The data were analyzed using the Mann-Whitney U test, the Kruskal Wallis H test, logistic regression analyses, and decision tree analysis. RESULTS: Migraine and headache was reported by 190 subjects (20.9%) and 391 subjects (42.9%) respectively. We found that patients that could be classified as VM in the study (i.e., those with frequent vertigo spells associated with migraine) more often reported complaints of severe MD symptoms, had reduced health-related quality of life, suffered more from anxiety, had more neurological complaints, and experienced a reduced sense of coherence than the non-migraneous patients with MD. However, neither the decision tree analysis nor the logistic regression analysis could reliably discriminate VM from MD patients. CONCLUSION: Our study results confirm that MD is frequently associated with headache and migraine. In addition, results also indicate that migraine provokes the severity of MD. We suggest that MD and VM may share similar pathophysiological mechanisms. Hence, the future MD classification systems should include a category referred to as 'MD with migraine' that will include patients with VM.


Assuntos
Doença de Meniere/epidemiologia , Transtornos de Enxaqueca/epidemiologia , Vertigem/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade , Feminino , Finlândia/epidemiologia , Cefaleia/epidemiologia , Cefaleia/fisiopatologia , Humanos , Modelos Logísticos , Masculino , Doença de Meniere/fisiopatologia , Pessoa de Meia-Idade , Transtornos de Enxaqueca/fisiopatologia , Qualidade de Vida , Estudos Retrospectivos , Senso de Coerência , Vertigem/fisiopatologia
10.
BMJ Case Rep ; 12(5)2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-31133549

RESUMO

A sexual headache or coital cephalgia is a headache associated with sexual activity and is a well-recognised condition. It is usually benign, primary and self-limiting. However, occasionally sexual headaches can result from more sinister causes. Intraparenchymal and subdural haemorrhages have been reported as secondary causes of sexual headaches. We present the case of a 61-year-old woman with no comorbidities who presented acutely with a sexual headache and vision loss, and was found to have an occipital and parietal intraparenchymal haemorrhage. She was normotensive and after extensive workup was found to have no predisposing condition for her haemorrhage. The patient had an uneventful recovery with physical rehabilitation and had regular follow-ups, with no residual weakness. She was in a completely normal state of health 1 year after her event, and continued to be off any medications.


Assuntos
Coito/fisiologia , Cefaleia/etiologia , Hemorragias Intracranianas/complicações , Doença Aguda , Feminino , Cefaleia/diagnóstico , Cefaleia/fisiopatologia , Humanos , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/reabilitação , Pessoa de Meia-Idade , Comportamento Sexual/fisiologia , Resultado do Tratamento
11.
Biomed Res Int ; 2019: 4829102, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31016190

RESUMO

This study aimed to summarize the clinical features, diagnosis, and treatment of Chiari malformation type I- (CM-1-) associated syringobulbia. We performed a literature review of CM-1-associated syringobulbia in PubMed, Ovid MEDLINE, and Web of Science databases. Our concerns were the clinical features, radiologic presentations, treatment therapies, and prognoses of CM-1-associated syringobulbia. This review identified 23 articles with 53 cases. Symptoms included headache, neck pain, cranial nerve palsy, limb weakness/dysesthesia, Horner syndrome, ataxia, and respiratory disorders. The most frequently involved area was the medulla. Most of the patients also had syringomyelia. Surgical procedures performed included posterior fossa decompression, foramen magnum decompression, cervical laminectomy, duraplasty, and syringobulbic cavity shunt. Most patients experienced symptom alleviation or resolution postoperatively. A syringobulbic cavity shunt provided good results in refractory cases. Physicians should be aware of the possibility of syringobulbia in CM-1 patients, especially those with symptoms of sudden-onset brain-stem involvement. The diagnosis relies on the disorder's specific symptomatology and magnetic resonance imaging. Our review suggests that the initial therapy should be posterior fossa decomposition with or without duraplasty. In refractory cases, additional syringobulbic cavity shunt is the preferred option.


Assuntos
Malformação de Arnold-Chiari/diagnóstico , Malformação de Arnold-Chiari/terapia , Bulbo/fisiopatologia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Cefaleia/fisiopatologia , Humanos , Lactente , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Siringomielia/fisiopatologia , Resultado do Tratamento , Adulto Jovem
12.
World Neurosurg ; 128: e81-e86, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30974276

RESUMO

BACKGROUND: Intracranial meningioma is the most common brain tumor operated in the 2 teaching hospitals in Ethiopia. This study reviews the clinical outcome of intracranial meningiomas in a resource-limited setup. METHODS: This is a retrospective study undertaken at 2 neurosurgical teaching hospitals: Black Lion Specialized Hospital and Myungsung Christian Medical Center. It includes all operated patients with intracranial meningioma during the time period January 2009 to December 2013. Patient data regarding sociodemographics, presenting complaint, focal neurologic deficit, preoperative imaging, postoperative neurologic findings, intraoperative findings, and histopathologic results were collected and analyzed. RESULTS: A total of 91 patients were enrolled in the study. Tumor size was estimated in 79 cases (86.8%). Fifty-one tumors (64.6%) were >5 cm in diameter, whereas 28 (35.4%) were ≤5 cm. Only 4 patients had tumors <3 cm (5.1%). Tumor size was shown to be related to postoperative functional outcome (P = 0.032). The surgical mortality rate, which was defined as death within 1 month, was 14.3%. Among 88 patients with a postoperative Karnofsky Performance Status Scale score, 43% achieved a postoperative score ≥70. CONCLUSIONS: Meningioma size determines the outcome of the patients. It was shown that the functional outcome of patients is encouraging even though further improvement on neurosurgical care is needed.


Assuntos
Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Adolescente , Adulto , Idoso , Anticonvulsivantes/uso terapêutico , Criança , Doenças dos Nervos Cranianos/etiologia , Doenças dos Nervos Cranianos/fisiopatologia , Etiópia/epidemiologia , Feminino , Glucocorticoides/uso terapêutico , Cefaleia/etiologia , Cefaleia/fisiopatologia , Hospitais de Ensino , Humanos , Masculino , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/patologia , Neoplasias Meníngeas/fisiopatologia , Meningioma/complicações , Meningioma/patologia , Meningioma/fisiopatologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Adulto Jovem
14.
Neurol Sci ; 40(Suppl 1): 75-80, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30906962

RESUMO

Migraine is a common, severe disease, affecting the brain and blood vessels, causing much pain, time missed from work and family, and severe disability. It affects approximately 12% of most Western populations studied and affects women three times more than men. Cluster headache is a much less common dysfunction of the hypothalamus, involving the sphenopalatine ganglion and other areas; it causes more frequent, shorter, and even more intense pain than migraine. The pain usually comes in cycles and is associated with ipsilateral autonomic features and associated with irritability and inability to stay still. It affects less than 0.1% of the population and is slightly more prevalent in men than women. Although we have some acute care and preventive medications for both types of headache, no treatment is optimal for each patient and some will not respond well or have significant adverse events to existing therapies.


Assuntos
Cefaleia Histamínica/tratamento farmacológico , Cefaleia/tratamento farmacológico , Transtornos de Enxaqueca/tratamento farmacológico , Manejo da Dor , Peptídeo Relacionado com Gene de Calcitonina/sangue , Cefaleia Histamínica/fisiopatologia , Cefaleia/fisiopatologia , Humanos , Transtornos de Enxaqueca/fisiopatologia , Dor/diagnóstico , Dor/fisiopatologia
15.
Neurol Sci ; 40(Suppl 1): 27-29, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30919200

RESUMO

Why does the brain choose pain? Why does an organ that is able to mask pain, even when intense as in fractures or in fighting wounds, decide to let pain pass and begin conscious, such as that of migraine, when there is no noxa patogena and there is no threat to the integrity of the organism, failing in the main function of pain, that of protection? In this brief review, we retrace the journey that led to the identification of the first complex mechanism of regulation of painful input, the spinal gate control system, through the identification of the predominantly thalamocortical supraspinal centers of the neuromatrix, up to the recognition of a pain matrix extremely articulate and sophisticated that integrates elementary sensations with much more complex functions, related to memory, affectivity, emotion, autonomic self-regulation, and homeostasis systems and so on. Why does the protection system lose its fundamental function in migraine in a behavioral harakiri that periodically damages only itself? This is the challenge facing those dealing with primary headaches in the next future: why migraine? The great strides made in the last decades that have led to the understanding of complex pathogenetic mechanisms risk remaining orphans if we fail to identify the primum movens at the base of one of the most common pathologies in the human race.


Assuntos
Encéfalo/fisiopatologia , Cefaleia/fisiopatologia , Transtornos de Enxaqueca/fisiopatologia , Manejo da Dor , Dor/fisiopatologia , Sistema Nervoso Autônomo/fisiopatologia , Cefaleia/terapia , Humanos , Transtornos de Enxaqueca/terapia
16.
J Clin Neurosci ; 65: 140-144, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30876933

RESUMO

Chronic Forward Head Posture is associated with headaches, neck pain, and disability, though few studies have investigated the effects it has on the suboccipital triangle. The objective of this study was to quantitatively assess whether the biomechanical changes in the suboccipital triangle help explain the clinical manifestations of Forward Head Posture. Specifically, this study aimed to identify whether the Greater Occipital Nerve or C2 nerve root may be compressed in Forward Head Posture. Three-dimensional, specimen-specific computer models were rendered from thirteen cadaveric cervical spine specimens. The spines transitioned from neutral to Forward head posture while motion data was collected. This data was synced with the computer models to make precise measurements. In Forward Head Posture, occiput-C1, C1-C2, and occiput-C2 segments extended by 10.7 ±â€¯4.6 deg, 4.6 ±â€¯4.3 deg, and 15.3 ±â€¯2.3 deg, respectively. The Rectus Capitis Posterior Major and Minor and Obliquus Capitis Superior muscles shortened by 20.0 ±â€¯4.6%, 15.0 ±â€¯7.6%, and 6.6 ±â€¯3.3%, respectively. The Obliquus Capitis muscle inferior length did not change. The suboccipital triangle area decreased by 18.7 ±â€¯6.4%, but the protective gaps surrounding the C2 nerve root and the Greater Occipital Nerve did not reveal clinically significant impingement. The C2 nerve root gap decreased by 1.0 ±â€¯1.3 mm and the Greater Occipital Nerve gap by 0.2 ±â€¯0.18 mm. These results demonstrate that the C2 nerve root and the Greater Occipital Nerve are protected by the bony landscape of the cervical spine. However, there is likely persistent contraction of the rectus muscles in Forward Head Posture, which suggests a secondary tension-type etiology of the associated headache.


Assuntos
Cabeça , Cefaleia/fisiopatologia , Postura/fisiologia , Fenômenos Biomecânicos , Cadáver , Vértebras Cervicais , Simulação por Computador , Feminino , Movimentos da Cabeça , Humanos , Masculino , Pescoço , Músculos do Pescoço , Cervicalgia
17.
Neurol Sci ; 40(Suppl 1): 123-127, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30887241

RESUMO

Collaboration is more than evolutionary advantage, it is good business and good for learning. It is through collaboration that we open new doors, create new options, and develop unforeseen opportunities. More than simple information exchange, collaboration allows the joint creation of new value and creates multiple layers of interpersonal connection and interaction leading to enhanced learning. This newly created value has been termed the "collaborative advantage." The headache group at the C. Besta Institute in Milan, Italy, and the John Graham Headache Center in Boston, MA, have begun a collaboration in clinical Headache Medicine. The history and nature of the process and early results are discussed. Programs like this could help advance the field of headache medicine.


Assuntos
Cefaleia/tratamento farmacológico , Aprendizagem/fisiologia , Manejo da Dor , Dor/tratamento farmacológico , Estudos Clínicos como Assunto , Cefaleia/fisiopatologia , Humanos , Dor/fisiopatologia , Resultado do Tratamento
18.
Neuroimaging Clin N Am ; 29(2): 255-260, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30926115

RESUMO

Headache may be the most common presenting symptom of unruptured intracranial aneurysms. Unruptured intracranial aneurysm can be found in the work-up for headache but direct causality is not clear. Most of the headaches have been thought to be incidental symptoms of unruptured intracranial aneurysms. If high-risk patients with symptoms such as headache could be selected it would help in diagnosing unruptured intracranial aneurysms. Many aspects of unruptured intracranial aneurysm-associated headaches are unclear, including the mechanism, discriminating characteristics, and localization. This article reviews basic knowledge on cerebral aneurysm and headache, and describes the possible mechanism and characteristics of aneurysm-associated headaches.


Assuntos
Cefaleia/etiologia , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Neuroimagem , Cefaleia/fisiopatologia , Humanos , Aneurisma Intracraniano/fisiopatologia
19.
Neuroimaging Clin N Am ; 29(2): 271-289, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30926117

RESUMO

Pediatric headache is a common problem, with various underlying causes. Appropriate patient selection for neuroimaging is necessary to optimize the clinical evaluation. This review aims to provide a focused discussion of the clinical evaluation of children with headache, including published guidelines pertaining to neuroimaging, technical considerations for neuroimaging, and tailoring of examinations for specific clinical entities known to cause pediatric headache.


Assuntos
Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Cefaleia/diagnóstico , Cefaleia/fisiopatologia , Imagem por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Criança , Humanos , Neuroimagem/métodos
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