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1.
Rev Neurol ; 74(2): 55-60, 2022 01 16.
Artigo em Espanhol | MEDLINE | ID: mdl-35014020

RESUMO

INTRODUCTION: The SARS-CoV-2 pandemic has given rise to a major change in healthcare and brought teleconsultation to the forefront. In neurology, headaches are the most frequent reason for visits. AIM: To assess the impact of the COVID-19 pandemic on the structure of headache units in Andalusia and the adaptations made to healthcare that are potentially useful innovations that can continue to be developed when the pandemic is over. MATERIALS AND METHODS: Cross-sectional observational study using an online survey of neurologists responsible for headache units and specialised consultations in Andalusia. RESULTS: During the state of alarm, all respondents used teleconsultation. The vast majority (92.8%) maintained some face-to-face activity, mostly for invasive techniques and new patients, using individual protection measures and as a way to avoid crowds. Half of them (50%) maintained botulinum toxin administrations at the scheduled times and 78.6% continued to prescribe monoclonal antibodies against calcitonin gene-related peptide. Altogether 78.5% are generally satisfied with the use of teleconsultation and 57.1% think it could be quite useful in the future. The main advantages reported were avoiding the need for the patient to travel and time savings; the disadvantages were the absence of physical examinations and difficulties in communicating. The most frequently expressed need for improvement was the use of video-calls. CONCLUSIONS: Some of the changes adopted during this time could continue to be useful in the future and, in the case of headaches, teleconsultation could be used as an option for following up patients who have already been diagnosed and do not require any invasive techniques.


TITLE: Adaptación de las unidades de cefalea de Andalucía a la pandemia por COVID-19. Análisis del Grupo de Estudio de Cefaleas de la Sociedad Andaluza de Neurología.Introducción. La pandemia por SARS-CoV-2 ha supuesto un gran cambio en la atención sanitaria y ha dado protagonismo a la teleconsulta. En neurología, las cefaleas constituyen el motivo más frecuente de consulta. Objetivo. Evaluar el impacto de la pandemia por COVID-19 en la estructura de las unidades de cefaleas de Andalucía y las adaptaciones asistenciales potencialmente útiles tras ella. Materiales y métodos. Estudio observacional transversal mediante encuesta en línea a los neurólogos responsables de las unidades y consultas monográficas de cefaleas de Andalucía. Resultados. Durante el estado de alarma, todos los encuestados usaron teleconsulta. El 92,8% mantuvo alguna actividad presencial, fundamentalmente para técnicas invasivas y pacientes nuevos, utilizando medidas de protección individual y para evitar aglomeraciones. El 50% mantuvo las administraciones de toxina botulínica en los tiempos adecuados y el 78,6% siguió prescribiendo anticuerpos monoclonales frente al péptido relacionado con el gen de la calcitonina. El 78,5% se encuentra globalmente satisfecho con el uso de la teleconsulta y el 57,1% considera que podría ser bastante útil de cara al futuro. Las principales ventajas expresadas fueron evitar el desplazamiento de los pacientes y el ahorro de tiempo; los inconvenientes, la ausencia de exploración física y la dificultad de comunicación. La necesidad de mejora más expresada fue el uso de videollamada. Conclusiones. Algunos de los cambios adoptados en este tiempo podrían seguir siendo útiles en el futuro y, en el caso de las cefaleas, la teleconsulta se podría emplear como opción para el seguimiento de pacientes ya diagnosticados y que no requieran técnicas invasivas.


Assuntos
COVID-19/epidemiologia , Cefaleia , Unidades Hospitalares/organização & administração , Hospitais Universitários/organização & administração , Neurologia/organização & administração , Pandemias , SARS-CoV-2 , Telemedicina/tendências , Anticorpos Monoclonais/uso terapêutico , Atitude do Pessoal de Saúde , Toxinas Botulínicas Tipo A/uso terapêutico , Estudos Transversais , Cefaleia/epidemiologia , Cefaleia/terapia , Pesquisas sobre Serviços de Saúde , Unidades Hospitalares/estatística & dados numéricos , Humanos , Neurologistas/psicologia , Neurologia/métodos , Satisfação Pessoal , Utilização de Procedimentos e Técnicas , Espanha/epidemiologia , Telemedicina/estatística & dados numéricos , Fatores de Tempo
2.
Curr Opin Otolaryngol Head Neck Surg ; 30(1): 63-67, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-34958323

RESUMO

PURPOSE OF REVIEW: Although the majority of patients with sinus headache do not have rhinosinusitis, many patients will unnecessarily undergo work-up and treatment for rhinosinusitis. This leads to a significant cost burden to the healthcare system. In the era of value-based care, more effective management paradigms need to be developed for sinus headache. RECENT FINDINGS: Recent efforts to classify nonrhinogenic headache, namely the International Classification of Orofacial Pain, have served as an important step in advancing our understanding of this heterogeneous condition. In addition, a review of the literature points to certain clinical features that may allow for the identification of nonrhinogenic headache based on history. SUMMARY: A greater understanding of nonrhinogenic headache as well as innovative tools to differentiate rhinogenic from nonrhinogenic headache are needed to change the paradigm in the management of patients with sinus headache.


Assuntos
Cefaleia , Sinusite , Cefaleia/diagnóstico , Cefaleia/etiologia , Cefaleia/terapia , Humanos , Sinusite/diagnóstico , Sinusite/terapia
3.
Curr Pain Headache Rep ; 25(11): 73, 2021 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-34766205

RESUMO

PURPOSE OF REVIEW: Headache is a common symptom of COVID-19 with emerging literature being published on the subject. Although it may seem unspecific, scientific evidence has allowed a better definition of this headache type, revealing relevant associations with other COVID-19 symptoms and prognoses. We therefore sought to highlight the most remarkable findings concerning headache secondary to COVID-19, specifically focusing on epidemiology, characteristics, pathophysiology, and treatments. RECENT FINDINGS: The real prevalence of headache as a symptom of COVID-19 is still unclear ranging from 10 to 70%. Headache mainly has a tension-type-like phenotype, although 25% of individuals present with migraine-like features that also occur in patients without personal migraine history. This finding suggests that a likely pathophysiological mechanism is the activation of the trigeminovascular system. SARS-CoV-2 neurotropism can occur by trans-synaptic invasion through the olfactory route from the nasal cavity, leading to anosmia which has been associated with headache. SARS-CoV-2 protein has been found not only in olfactory mucosa and bulbs but also in trigeminal branches and the trigeminal ganglion, supporting this hypothesis. However, other mechanisms such as brain vessels inflammation due to SARS-CoV-2 damage to the endothelium or systemic inflammation in the context of cytokine storm cannot be ruled out. Interestingly, headache has been associated with lower COVID-19 mortality. No specific treatment for COVID-19 headache is available at present. Studies show that investigating COVID-19 headache represents an opportunity not only to better understand COVID-19 in general but also to advance in the knowledge of both secondary and primary headaches. Future research is therefore warranted.


Assuntos
COVID-19/epidemiologia , Cefaleia/epidemiologia , Anosmia/fisiopatologia , COVID-19/complicações , COVID-19/mortalidade , COVID-19/fisiopatologia , Endotélio Vascular , Cefaleia/etiologia , Cefaleia/fisiopatologia , Cefaleia/terapia , Humanos , Inflamação , Transtornos de Enxaqueca/fisiopatologia , SARS-CoV-2 , Cefaleia do Tipo Tensional/fisiopatologia , Gânglio Trigeminal/fisiopatologia , Gânglio Trigeminal/virologia , Nervo Trigêmeo/fisiopatologia , Nervo Trigêmeo/virologia , Tropismo Viral
5.
J Appl Oral Sci ; 29: e20210059, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34524370

RESUMO

OBJECTIVE: To assess the effects of three 8-week exercise programs on the frequency, intensity, and impact of headaches in patients with headache attributed to temporomandibular disorder (TMD). METHODOLOGY: Thirty-six patients diagnosed with headache attributed to TMD participated in the study and were divided into three groups of 12 patients: a therapeutic exercise program (G1, mean age: 26.3±5.6 years), a therapeutic and aerobic exercise program (G2, mean age: 26.0±4.6 years), and an aerobic exercise program (G3, 25.8±2.94 years). Headache frequency and intensity were evaluated using a headache diary, and the adverse headache impact was evaluated using the Headache Impact Test (HIT-6). The intensity was reported using the numerical pain rating scale. These parameters were evaluated twice at baseline (A01/A02), at the end of the 8-week intervention period (A1), and 8-12 weeks after the end of the intervention (A2). RESULTS: At A1, none of the G2 patients reported having headaches, in G1, only two patients reported headaches, and in G3, ten patients reported headache. The headache intensity scores (0.3 [95% CI: -0.401, 1.068]), (0.0 [95% CI: -0.734, 0.734]) and HIT-6 (50.7 [95% CI: 38.008, 63.459]), (49.5 [95% CI: 36.808, 62.259]), significantly decreased in G1 and G2 at A1. At A2 headache intensity scores (0.5 [95% CI: -0.256, 1.256]), (0.0 [95% CI: -0.756, 0.756]) and HIT-6 (55.1 [95% CI: 42.998, 67.268]), (51.7 [95% CI: 39.532, 63.802]) in G1 and G2 haven't change significantly. The effects obtained immediately after the completion of the intervention programs were maintained until the final follow-up in all groups. CONCLUSION: The programs conducted by G1 (therapeutic exercises) and G2 (therapeutic and aerobic exercise) had significant results at A1 and A2.


Assuntos
Cefaleia , Transtornos da Articulação Temporomandibular , Adulto , Exercício Físico , Cefaleia/etiologia , Cefaleia/terapia , Humanos , Transtornos da Articulação Temporomandibular/terapia , Adulto Jovem
6.
Epilepsy Behav ; 123: 108285, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34493459
7.
Rev Med Suisse ; 17(751): 1624-1626, 2021 Sep 22.
Artigo em Francês | MEDLINE | ID: mdl-34550657

RESUMO

We prospectively followed a cohort of 26 subjects for an average period of 41 months who benefited from occipital nerve stimulation (ONS) in the context of chronic refractory headaches. In 17 patients treated, the frequency of headache decreased, and quality of life scores improved significantly. Among these patients, the "very good" response rate was 34 %. In this cohort, treatment-related adverse events are relatively common (42 %) but not severe. While it is difficult to anticipate the risk factors for non-response to treatment, we estimate that the risk of failure may not be related to the duration of the disease, but rather to the number of different preventives attempted prior to ONS.


Assuntos
Terapia por Estimulação Elétrica , Transtornos da Cefaleia , Cefaleia/terapia , Transtornos da Cefaleia/terapia , Humanos , Qualidade de Vida , Resultado do Tratamento
8.
Rev Med Suisse ; 17(749): 1499-1505, 2021 Sep 08.
Artigo em Francês | MEDLINE | ID: mdl-34495585

RESUMO

Idiopathic intracranial hypertension (IIH) is defined by the presence of headache with or without associated visual impairment, elevated cerebrospinal fluid pressure, and exclusion of a secondary etiology. The increased risk of severe visual impairment prompts rapid recognition and initial management by general practitioners, even though the incidence of this condition is low. Based on a case report, the aim of this review is to describe the typical clinical presentation of IIH, to discuss the underlying pathophysiology as well as work-up and management.


Assuntos
Pseudotumor Cerebral , Cefaleia/diagnóstico , Cefaleia/etiologia , Cefaleia/terapia , Humanos , Incidência , Pseudotumor Cerebral/diagnóstico , Pseudotumor Cerebral/etiologia , Pseudotumor Cerebral/terapia , Transtornos da Visão
11.
J Headache Pain ; 22(1): 90, 2021 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-34380429

RESUMO

BACKGROUND: There have been several calls for estimations of costs and consequences of headache interventions to inform European public-health policies. In a previous paper, in the absence of universally accepted methodology, we developed headache-type-specific analytical models to be applied to implementation of structured headache services in Europe as the health-care solution to headache. Here we apply this methodology and present the findings. METHODS: Data sources were published evidence and expert opinions, including those from an earlier economic evaluation framework using the WHO-CHOICE model. We used three headache-type-specific analytical models, for migraine, tension-type-headache (TTH) and medication-overuse-headache (MOH). We considered three European Region case studies, from Luxembourg, Russia and Spain to include a range of health-care systems, comparing current (suboptimal) care versus target care (structured services implemented, with provider-training and consumer-education). We made annual and 5-year cost estimates from health-care provider and societal perspectives (2020 figures, euros). We expressed effectiveness as healthy life years (HLYs) gained, and cost-effectiveness as incremental cost-effectiveness-ratios (ICERs; cost to be invested/HLY gained). We applied WHO thresholds for cost-effectiveness. RESULTS: The models demonstrated increased effectiveness, and cost-effectiveness (migraine) or cost saving (TTH, MOH) from the provider perspective over one and 5 years and consistently across the health-care systems and settings. From the societal perspective, we found structured headache services would be economically successful, not only delivering increased effectiveness but also cost saving across headache types and over time. The predicted magnitude of cost saving correlated positively with country wage levels. Lost productivity had a major impact on these estimates, but sensitivity analyses showed the intervention remained cost-effective across all models when we assumed that remedying disability would recover only 20% of lost productivity. CONCLUSIONS: This is the first study to propose a health-care solution for headache, in the form of structured headache services, and evaluate it economically in multiple settings. Despite numerous challenges, we demonstrated that economic evaluation of headache services, in terms of outcomes and costs, is feasible as well as necessary. Furthermore, it is strongly supportive of the proposed intervention, while its framework is general enough to be easily adapted and implemented across Europe.


Assuntos
Transtornos da Cefaleia , Cefaleia do Tipo Tensional , Análise Custo-Benefício , Europa (Continente) , Cefaleia/terapia , Humanos
13.
Artigo em Inglês | MEDLINE | ID: mdl-34334295

RESUMO

Pediatric headache impacts up to 80% of children, many recurrently, by the time they are 15 years old. Preventing the progression of episodic to chronic headache results in less truancy, staying current with schoolwork and improves children's quality of life. Lifestyle choices can play an important role in headache treatment. Early effective treatment of episodic headache can prevent transformation into a chronic form. While details of a child's headache are critical for making a proper diagnosis; patient education is critical and effective rescue and preventive treatment strategies enable patients to focus on enjoying activities of daily living. Recognizing "red flags" that may suggest a serious underlying etiology is critical in the early stages of diagnosing and preparing to treat children with headaches. Finally directing patients to manage their headaches at home and when to proceed to an emergency department, urgent care or infusion unit can lower the economic burden of acute headache management.


Assuntos
Atividades Cotidianas , Transtornos da Cefaleia , Adolescente , Criança , Cefaleia/diagnóstico , Cefaleia/etiologia , Cefaleia/terapia , Humanos , Qualidade de Vida , Resultado do Tratamento
14.
Am J Phys Med Rehabil ; 100(9): e129-e130, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34415888

RESUMO

ABSTRACT: Mechanical insufflation exsufflation creates cough flows to clear central airways secretions for patients with ineffective cough flows. At times, patients with even potentially effective spontaneous cough flows can have pain that prevents effective coughing. We describe a patient with Arnold-Chiari syndrome, syringomyelia, and hydrocephalus who had nine episodes of pneumonia through the age of 9 yrs, and cough associated headaches, who upon using mechanical insufflation exsufflation had no subsequent pneumonias for at least the next 17 yrs and no headaches when using it for coughing.


Assuntos
Malformação de Arnold-Chiari/complicações , Tosse/terapia , Cefaleia/terapia , Pneumonia/prevenção & controle , Respiração Artificial/métodos , Insuficiência Respiratória/terapia , Siringomielia/complicações , Criança , Feminino , Humanos , Hidrocefalia/complicações
15.
BMJ Case Rep ; 14(8)2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34404644

RESUMO

Spontaneous intracranial hypotension (SIH) is characterised by postural headache and a cerebrospinal fluid (CSF) pressure of ≤6 cmH20 measured with the patient in the lateral decubitus position. Other symptoms include tinnitus, altered hearing, diplopia, photophobia, nausea and neck stiffness, and must not have occurred within a month of dural puncture. Symptoms typically remit after normalisation of CSF pressure or successful sealing of the CSF leak. An epidural blood patch (EBP) is a treatment option in those who have not responded to bed rest, fluids, non-steroidal anti-inflammatories or caffeine. We present a case of SIH successfully treated with both conservative measures and EBP. We compare our case with similar cases in the literature and summarise what is known about EBP for SIH to help clinicians take a more informed approach to managing such patients.


Assuntos
Placa de Sangue Epidural , Hipotensão Intracraniana , Vazamento de Líquido Cefalorraquidiano/terapia , Feminino , Cefaleia/etiologia , Cefaleia/terapia , Humanos , Hipotensão Intracraniana/terapia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade
16.
BMJ Open ; 11(8): e048552, 2021 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-34404708

RESUMO

OBJECTIVE: To explore the experiences of patients suffering from new daily persistent headache (NDPH) regarding the diagnostic process, treatment and medical care. DESIGN: A qualitative phenomenological study was conducted. SETTING: A specialised headache unit at two university hospitals in Spain between February 2017 and December 2018. PARTICIPANTS: Patients diagnosed with NDPH according to the International Classification of Headache disorders (third beta edition). METHODS: Purposeful sampling was performed. Data were collected using unstructured and semistructured interviews, researchers' field notes and patients' drawings. An inductive thematic analysis was used to identify significant emerging themes from interviews, field notes and descriptions of patients' drawings. Also, Guillemin's proposal was used to analyse the contents of drawings. RESULTS: Nineteen patients with a mean age of 45.3 were recruited. Four main themes emerged: (1) Seeking a diagnosis, patients visit many doctors without receiving a clear answer and their diagnosis is delayed; (2) Self-medication-minimising pill intake, medication is ineffective, and therefore, some patients discontinue treatment, or are flexible with how they take medication; (3) Trying other non-pharmacological options, many patients turn to other therapies and complementary and/or alternative therapies as a second option, however these are ineffective and (4) Medical care, with two subthemes, referrals and lacking continuity of care, and building the doctor-patient relationship. Patients describe how the referral breaks the continuity of care, and how they identify the traits of a doctor who is approachable and which behaviours the doctor should avoid when caring for patients. CONCLUSIONS: An in-depth knowledge of the beliefs and expectations of patients with NDPH will allow the professional to establish a relationship of trust, which will improve the patients' knowledge of which therapies are the most appropriate, and to establish expectations based on the relationship with the doctor, and not only on patients' beliefs.


Assuntos
Transtornos da Cefaleia , Relações Médico-Paciente , Cefaleia/diagnóstico , Cefaleia/terapia , Humanos , Assistência ao Paciente , Espanha
17.
J Headache Pain ; 22(1): 99, 2021 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-34425753

RESUMO

BACKGROUND: Health economic evaluations support health-care decision-making by providing information on the costs and consequences of health interventions. No universally accepted methodology exists for modelling effectiveness and cost-effectiveness of interventions designed to close treatment gaps for headache disorders in countries of Europe (or elsewhere). Our aim here, within the European Brain Council's Value-of-Treatment project, was to develop headache-type-specific analytical models to be applied to implementation of structured headache services in Europe as the health-care solution to headache. METHODS: We developed three headache-type-specific decision-analytical models using the WHO-CHOICE framework and adapted these for three European Region country settings (Luxembourg, Russia and Spain), diverse in geographical location, population size, income level and health-care systems and for which we had population-based data. Each model compared current (suboptimal) care vs target care (delivered in accordance with the structured headache services model). Epidemiological and economic data were drawn from studies conducted by the Global Campaign against Headache; data on efficacy of treatments were taken from published randomized controlled trials; assumptions on uptake of treatments, and those made for Healthy Life Year (HLY) calculations and target-care benefits, were agreed with experts. We made annual and 5-year cost estimates from health-care provider (main analyses) and societal (secondary analyses) perspectives (2020 figures, euros). RESULTS: The analytical models were successfully developed and applied to each country setting. Headache-related costs (including use of health-care resources and lost productivity) and health outcomes (HLYs) were mapped across populations. The same calculations were repeated for each alternative (current vs target care). Analyses of the differences in costs and health outcomes between alternatives and the incremental cost-effectiveness ratios are presented elsewhere. CONCLUSIONS: This study presents the first headache-type-specific analytical models to evaluate effectiveness and cost-effectiveness of implementing structured headache services in countries in the European Region. The models are robust, and can assist policy makers in allocating health budgets between interventions to maximize the health of populations.


Assuntos
Transtornos da Cefaleia , Cefaleia , Análise Custo-Benefício , Atenção à Saúde , Europa (Continente) , Cefaleia/epidemiologia , Cefaleia/terapia , Humanos
18.
Ther Umsch ; 78(7): 341-348, 2021 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-34427110

RESUMO

Smarter Medicine in Headache Care - presentation and discussion of 5 recommendations Abstract. An unequivocal headache diagnosis cannot always be made. The lack of diagnostic tests able to prove primary headaches often prompts physicians to perform unnecessary examinations to reduce their uncertainty. When setting out the therapeutic strategy, again, insecurity often leads to mendable choices. In this Delphi study, members of the therapy commission of the Swiss Headache Society collected, rated, and re-rated doubtful and questionable procedures. Five recommendations that resulted from this survey are presented and reviewed in this article. The recommendations are: (A) no repeated cerebral imaging in headaches with unchanged phenotype; (B) no computed tomography in the work-up of non-acute headaches; (C) no tooth extraction to treat persistent idiopathic facial pain, (D) no migraine surgery; (E) no removal of amalgam fillings to treat headache disorders.


Assuntos
Medicina , Transtornos de Enxaqueca , Médicos , Diagnóstico por Imagem , Cefaleia/diagnóstico , Cefaleia/terapia , Humanos , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/terapia
19.
Curr Pain Headache Rep ; 25(8): 56, 2021 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-34268642

RESUMO

PURPOSE OF REVIEW: We define dehydration and its relationship to pain physiology including both primary and secondary headache disorders. RECENT FINDINGS: Intravenous fluids administered for acute migraine attacks in an emergency department setting have not been shown to improve pain outcomes. However, increased intravascular volume before diagnostic lumbar puncture may reduce the frequency of post-lumbar puncture headache from iatrogenic spinal fluid leak. Maintenance of euhydration can help treat orthostatic and "coat-hanger" headache due to autonomic disorders. Similarly, prevention of fluid losses can mitigate secondary headaches provoked by dehydration such as cerebral venous thrombosis or pituitary apoplexy. Dehydration alone may cause headache, but oftentimes exacerbates underlying medical conditions such as primary headache disorders or other conditions dependent on fluid balance.


Assuntos
Desidratação/epidemiologia , Cefaleia/epidemiologia , Hidratação , Cefaleia/terapia , Humanos
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