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1.
Pan Afr Med J ; 39: 198, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34603579

RESUMO

A mucocele is a cystic and expansive lesion of the sinus cavities. It is uncommon in the sphenoid sinus and its management is quite challenging especially in low to middle income countries like Cameroon. A 43-years-old female was referred to us by a neurologist for chronic headache and visual disturbances. The pain was unresponsive to analgesics. Physical examination was non-remarkable and a head CT scan realized showed a cyst-like lesion in the sphenoid sinus cavity. Surgical endoscopic treatment was proposed and realized with basic endoscopic instruments, consisting of opening the cavity with drainage of the mucocele. A large opening was made on the anterior wall of the sphenoid sinus, in order to ensure continuous drainage and prevent a recurrence. Sphenoid sinus mucocele is a rare condition, and its diagnosis can be difficult. Confirmation requires specific imaging and treatment is presently well established, but it can be managed with basic tools.


Assuntos
Mucocele/diagnóstico por imagem , Doenças dos Seios Paranasais/diagnóstico por imagem , Seio Esfenoidal/diagnóstico por imagem , Adulto , Camarões , Drenagem , Endoscopia , Feminino , Transtornos da Cefaleia/etiologia , Humanos , Mucocele/cirurgia , Doenças dos Seios Paranasais/cirurgia , Seio Esfenoidal/cirurgia , Tomografia Computadorizada por Raios X , Transtornos da Visão/etiologia
2.
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
3.
Indian Pediatr ; 58(8): 757-764, 2021 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-34465659

RESUMO

Migraine and tension-type headache are common in children and adolescents, but several other headache disorders may pose a great challenge in diagnosis and management to families and attending clinicians. In this review, we highlight several of these disorders, which need appropriate assessment to make the right diagnosis and appropriate investigations where necessary. Timely recognition and implementation of appropriate management strategies can improve the health of children with some disorders, and is vital in achieving improvement in the quality of life.


Assuntos
Transtornos da Cefaleia , Transtornos de Enxaqueca , Cefaleia do Tipo Tensional , Adolescente , Criança , Cefaleia/diagnóstico , Cefaleia/epidemiologia , Humanos , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/epidemiologia , Qualidade de Vida
4.
Rev Neurol (Paris) ; 177(7): 725-733, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34340812

RESUMO

The French Headache Society proposes updated French guidelines for the management of migraine. The first part of these recommendations is focused on the diagnosis and assessment of migraine. First, migraine needs to be precisely diagnosed according to the currently validated criteria of the International Classification of Headache Disorders, 3d version (ICHD-3). Migraine-related disability has to be assessed and we suggest to use the 6 questions of the headache impact test (HIT-6). Then, it is important to check for risk factors and comorbidities increasing the risk to develop chronic migraine, especially frequency of headaches, acute medication overuse and presence of depression. We suggest to use a migraine calendar and the Hospital Anxiety and Depression scale (HAD). It is also necessary to evaluate the efficacy and tolerability of current migraine treatments and we suggest to systematically use the self-administered Migraine Treatment Optimization Questionnaire (M-TOQ) for acute migraine treatment. Finally, a treatment strategy and a follow-up plan have to be proposed. Guidelines for pharmacological and non-pharmacological treatments are presented in the second and third part of the recommendations.


Assuntos
Transtornos da Cefaleia , Transtornos de Enxaqueca , Adulto , Comorbidade , Cefaleia , Transtornos da Cefaleia/diagnóstico , Transtornos da Cefaleia/epidemiologia , Transtornos da Cefaleia/terapia , Humanos , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/epidemiologia , Transtornos de Enxaqueca/terapia , Inquéritos e Questionários
5.
Rev Neurol (Paris) ; 177(7): 773-778, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34366172

RESUMO

Four episodic syndromes are recognized in the current version of the International Classification of Headache Disorders (ICHD): cyclic vomiting syndrome (CVS); abdominal migraine; benign paroxysmal vertigo; benign paroxysmal torticollis. Previously called childhood periodic syndromes, they are thought to be early expressions of a migrainous spectrum. They usually occur in childhood or adolescence and some of these patients will develop migraine later in childhood or in adulthood. More rarely, some of these disorders, in particular CVS and abdominal migraine, can persist or even begin at adulthood. The concept of episodic syndromes associated with migraine in adults is relatively recent, recognized for the first time in the version III-beta of the ICHD (2013). It is important for the adult neurologist to recognize the clinical pattern of these disorders. Lack of knowledge of these disorders often leads to delayed diagnosis, and a large number of complementary tests. Treatments are often borrowed from migraine abortive and preventive treatments. This review summarizes the characteristics of episodic syndromes and is particularly focused on data in adults.


Assuntos
Transtornos da Cefaleia , Transtornos de Enxaqueca , Adolescente , Adulto , Vertigem Posicional Paroxística Benigna , Humanos , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/epidemiologia , Neurologistas , Síndrome
6.
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
7.
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
8.
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
9.
Neurol Sci ; 42(10): 3965-3968, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34264414

RESUMO

BACKGROUND: The 2019 Coronavirus (SARS-CoV-2) is a novel respiratory virus which causes Coronavirus Disease19 (COVID-19). Although the predominant clinical picture of COVID-19 is represented by respiratory symptoms, neurological manifestations are being increasingly recognized. Headache, in particular migraine-like and tension types, has been largely reported in patients suffering from COVID-19 both in the acute and the healing phase of the infection. New daily persistent headache (NDPH) is a primary headache characterized by persistent and daily painful symptoms, with pain becoming continuous and non-remitting within 24 h, and lasting more than 3 months. Even though an increasing number of reports describe patients who develop a persistent headache, diagnosis of NPDH has been rarely explored in the context of COVID-19. METHODS: Two patients with persistent headache and Sars-CoV-2 infection were identified. Both underwent a full clinical and neuroradiological evaluation. Blood sample with inflammatory biomarkers search was also performed. RESULTS: According to International Classifications of Headache Disorders diagnosis of probable new daily persistent headache was made. The treatment with high doses of steroids was associated with relief of symptoms. CONCLUSIONS: Our report described two cases of probable NDPH due to SARS-CoV-2 infection. Clinical evaluation of COVID-19 patients presenting with persistent headache should take into consideration NDPH. Given the supposed major role for neuroinflammation in the genesis of Sars-CoV-2-driven NDPH, immunomodulatory therapy should be promptly started. In line with this hypothesis, we obtained a good therapeutic response to short-term high dose of corticosteroids.


Assuntos
COVID-19 , Transtornos da Cefaleia , Transtornos de Enxaqueca , Cefaleia/tratamento farmacológico , Cefaleia/etiologia , Transtornos da Cefaleia/diagnóstico , Transtornos da Cefaleia/tratamento farmacológico , Transtornos da Cefaleia/etiologia , Humanos , SARS-CoV-2
10.
J Headache Pain ; 22(1): 71, 2021 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-34261435

RESUMO

BACKGROUND: Primary headache disorders are common and burdensome conditions. They are associated to several comorbidities, such as cardiovascular or psychiatric ones, which, in turn, contribute to the global burden of headache. The aim of this study is to provide a comprehensive description of the pooled prevalence of comorbidities of primary headache disorders using a meta-analytical approach based on studies published between 2000 and 2020. METHODS: Scopus was searched for primary research (clinical and population studies) in which medical comorbidities were described in adults with primary headache disorders. Comorbidities were extracted using a taxonomy derived from the Global Burden of Disease (GBD) study. We compared prevalence of comorbidities among headache sufferers against general population using GBD-2019 estimates, and compared comorbidities' proportions in clinical vs. population studies, and by age and gender. RESULTS: A total of 139 studies reporting information on 4.19 million subjects with primary headaches were included: in total 2.75 million comorbidities were reported (median per subject 0.64, interquartile range 0.32-1.07). The most frequently addressed comorbidities were: depressive disorders, addressed in 51 studies (pooled proportion 23 %, 95 % CI 20-26 %); hypertension, addressed in 48 studies (pooled proportion 24 %, 95 % CI 22-26 %); anxiety disorders addressed in 40 studies (pooled proportion 25 %, 95 % CI 22-28 %). For conditions such as anxiety, depression and back pain, prevalence among headache sufferers was higher than in GBD-2109 estimates. Associations with average age and female prevalence within studies showed that hypertension was more frequent in studies with higher age and less females, whereas fibromyalgia, restless leg syndrome, and depressive disorders were more frequent in studies with younger age and more female. CONCLUSIONS: Some of the most relevant comorbidities of primary headache disorders - back pain, anxiety and depression, diabetes, ischemic heart disease and stroke - are among the most burdensome conditions, together with headache themselves, according to the GBD study. A joint treatment of headaches and of these comorbidities may positively impact on headache sufferers' health status and contribute to reduce the impact of a group of highly burdensome diseases.


Assuntos
Transtornos da Cefaleia Primários , Transtornos da Cefaleia , Adulto , Ansiedade , Transtornos de Ansiedade/epidemiologia , Comorbidade , Estudos Transversais , Feminino , Transtornos da Cefaleia/epidemiologia , Humanos , Prevalência
11.
J Headache Pain ; 22(1): 73, 2021 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-34273952

RESUMO

BACKGROUND: Headache disorders are disabling and have a significant impact on productivity. The relationship between these two consequences is of considerable economic and political interest. We enquired into it through a systematic search of the English-language literature. METHODS: We followed PRISMA guidelines in specifying search terms and syntax and in article selection. We used the term "disability" in the search, accepting any meaning that authors attached to it, but this proved problematic. Accordingly, we adopted the definition used in the Global Burden of Disease study. In article selection, we included only those that purported to measure disability as so defined and lost productivity. We reviewed the full texts of those selected. We included further articles identified from review of the bibliographies of selected articles. RESULTS: The literature search found 598 studies, of which 21 warranted further review. Their bibliographies identified another four of possible relevance. On full-text reading of these 25, all were rejected. Ten applied incompatible definitions of disability and/or lost productivity. Two did not measure both. Four reported lost productivity but not disability. Eight studies reported and measured both but did not assess the association between them or provide the means of doing so. One was purely methodological. CONCLUSIONS: The literature is silent on the relationship between headache-attributed disability and lost productivity. In view of its health economic and political importance, empirical studies are required to remedy this. A prerequisite is to clarify what is meant by "disability" in this context.


Assuntos
Transtornos da Cefaleia , Cefaleia , Eficiência , Humanos
12.
J Headache Pain ; 22(1): 63, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34210258

RESUMO

BACKGROUND: The first manuscript in this series delineated a model of structured headache services, potentially cost-effective but requiring formal cost-effectiveness analysis (CEA). We envisaged a need for a new outcome measure for this purpose, applicable to all forms of treatment, care and care-delivery systems as opposed to comparisons of single-modality treatments. CONCEPTION AND DELINEATION: A literature review confirmed the lack of any suitable established measure. We prioritised construct validity, simplicity, comprehensiveness and expression in intuitive units. We noted that pain was the key burdensome symptom of migraine and episodic tension-type headache (TTH), that pain above a certain level was disabling, that it was difficult to put economic value to pain but relatively easy to do this for time, a casualty of headache leading to lost productivity. Alleviation of pain to a non-disabling level would be expected to bring restoration of function. We therefore based the measure on time spent in the ictal state (TIS) of migraine or TTH, either as total TIS or proportion of all time. We expressed impact on health, in units of time, as TIS*DW, where DW was the disability weight for the ictal state supplied by the Global Burden of Disease (GBD) studies. If the time unit was hours, TIS*DW yielded hours lived with (or lost to) disability (HLDs), in analogy with GBD's years lived with disability (YLDs). UTILITY ASSESSMENT: Acute treatments would reduce TIS by shortening attack duration, preventative treatments by reducing attack frequency; health-care systems such as structured headache services would have these effects by delivering these treatments. These benefits were all measurable as HLDs-averted. Population-level estimates would be derived by factoring in prevalence, but also taking treatment coverage and adherence into account. For health-care systems, additional gains from provider-training (promoting adherence to guidelines and, therefore, enhancing coverage) and consumer-education (improving adherence to care plans), increasing numbers within populations gaining the benefits of treatments, would be measurable by the same metric. CONCLUSIONS: The new outcome measure expressed in intuitive units of time is applicable to treatments of all modalities and to system-level interventions for multiple headache types, with utility for CEA and for informing health policy.


Assuntos
Transtornos da Cefaleia , Cefaleia do Tipo Tensional , Carga Global da Doença , Cefaleia , Transtornos da Cefaleia/diagnóstico , Transtornos da Cefaleia/terapia , Humanos , Avaliação de Resultados em Cuidados de Saúde
13.
Headache ; 61(7): 1123-1131, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34309828

RESUMO

OBJECTIVE: To assess telehealth practice for headache visits in the United States. BACKGROUND: The rapid roll out of telehealth during the COVID-19 pandemic impacted headache specialists. METHODS: American Headache Society (AHS) members were emailed an anonymous survey (9/9/20-10/12/20) to complete if they had logged ≥2 months or 50+ headache visits via telehealth. RESULTS: Out of 1348 members, 225 (16.7%) responded. Most were female (59.8%; 113/189). Median age was 47 (interquartile range [IQR] 37-57) (N = 154). The majority were MD/DOs (83.7%; 159/190) or NP/PAs (14.7%; 28/190), and most (65.1%; 123/189) were in academia. Years in practice were 0-3: 28; 4-10: 58; 11-20: 42; 20+: 61. Median number of telehealth visits was 120 (IQR 77.5-250) in the prior 3 months. Respondents were "comfortable/very comfortable" treating via telehealth (a) new patient with a chief complaint of headache (median, IQR 4 [3-5]); (b) follow-up for migraine (median, IQR 5 [5-5]); (c) follow-up for secondary headache (median, IQR 4 [3-4]). About half (51.1%; 97/190) offer urgent telehealth. Beyond being unable to perform procedures, top barriers were conducting parts of the neurologic exam (157/189), absence of vital signs (117/189), and socioeconomic/technologic barriers (91/189). Top positive attributes were patient convenience (185/190), reducing patient travel stress (172/190), patient cost reduction (151/190), flexibility with personal matters (128/190), patient comfort at home (114/190), and patient medications nearby (103/190). Only 21.3% (33/155) of providers said telehealth visit length differed from in-person visits, and 55.3% (105/190) believe that the no-show rate improved. On a 1-5 Likert scale, providers were "interested"/"very interested" in digitally prescribing headache apps (median 4, IQR 3-5) and "interested"/"very interested" in remotely monitoring patient symptoms (median 4, IQR 3-5). CONCLUSIONS: Respondents were comfortable treating patients with migraine via telehealth. They note positive attributes for patients and how access may be improved. Technology innovations (remote vital signs, digitally prescribing headache apps) and remote symptom monitoring are areas of interest and warrant future research.


Assuntos
Atitude do Pessoal de Saúde , Transtornos da Cefaleia/diagnóstico , Transtornos da Cefaleia/terapia , Médicos/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/diagnóstico , Sociedades Médicas/estatística & dados numéricos , Estados Unidos
14.
J Headache Pain ; 22(1): 78, 2021 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-34289806

RESUMO

In countries where headache services exist at all, their focus is usually on specialist (tertiary) care. This is clinically and economically inappropriate: most headache disorders can effectively and more efficiently (and at lower cost) be treated in educationally supported primary care. At the same time, compartmentalizing divisions between primary, secondary and tertiary care in many health-care systems create multiple inefficiencies, confronting patients attempting to navigate these levels (the "patient journey") with perplexing obstacles.High demand for headache care, estimated here in a needs-assessment exercise, is the biggest of the challenges to reform. It is also the principal reason why reform is necessary.The structured headache services model presented here by experts from all world regions on behalf of the Global Campaign against Headache is the suggested health-care solution to headache. It develops and refines previous proposals, responding to the challenge of high demand by basing headache services in primary care, with two supporting arguments. First, only primary care can deliver headache services equitably to the large numbers of people needing it. Second, with educational supports, they can do so effectively to most of these people. The model calls for vertical integration between care levels (primary, secondary and tertiary), and protection of the more advanced levels for the minority of patients who need them. At the same time, it is amenable to horizontal integration with other care services. It is adaptable according to the broader national or regional health services in which headache services should be embedded.It is, according to evidence and argument presented, an efficient and cost-effective model, but these are claims to be tested in formal economic analyses.


Assuntos
Transtornos da Cefaleia , Cefaleia , Atenção à Saúde , Cefaleia/terapia , Humanos , Atenção Primária à Saúde
15.
Neurology ; 97(6): 280-289, 2021 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-34108270

RESUMO

OBJECTIVE: To review contemporary issues of health care disparities in headache medicine with regard to race/ethnicity, socioeconomic status (SES), and geography and propose solutions for addressing these disparities. METHODS: An Internet and PubMed search was performed and literature was reviewed for key concepts underpinning disparities in headache medicine. Content was refined to areas most salient to our goal of informing the provision of equitable care in headache treatment through discussions with a group of 16 experts from a range of headache subspecialties. RESULTS: Taken together, a multitude of factors, including racism, SES, insurance status, and geographical disparities, contribute to the inequities that exist within the health care system when treating headache disorders. Interventions such as improving public education, advocacy, optimizing telemedicine, engaging in community outreach to educate primary care providers, training providers in cultural sensitivity and competence and implicit bias, addressing health literacy, and developing recruitment strategies to increase representation of underserved groups within headache research are proposed as solutions to ameliorate disparities. CONCLUSION: Neurologists have a responsibility to provide and deliver equitable care to all. It is important that disparities in the management of headache disorders are identified and addressed.


Assuntos
Transtornos da Cefaleia/terapia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos
16.
Ugeskr Laeger ; 183(24)2021 06 14.
Artigo em Dinamarquês | MEDLINE | ID: mdl-34120689

RESUMO

Hemicrania continua (HC) is a primary chronic headache disorder characterised with a broad range of autonomic symptoms. In this case report a 29-year-old patient was bothered by appearance of a unilateral sharp pain located behind the right eye at the same spot where the headache usually was located. He was diagnosed with HC and treated with indomethacin with good effect. However, due to discomfort and hanging eyelids he underwent bilateral blepharoplasty, and the headache and pain resolved completely.


Assuntos
Transtornos da Cefaleia , Indometacina , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Cefaleia/tratamento farmacológico , Cefaleia/etiologia , Transtornos da Cefaleia/tratamento farmacológico , Transtornos da Cefaleia/etiologia , Humanos , Indometacina/uso terapêutico , Masculino
17.
Ann Plast Surg ; 87(1): 73-79, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34133367

RESUMO

BACKGROUND: Migraine surgery has been shown to be efficacious, but nuanced effects of surgery on pain and individuals' lives remain incompletely understood. Surgery may be performed at a single or multiple "primary" sites. The aims of this study were to investigate patient perceptions following single-site surgery and compare themes in patients undergoing single-site surgery with those from a previously published conceptual framework generated with patients undergoing multisite surgery. METHODS: Patients who underwent single-site headache surgery participated in open-ended interviews at least 1 year after surgery. Participants (n = 14) had undergone either occipital, temporal, or nasoseptal site surgery. A multidisciplinary team analyzed transcripts. Recurring themes were identified and compared and contrasted to those observed in patients who underwent multiple-site surgery (n = 15) in a previous study (Plast Reconstr Surg 2019;144(4):956-964). RESULTS: Similar recurring themes emerged from the single-site cohort, and the conceptual framework was applicable to all participants. Two new themes emerged from the single-site analysis. First, 5 of 14 participants described being "migraine-free" postoperatively, a finding not observed in the multisite group. Second, several individuals described financial benefits after surgery, via decreased prescription medication requirements, raises at work, and improved productivity. CONCLUSIONS: Single-site headache surgery appears to positively impact patients' lives in ways that support and expand upon previously published outcomes. Patients undergoing surgery at a single site may be more likely to experience a "pain-free" state, which may relate to the underlying pathophysiology of chronic headache. The effect of surgery on finances appears to be an outcome of interest to patients, which should be explored further.


Assuntos
Transtornos da Cefaleia , Transtornos de Enxaqueca , Estudos de Coortes , Cefaleia/etiologia , Humanos , Transtornos de Enxaqueca/cirurgia , Recidiva
18.
J Alzheimers Dis ; 81(4): 1555-1566, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33967050

RESUMO

BACKGROUND: Migraine is known to mildly increase the risk for ischemic stroke and is associated with vascular MRI markers. However, the potential effect of chronic headache (CH) on stroke outcomes has not been studied. OBJECTIVE: We aimed to assess the interrelation between CH and post-stroke cognitive impairment. METHODS: Data from 455 patients with a first ever stroke from the TABASCO study was available. All patients underwent 3T brain MRI, blood analysis, and a serial cognitive assessment at baseline and 6, 12, and 24 months after. RESULTS: Eighty-five (18.7%) patients reported suffering from CH, of whom 53 (62.4%) reported symptoms of photophobia or nausea, and 34 (40%) reported an aura. CH was associated with female sex, lower prevalence of T2DM (p < 0.001), and lower HbA1C levels (p < 0.001). Multiple regression analysis, controlling for age, sex, education, vascular risk factors, and the presence of acute lesions in MRI, revealed that CH was an independent predictor of better cognitive scores 6, 12, and 24 months post-stroke (p = 0.015, p = 0.01, and p = 0.012, respectively). Stroke patients suffering from CH had also higher normalized gray, white matter, and thalamus volumes, and better white matter microstructural integrity (p < 0.001, p = 0.037, p < 0.001, p = 0.008, respectively)Conclusion:In this study, CH was consistently associated with better long term cognitive scores among post stroke subjects. These surprising findings may partially arise from the higher prevalence of T2DM among subjects without CH, that may represent the existence of chronic cerebrovascular disease, and may reflect mechanisms involving glucose metabolism.


Assuntos
Encéfalo/diagnóstico por imagem , Cognição/fisiologia , Transtornos da Cefaleia/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Idoso , Feminino , Transtornos da Cefaleia/complicações , Transtornos da Cefaleia/psicologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Estudos Prospectivos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/psicologia , Sobreviventes
19.
JAMA ; 325(18): 1874-1885, 2021 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-33974014

RESUMO

Importance: Approximately 90% of people in the US experience headache during their lifetime. Migraine is the second leading cause of years lived with disability worldwide. Observations: Primary headache disorders are defined as headaches that are unrelated to an underlying medical condition and are categorized into 4 groups: migraine, tension-type headache, trigeminal autonomic cephalalgias, and other primary headache disorders. Studies evaluating prevalence in more than 100 000 people reported that tension-type headache affected 38% of the population, while migraine affected 12% and was the most disabling. Secondary headache disorders are defined as headaches due to an underlying medical condition and are classified according to whether they are due to vascular, neoplastic, infectious, or intracranial pressure/volume causes. Patients presenting with headache should be evaluated to determine whether their headache is most likely a primary or a secondary headache disorder. They should be evaluated for symptoms or signs that suggest an urgent medical problem such as an abrupt onset, neurologic signs, age 50 years and older, presence of cancer or immunosuppression, and provocation by physical activities or postural changes. Acute migraine treatment includes acetaminophen, nonsteroidal anti-inflammatory drugs, and combination products that include caffeine. Patients not responsive to these treatments may require migraine-specific treatments including triptans (5-HT1B/D agonists), which eliminate pain in 20% to 30% of patients by 2 hours, but are accompanied by adverse effects such as transient flushing, tightness, or tingling in the upper body in 25% of patients. Patients with or at high risk for cardiovascular disease should avoid triptans because of vasoconstrictive properties. Acute treatments with gepants, antagonists to receptors for the inflammatory neuropeptide calcitonin gene-related peptide, such as rimegepant or ubrogepant, can eliminate headache symptoms for 2 hours in 20% of patients but have adverse effects of nausea and dry mouth in 1% to 4% of patients. A 5-HT1F agonist, lasmiditan, is also available for acute migraine treatment and appears safe in patients with cardiovascular risk factors. Preventive treatments include antihypertensives, antiepileptics, antidepressants, calcitonin gene-related peptide monoclonal antibodies, and onabotulinumtoxinA, which reduce migraine by 1 to 3 days per month relative to placebo. Conclusions and Relevance: Headache disorders affect approximately 90% of people during their lifetime. Among primary headache disorders, migraine is most debilitating and can be treated acutely with analgesics, nonsteroidal anti-inflammatory drugs, triptans, gepants, and lasmiditan.


Assuntos
Transtornos da Cefaleia , Transtornos de Enxaqueca/tratamento farmacológico , Analgésicos/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Antagonistas do Receptor do Peptídeo Relacionado ao Gene de Calcitonina/uso terapêutico , Diagnóstico Diferencial , Transtornos da Cefaleia/diagnóstico , Transtornos da Cefaleia/etiologia , Transtornos da Cefaleia/terapia , Humanos , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/prevenção & controle , Cefaleia do Tipo Tensional/diagnóstico , Cefaleia do Tipo Tensional/tratamento farmacológico , Triptaminas/uso terapêutico
20.
Lancet Neurol ; 20(6): 460-469, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34022171

RESUMO

Post-traumatic headache is a common sequela of traumatic brain injury and is classified as a secondary headache disorder. In the past 10 years, considerable progress has been made to better understand the clinical features of this disorder, generating momentum to identify effective therapies. Post-traumatic headache is increasingly being recognised as a heterogeneous headache disorder, with patients often classified into subphenotypes that might be more responsive to specific therapies. Such considerations are not accounted for in three iterations of diagnostic criteria published by the International Headache Society. The scarcity of evidence-based approaches has left clinicians to choose therapies on the basis of the primary headache phenotype (eg, migraine and tension-type headache) and that are most compatible with the clinical picture. A concerted effort is needed to address these shortcomings and should include large prospective cohort studies as well as randomised controlled trials. This approach, in turn, will result in better disease characterisation and availability of evidence-based treatment options.


Assuntos
Lesões Encefálicas Traumáticas/terapia , Cefaleia Pós-Traumática/classificação , Cefaleia Pós-Traumática/terapia , Lesões Encefálicas/complicações , Lesões Encefálicas Traumáticas/classificação , Lesões Encefálicas Traumáticas/fisiopatologia , Progressão da Doença , Cefaleia , Transtornos da Cefaleia , Transtornos da Cefaleia Secundários/classificação , Transtornos da Cefaleia Secundários/etiologia , Humanos , Transtornos de Enxaqueca , Cefaleia Pós-Traumática/fisiopatologia , Estudos Prospectivos , Cefaleia do Tipo Tensional
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