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3.
Medicine (Baltimore) ; 99(42): e22253, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080672

RESUMO

BACKGROUND: Omega-3 fatty acids (FAs) can produce several beneficial effects and are commonly used for the treatment of migraine symptoms. Although current therapeutic measures for migraine included pharmacological therapies, dietary supplements, and herbal ingredients, dietary patterns, acupuncture, relaxation techniques, biofeedback, and psychotherapy, omega-3 FAs therapeutic role seems to be obtained through the inhibition or reduction of the release of inflammatory cytokines. The present review aims to provide updated information about the effects of omega-3 FAs in migraine treatment, investigating their clinical effects alone or in combination with other substances. METHODS: Bibliographic research was conducted by examining scientific literature from January 2000 until January 31, 2020. Ten clinical studies were included in the review. Quality assessment of randomized controlled trials was performed by using the JADAD scale. RESULTS: Clinical studies methodology is not always of good quality and results show moderate evidence concerning the therapeutic role of omega-3 FAs in migraine. CONCLUSION: Further clinical trials are necessary to implement the knowledge concerning the use of omega-3 fatty acids in the treatment of migraine.


Assuntos
Suplementos Nutricionais , Ácidos Graxos Ômega-3/uso terapêutico , Transtornos de Enxaqueca/tratamento farmacológico , Humanos
4.
Artigo em Chinês | MEDLINE | ID: mdl-33040507

RESUMO

Objective:To analyze the clinical characteristics of patients with Meniere's disease and vestibular migraine, improve the understanding of such diseases for accurate treatment. Method:Eighteen patients with MD and VM were reviewed and the clinical characteristics of the patients were evaluated. Result:There were 4 males and 14 females whose average age was 55.2 years old. The average onset age was 36.5 years meanwhile the headache occured 7.5 years earlier than the vertigo. The average time of vertigo attacks was 30 min-24 h; The mainly kind of headache was unilateral pulsatile headache with or without vertigo attacks; All patients showed the characteristics of photophobia or phonophobia, 7 of them showed visual aura and 9 of them experienced vertigo attacks with headache but without auditory symptoms; 11 patients experienced motion sickness and 10 patients had a related family history. Electrocochleogram abnormal was 11 ears; c-VEMP abnormal was 11 cases; Caloric test abnormal was 13 cases; Velocity step test abnormal was 4 cases. Conclusion:MD and VM shows recurrent vertigo, There are evidences of hearing loss and abnormal changes of electrocochleogram、c-VEMP and lateral semicircular canal function in MD; VM experienced migraine attacks with the characteristics of photophobia、phonophobia and visual aura; The patients can be diagnosed with overlap syndrome when they fulfill the diagnostic criteria of MD and VM at the same time and the two diseases should be treated at the same time.


Assuntos
Doença de Meniere , Transtornos de Enxaqueca , Tontura , Feminino , Cefaleia , Humanos , Masculino , Doença de Meniere/complicações , Doença de Meniere/diagnóstico , Pessoa de Meia-Idade , Transtornos de Enxaqueca/diagnóstico , Vertigem/diagnóstico
5.
Neurol Sci ; 41(12): 3385-3389, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33001407

RESUMO

OBJECTIVES: The COVID-19 pandemic and the consequent lockdown came as a storm disrupting people's everyday life. This study aimed at observing whether the COVID-19 related lockdown influenced migraine frequency and disability in migraine patients on therapy with monoclonal antibodies inhibiting the CGRP pathway. METHODS: In this longitudinal observational cohort study, 147 consecutive patients receiving monthly administration of erenumab or galcanezumab were enrolled in four Italian headache centers. All patients filled a questionnaire concerning working and household settings, recent flu symptoms or COVID-19 diagnosis, and family loss due to COVID-19 infection. Monthly migraine days (MMDs), monthly painkiller intake (MPI), and HIT-6 disability relative to the first month of lockdown imposition (T-lock) and the month before (T-free) were also collected. RESULTS: From T-free to T-lock, the cohort displayed a reduction in MMDs (from 10.5 ± 7.6 to 9.8 ± 7.6, p = .024) and HIT-6 scores (from 59.3 ± 8.3 men reduced MPI more frequently than women (p = .005). CONCLUSIONS: Our study observed that the lockdown impact to 57.8 ± 8.8, p = .009), while MPI resulted unchanged (from 11.6 ± 11.5 to 11.1 ± 11.7; p = .114). MMDs, MPI, and HIT-6 variations from T-free to T-lock did not differ according to work settings or household. Patients beyond the first 3 months of therapy presented less often a reduction in MMDs (p = .006) and on everyday life did not affect the migraine load in patients receiving monoclonal antibodies inhibiting the CGRP pathway. Patients in the first months of therapy experienced a greater improvement according to drug pharmacokinetics, while women more frequently needed rescue medications, possibly indicating presenteeism or cephalalgophobia.


Assuntos
Antagonistas do Receptor do Peptídeo Relacionado ao Gene de Calcitonina/uso terapêutico , Infecções por Coronavirus/prevenção & controle , Transtornos de Enxaqueca/tratamento farmacológico , Transtornos de Enxaqueca/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Quarentena/psicologia , Adulto , Anticorpos Monoclonais Humanizados/uso terapêutico , Estudos de Coortes , Feminino , Humanos , Itália/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
6.
J Headache Pain ; 21(1): 128, 2020 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-33121445

RESUMO

BACKGROUND: The Covid-19 pandemic is causing changes in delivery of medical care worldwide. It is not known how the management of headache patients was affected by the lockdown during the pandemic. The aim of the present study was to investigate how the initial phase of the Covid-19 pandemic affected the hospital management of headache in Denmark and Norway. METHODS: All neurological departments in Denmark (n = 14) and Norway (n = 18) were invited to a questionnaire survey. The study focused on the lockdown and all questions were answered in regard to the period between March 12th and April 15th, 2020. RESULTS: The responder rate was 91% (29/32). Of the neurological departments 86% changed their headache practice during the lockdown. The most common change was a shift to more telephone consultations (86%). Video consultations were offered by 45%. The number of new headache referrals decreased. Only 36% administered botulinum toxin A treatment according to usual schemes. Sixty% reported that fewer patients were admitted for in-hospital emergency diagnostics and treatment. Among departments conducting headache research 57% had to halt ongoing projects. Overall, 54% reported that the standard of care was worse for headache patients during the pandemic. CONCLUSION: Hospital-based headache care and research was impacted in Denmark and Norway during the initial phase of the Covid-19-pandemic.


Assuntos
Infecções por Coronavirus , Assistência à Saúde , Transtornos da Cefaleia/terapia , Neurologia , Pandemias , Pneumonia Viral , Telemedicina/estatística & dados numéricos , Betacoronavirus , Toxinas Botulínicas Tipo A/uso terapêutico , Cefaleia Histamínica/diagnóstico , Cefaleia Histamínica/terapia , Dinamarca , Gerenciamento Clínico , Cefaleia/diagnóstico , Cefaleia/terapia , Transtornos da Cefaleia/diagnóstico , Departamentos Hospitalares , Hospitalização/estatística & dados numéricos , Humanos , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/terapia , Fármacos Neuromusculares/uso terapêutico , Noruega , Ambulatório Hospitalar , Encaminhamento e Consulta , Inquéritos e Questionários , Telecomunicações/estatística & dados numéricos , Comunicação por Videoconferência/estatística & dados numéricos
7.
Medicine (Baltimore) ; 99(44): e23036, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126394

RESUMO

INTRODUCTION: Migraines are caused by neurological and vascular dysfunction, with a side or both sides of the head pain recurrent attack, often accompanied by nausea, vomiting, light, and sound allergy as the characteristics, is the clinical common disease, frequently occurring disease. The incidence of migraine is 8.4% to 28% worldwide (highest in Germany), and the lifetime incidence is about 14.0%. About 18.2% for women and 6.5% for men, About 23 percent of families have at least one migraine sufferer. It can occur at any age, and more than half of patients have headaches that interfere with work or school, while nearly a third may miss work or school because of the headache. Therefore, how to relief headache immediately and reduce the impact on life and work, becomes the basic clinical appeal of many patients. Analgesics are the main treatment for migraine in western medicine, many patients, who worried about the side effects of drugs, often take them only when the pain is unbearable, which can only treat the symptoms rather than the root causes. Auricular acupuncture as a form of acupuncture therapy which is proved to be effective in RCTs and very suitable for patients, has been used in patients who suffer from migraine for a long time, therefore a systematic review is necessary to provide available evidence for further study. METHODS AND ANALYSIS: The following databases will be searched from their inception to September 2020: Electronic database includes PubMed, Embase, Cochrane Library, Web of Science, Nature, Science online, VIP medicine information, and CNKI (China National Knowledge Infrastructure). Primary outcomes: Score of migraine symptoms. Additional outcomes: The overall effective rate. Data will be extracted by two researchers independently, risk of bias of the meta-analysis will be evaluated based on the Cochrane Handbook for Systematic Reviews of Interventions. All data analysis will be conducted by data statistics software Review Manager V.5.3. and Stata V.12.0. RESULTS: The results of this study will systematically evaluate the effectiveness and safety of auricular acupuncture intervention for people with migraine. CONCLUSION: The systematic review of this study will summarize the current published evidence of auricular acupuncture for the treatment of migraine, which can further guide the promotion and application of it. ETHICS AND DISSEMINATION: This study is a systematic review, the outcomes are based on the published evidence, so examination and agreement by the ethics committee are not required in this study. We intend to publish the study results in a journal or conference presentations. OPEN SCIENCE FRA NETWORK (OSF) REGISTRATION NUMBER: October 2, 2020 osf.io/q6arf. (https://osf.io/q6arf/.).


Assuntos
Acupuntura Auricular , Transtornos de Enxaqueca/terapia , Humanos , Projetos de Pesquisa
8.
Lancet Neurol ; 19(10): 814-825, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32949542

RESUMO

BACKGROUND: Many patients who require migraine preventive treatment have not been able to tolerate or have not responded to multiple previous preventive medications. We aimed to assess the safety and efficacy of galcanezumab, an antibody to calcitonin gene-related peptide, in patients with migraine who had not benefited from preventive medications from two to four categories. METHODS: CONQUER was a multicentre, randomised, double-blind, placebo-controlled, phase 3b trial done at 64 sites (hospitals, clinics, or research centres) in 12 countries (Belgium, Canada, Czech Republic, France, Germany, Hungary, Japan, the Netherlands, South Korea, Spain, the UK, and the USA). Patients were 18-75 years of age, with episodic or chronic migraine, with migraine onset before the age of 50 years, who had a documented failure of preventive medications from two to four drug categories in the past 10 years owing to lack of efficacy or tolerability, or both. Patients were randomised 1:1 to receive subcutaneous placebo or galcanezumab 120 mg per month (with a 240 mg loading dose administered as two 120 mg injections) for 3 months. For masking purposes, patients receiving placebo also received two injections during the first dosing visit. Randomisation was done by a computer-generated random sequence by means of an interactive web-response system stratified by country and migraine frequency (low frequency episodic migraine, four to fewer than eight migraine headache days per month; high frequency episodic migraine, eight to 14 migraine headache days per month and fewer than 15 headache days per month; chronic migraine, at least eight migraine headache days per month and at least 15 headache days per month). The primary endpoint was the overall mean change from baseline in number of monthly migraine headache days during the 3-month treatment period in all patients who were randomly assigned and received at least one dose of study drug. This trial is registered with ClinicalTrials.gov, NCT03559257, and is now completed. FINDINGS: Between Sept 10, 2018, and March 21, 2019, 462 participants with episodic (269 [58%]) or chronic (193 [42%]) migraine were randomly assigned and received at least one injection with placebo (n=230) or galcanezumab (n=232). Galcanezumab-treated patients had significantly greater reduction in migraine headache days versus placebo across months 1-3. The galcanezumab group had on average 4·1 fewer monthly migraine headache days compared with baseline (13·4), while the placebo group had on average 1·0 fewer than at baseline (13·0; between-group difference -3·1 [95% CI -3·9 to -2·3]; p<0·0001; effect size=0·72). Types and number of treatment-emergent adverse events were similar between galcanezumab and placebo. Treatment-emergent adverse events were reported in 122 (53%) of 230 patients in the placebo group and 119 (51%) of 232 patients in the galcanezumab group. There were four serious adverse events during the study, two (1%) reported in the placebo group and two (1%) reported in the galcanezumab group. INTERPRETATION: Galcanezumab was superior to placebo in the preventive treatment of migraine and was safe and well tolerated in patients for whom multiple previous standard-of-care preventive treatments had failed. Galcanezumab might represent an important treatment option for patients who have not benefited from or tolerated previous standard-of-care treatments. FUNDING: Eli Lilly.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/tratamento farmacológico , Falha de Tratamento , Adolescente , Adulto , Idoso , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
11.
Stroke ; 51(10): 3039-3044, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32867601

RESUMO

BACKGROUND AND PURPOSE: Delayed cerebral ischemia (DCI) is a major contributor to the high morbidity in patients with aneurysmal subarachnoid hemorrhage (aSAH). Spreading depolarizations may play a role in DCI pathophysiology. Because patients with migraine are probably more susceptible to spreading depolarizations, we investigated whether patients with aneurysmal subarachnoid hemorrhage with migraine are at increased risk for DCI. METHODS: We included patients with aneurysmal subarachnoid hemorrhage from 3 hospitals in the Netherlands. We assessed lifetime migraine history with a short screener. DCI was defined as neurological deterioration lasting >1 hour not attributable to other causes by diagnostic work-up. Adjustments were made for possible confounders in multivariable Cox regression analyses and adjusted hazard ratios (aHR) were calculated. We assessed the interaction effects of age and sex. RESULTS: We included 582 patients (mean age 57 years, 71% women) mostly with mild to moderate aneurysmal subarachnoid hemorrhage of whom 108 (19%) had a history of migraine (57 with aura). Patients with migraine were not at increased risk of developing DCI compared with patients without migraine (22% versus 24%, aHR, 0.89 [95% CI, 0.56-1.43]). Additionally, no increased risk was found in patients with migraine with possible aura (aHR, 0.74 [95% CI, 0.39-1.43]), in women (aHR, 0.88 [95% CI, 0.53-1.45], Pinteraction=0.859), or in young patients aged <50 years (aHR, 1.59 [95% CI, 0.72-3.49]), although numbers in these subgroups were limited. We found an interaction between migraine and age with an increased risk of DCI among young patients with migraine (Pinteraction=0.075). CONCLUSIONS: Patients with migraine are in general not at increased risk of DCI. Future studies should focus in particular on young SAH patients, in whom there might be an association between migraine history and development of DCI.


Assuntos
Isquemia Encefálica/etiologia , Transtornos de Enxaqueca/complicações , Hemorragia Subaracnóidea/complicações , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Fatores de Tempo
12.
J Headache Pain ; 21(1): 115, 2020 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-32972360

RESUMO

BACKGROUND: Since the declaration COVID-19 as a pandemic, healthcare systems around the world have faced a huge challenge in managing patients with chronic diseases. Patients with migraine were specifically vulnerable to inadequate medical care. We aimed to investigate the "real-world" impact of COVID-19 pandemic on migraine patients, and to identify risk factors for poor outcome. METHODS: We administered an online, self-reported survey that included demographic, migraine-related, COVID-19-specific and overall psychosocial variables between July 15 and July 30, 2020. We recruited a sample of patients with migraine from headache clinic registry and via social media to complete an anonymous survey. Outcomes included demographic variables, change in migraine frequency and severity during the lockdown period, communication with treating physician, compliance to migraine treatment, difficulty in getting medications, medication overuse, symptoms of anxiety and/or depression, sleep and eating habits disturbance, screen time exposure, work during pandemic, use of traditional medicine, effect of Botox injection cancellation, and overall worries and concerns during pandemic. RESULTS: A total of 1018 patients completed the survey. Of the respondents, 859 (84.3%) were females; 733 (71.9%) were aged 20 to 40 years, 630 (61.8%) were married, and 466 (45.7%) reported working during the pandemic. In comparison to pre-pandemic period, 607 respondents (59.6%) reported increase in migraine frequency, 163 (16%) reported decrease in frequency, and 105 (10.3%) transformed to chronic migraine. Severity was reported to increase by 653 (64.1%) respondents. The majority of respondents; 626 (61.5%) did not communicate with their neurologists, 477 (46.9%) reported compliance to treatment, and 597 (58.7%) reported overuse of analgesics. Botox injections cancellation had a negative impact on 150 respondents (66.1%) from those receiving it. Forty-one respondents (4%) were infected with COVID-19; 26 (63.4%) reported worsening of their headaches amid infection period. Sleep disturbance was reported by 794 (78.1%) of respondents, and 809 (79.5%) reported having symptoms of anxiety and/or depression. CONCLUSIONS AND RELEVANCE: COVID-19 pandemic had an overall negative impact on patients with migraine. Several risk factors for poor outcome were identified. Long-term strategies should be validated and implemented to deliver quality care for patients with migraine, with emphasis on psychosocial well-being.


Assuntos
Infecções por Coronavirus/epidemiologia , Transtornos de Enxaqueca/fisiopatologia , Pneumonia Viral/epidemiologia , Uso Excessivo de Medicamentos Prescritos/estatística & dados numéricos , Adulto , Analgésicos/uso terapêutico , Ansiedade/psicologia , Betacoronavirus , Toxinas Botulínicas Tipo A/uso terapêutico , Comunicação , Depressão/psicologia , Feminino , Acesso aos Serviços de Saúde , Humanos , Internet , Kuweit/epidemiologia , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/tratamento farmacológico , Transtornos de Enxaqueca/prevenção & controle , Transtornos de Enxaqueca/psicologia , Fármacos Neuromusculares/uso terapêutico , Pandemias , Relações Médico-Paciente , Fatores de Risco , Sono , Distúrbios do Início e da Manutenção do Sono/fisiopatologia , Distúrbios do Início e da Manutenção do Sono/psicologia , Inquéritos e Questionários , Adulto Jovem
13.
Plast Reconstr Surg ; 146(4): 863-871, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32970009

RESUMO

BACKGROUND: Patient selection for headache surgery is an important variable to ensure successful outcomes. In the authors' experience, a valuable method to visualize pain/trigger sites is to ask patients to draw their pain. The authors have found that there are pathognomonic pain patterns for each site, and typically do not operate on patients with atypical pain sketches, as they believe such patients are poor surgical candidates. However, a small subset of these atypical patients undergo surgery based on other strong clinical findings. In this study, the authors attempt to quantify this clinical experience. METHODS: Patients were prospectively enrolled and completed pain sketches at screening. One hundred six diagrams were analyzed/categorized by two independent, blinded reviewers as follows: (1) typical (pain over nerve distribution, expected radiation); (2) intermediate (pain over nerve distribution, atypical radiation); or (3) atypical (pain outside of normal nerve distribution, atypical radiation). Preoperative and postoperative Migraine Headache Index was compared between subgroups using unpaired t tests. RESULTS: Migraine Headache Index improvement was 73 ± 38 percent in the typical group, 78 ± 30 percent in the intermediate group, and 30 ± 40 percent in the atypical group. There was a significant difference in Migraine Headache Index between the typical and atypical groups (p = 0.03) and between the intermediate and atypical groups (p < 0.01). The chance of achieving Migraine Headache Index improvement greater than 30 percent in the atypical group was 20 percent. CONCLUSIONS: Patient pain sketches classified as atypical (facial pain, atypical pain point origin, diffuse pain) can predict poor outcomes in headache surgery. As the authors continue to develop patient selection criteria for headache surgery, patient sketches should be considered as an effective, cheap, and simple-to-interpret tool for selecting candidates for surgery.


Assuntos
Cefaleia/cirurgia , Transtornos de Enxaqueca/cirurgia , Medição da Dor/métodos , Pontos-Gatilho/cirurgia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
14.
Mol Pharmacol ; 98(4): 433-444, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32958571

RESUMO

For decades the broad role of opioids in addiction, neuropsychiatric disorders, and pain states has been somewhat well established. However, in recent years, with the rise of technological advances, not only is the existing dogma being challenged, but we are identifying new disease areas in which opioids play a critical role. This review highlights four new areas of exploration in the opioid field. The most recent addition to the opioid family, the nociceptin receptor system, shows promise as the missing link in understanding the neurocircuitry of motivation. It is well known that activation of the kappa opioid receptor system modulates negative affect and dysphoria, but recent studies now implicate the kappa opioid system in the modulation of negative affect associated with pain. Opioids are critical in pain management; however, the often-forgotten delta opioid receptor system has been identified as a novel therapeutic target for headache disorders and migraine. Lastly, changes to the gut microbiome have been shown to directly contribute to many of the symptoms of chronic opioid use and opioid related behaviors. This review summarizes the findings from each of these areas with an emphasis on identifying new therapeutic targets. SIGNIFICANCE STATEMENT: The focus of this minireview is to highlight new disease areas or new aspects of disease in which opioids have been implicated; this includes pain, motivation, migraine, and the microbiome. In some cases, this has resulted in the pursuit of a novel therapeutic target and resultant clinical trial. We believe this is very timely and will be a refreshing take on reading about opioids and disease.


Assuntos
Analgésicos Opioides/farmacologia , Transtornos de Enxaqueca/metabolismo , Transtornos Relacionados ao Uso de Opioides/microbiologia , Dor/metabolismo , Receptores Opioides/metabolismo , Analgésicos Opioides/uso terapêutico , Animais , Microbioma Gastrointestinal/efeitos dos fármacos , Humanos , Transtornos de Enxaqueca/tratamento farmacológico , Motivação , Transtornos Relacionados ao Uso de Opioides/metabolismo , Dor/tratamento farmacológico , Receptores Opioides delta/metabolismo , Receptores Opioides kappa/metabolismo , Transdução de Sinais/efeitos dos fármacos
15.
Medicine (Baltimore) ; 99(31): e21268, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756105

RESUMO

BACKGROUND: Nowadays, acupoint catgut embedding is being used widely in the treatment of migraine. So far, there is no a systematic review has been conducted. Therefore, the purpose of this paper is to systematically evaluate the efficacy and safety of acupoint catgut embedding on migraine. METHODS: We will search the following databases from their inception to May 2020: PubMed, Embase, Medline, EBSCO, Web of Science, Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database, Wan Fang Database, the Chongqing VIP Chinese Science and Technology Periodical Database, Cochrane Library. In addition, we will manually retrieve other resources including conference articles, and gray literature. The randomized controlled trials in English or Chinese associated with acupoint catgut embedding for migraines will be included. The data collection and analysis will be conducted independently by 2 reviewers. Meta-analysis will be performed using Rev Man V.5.3.5 statistical software. RESULTS: This study will provide a high-quality synthesis to evaluate the efficacy and safety of acupoint catgut embedding for patients with migraine. CONCLUSION: This systematic review will provide evidence to judge whether acupoint catgut embedding is an effective and safe intervention for patients with migraines. It will provide reliable evidence for its extensive application. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/RP9NW.


Assuntos
Pontos de Acupuntura , Categute , Transtornos de Enxaqueca/terapia , Revisões Sistemáticas como Assunto , Terapia por Acupuntura , Humanos
16.
Praxis (Bern 1994) ; 109(10): 806-811, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32752959

RESUMO

Migraine? Arnold Chiari Malformation? Or Just a Migraine? Abstract. In a young woman with a long-time headache in the sense of a migraine, a neurological reassessment including new findings of the existing MRI images of the skull resulted in the diagnosis of a Chiari malformation type 1. After successful operation of the MRI findings, the headache decreased significantly. However, since minor headaches of a different quality persist, a migraine plus malformation as an incidental finding are most likely.


Assuntos
Malformação de Arnold-Chiari , Transtornos de Enxaqueca , Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/diagnóstico por imagem , Osso e Ossos , Feminino , Cefaleia , Humanos , Imagem por Ressonância Magnética , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/diagnóstico por imagem
17.
J Headache Pain ; 21(1): 100, 2020 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-32787771

RESUMO

BACKGROUND: Psychological distress is highly prevalent among migraineurs during public health emergencies. The coronavirus disease 2019 (nCOV-2019) has created mass panic in China due to its highly contagious by contact and aerosols and lack of effective treatment. However, the emotion status of migraineurs stayed unclear during the nCOV-2019 outbreak. OBJECTIVE: To understand psychological distress of migraineurs by comparing with common population and identify potential high-risk factors of severe psychological distress among migraine patients. METHOD: We enrolled the migraineurs treated at the department of Neurology of West China Hospital and healthy controls with age- and sex-matched to migraineurs. Data on clinicodemographics and psychological distress in the month of February 2020 (during in the nCOV-2019 outbreak in China) were collected. We used the Kessler 6-item (K-6) scale to assess psychological distress. Potential risk factors of severe psychological distress were identified using univariate and multivariate logistic regression. RESULTS: The 144 migraineurs and 150 controls were included in the study. Migraineurs showed significantly higher K-6 scores than controls (P < 0.001). Migraine attack frequency in previous 30 days and time spent paying attention to outbreak showed significant in multivariate logistic regression with respective odds ratios of 2.225 (95%CI 1.361-3.628, P = 0.001) and 1.589 (95% 1.117-2.26, P = 0.01). CONCLUSION: During public health outbreaks, healthcare professionals should focus not only on controlling and reducing migraine attack but also on mental health of migraineurs, especially those with high frequency migraine attack.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Transtornos de Enxaqueca , Pandemias , Pneumonia Viral , Angústia Psicológica , China/epidemiologia , Estudos Transversais , Pessoal de Saúde , Humanos , Prevalência , Fatores de Risco
18.
Artigo em Chinês | MEDLINE | ID: mdl-32842206

RESUMO

Objective:To analyze the clinical features of Vestibular migraine(VM) and provide evidence for its accurate diagnosis and medical identification of flight personnel. Method:A total of 490 samples of VM patients were collected. Among them, 88 samples were secondary to benign paroxysmal positional vertigo(BPPV), and 11 samples were co-occurring with Meniere's disease(MD). All patients received drugs, lifestyle management, vestibular rehabilitation and other comprehensive treatment, and analyzed the clinical features and effect within 6 months. Result:①The male-female ratio of VM patients was 1∶1.95, the average age was (50.2±14.3) years old, (48.7±15.0) years old for males and (51.0±13.9) years old for females. No statistically significant differences were found(P>0.05). The average duration was(54.5±84.8) months, (35.0±59.0) months for males and(64.7±94.0) months for females. The difference was statistically significant(P<0.05). ②The main clinical symptoms are dizziness, migraine or previous history of migraine, fear of sound/noisy environment sensitivity, photophobia/visual sensitivity, nausea/vomiting, vestibular posture symptoms, tinnitus, hearing loss, etc. , diarrhea during dizziness or headache was one special symptom of VM; ③The abnormal rate of vestibular autorotation test(VAT) in 118 VM patients was 72.3%, while the abnormal rate of caloric test in 170 VM patients was 32.9%; ④The effective remission rate within 6 months of VM patients with secondary BPPV and MD was 78.6% and 83.4%, while the VM patients without secondary benign paroxysmal positional vertigo(BPPV) and Meniere's disease(MD) was 93.3%. The difference was statistically significant(P<0.05). Conclusion:The clinical manifestations of VM patients were various. Female VM patients had higher incidence, the course of disease than male VM patients, diarrhea can be regarded as one of the clinical features distinguished from MD. The abnormal rate of VAT was higher in the common clinical examiniations of VM patients. VM patients treatment should focus on personalized prescription and lifestyle management, vestibular rehabilitation, and corresponding treatment at the same time should be given to patients with secondary BPPV and MD to improve the efficacy. The medical identification of flight personnel VM patients should be strictly controlled, pilots should be grounded, while flight combat personnel and flight technical personnel need chartered medical identification.


Assuntos
Doença de Meniere , Transtornos de Enxaqueca , Adulto , Vertigem Posicional Paroxística Benigna , Testes Calóricos , Tontura , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
19.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32732262

RESUMO

OBJECTIVES: Acute nystagmus (AN) is an uncommon neurologic sign in children presenting to pediatric emergency departments. We described the epidemiology, clinical features, and underlying causes of AN in a large cohort of children, aiming at identifying features associated with higher risk of severe underlying urgent conditions (UCs). METHODS: Clinical records of all patients aged 0 to 18 years presenting for AN to the pediatric emergency departments of 9 Italian hospitals in an 8-year period were retrospectively reviewed. Clinical and demographic features and the underlying causes were analyzed. A logistic regression model was applied to detect predictive variables associated with a higher risk of UCs. RESULTS: A total of 206 patients with AN were included (male-to-female ratio: 1.01; mean age: 8 years 11 months). The most frequently associated symptoms were headache (43.2%) and vertigo (42.2%). Ataxia (17.5%) and strabismus (13.1%) were the most common neurologic signs. Migraine (25.7%) and vestibular disorders (14.1%) were the most common causes of AN. Idiopathic infantile nystagmus was the most common cause in infants <1 year of age. UCs accounted for 18.9% of all cases, mostly represented by brain tumors (8.3%). Accordant with the logistic model, cranial nerve deficits, ataxia, or strabismus were strongly associated with an underlying UC. Presence of vertigo or attribution of a nonurgent triage code was associated with a reduced risk of UCs. CONCLUSIONS: AN should be considered an alarming finding in children given the risk of severe UCs. Cranial nerve palsy, ataxia, and strabismus should be considered red flags during the assessment of a child with AN.


Assuntos
Nistagmo Patológico/etiologia , Ataxia/complicações , Ataxia/diagnóstico , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico , Infecções do Sistema Nervoso Central/complicações , Infecções do Sistema Nervoso Central/diagnóstico , Criança , Pré-Escolar , Estudos de Coortes , Doenças dos Nervos Cranianos/complicações , Doenças dos Nervos Cranianos/diagnóstico , Doenças Desmielinizantes/complicações , Doenças Desmielinizantes/diagnóstico , Tontura/etiologia , Serviço Hospitalar de Emergência , Feminino , Cefaleia/etiologia , Humanos , Hipertensão Intracraniana/complicações , Hipertensão Intracraniana/diagnóstico , Itália , Masculino , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/diagnóstico , Náusea/etiologia , Envenenamento/complicações , Envenenamento/diagnóstico , Estudos Retrospectivos , Estrabismo/etiologia , Vertigem/etiologia , Doenças Vestibulares/complicações , Doenças Vestibulares/diagnóstico , Vômito/etiologia
20.
Plast Reconstr Surg ; 146(2): 381-388, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740591

RESUMO

BACKGROUND: Patients undergoing trigger-site deactivation surgery for headaches report a high prevalence (approximately 37 percent) of prior head or neck injury. Traditional medical treatment often fails to treat these posttraumatic patients. It is unclear whether surgery mirrors these poor outcomes. This study aims to describe the characteristics of posttraumatic headache surgery patients and compare their postoperative results to those of patients without a history of head or neck injury. METHODS: One hundred forty-two patients undergoing trigger-site deactivation surgery were prospectively enrolled. Patients were requested to complete a preoperative questionnaire on headache history, including the Migraine Headache Index and information on prior head or neck injury. Follow-up surveys were requested at approximately 12 months postoperatively. RESULTS: Seventy patients (49 percent) reported a history of head or neck injury, and 41 (29 percent) classified the injury as the precipitating event leading to their headache onset. Patients with a precipitating event were significantly less likely to report a family history of migraine. There was no significant difference in mean preoperative Migraine Headache Index between cohorts. At 12 months postoperatively, there was no significant difference in Migraine Headache Index reduction between groups. The proportion of patients who experienced at least a 50 and 80 percent improvement in Migraine Headache Index per group, respectively, was 83 and 67 percent (atraumatic), 76 and 68 percent (posttraumatic), and 71 and 63 percent (precipitating event). CONCLUSIONS: This study suggests that surgical outcomes in posttraumatic headache patients are comparable to those without injury. Trigger-site deactivation surgery candidates with a history of injury can therefore expect similar outcomes as reported for patients overall. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.


Assuntos
Traumatismos Craniocerebrais/complicações , Descompressão Cirúrgica/estatística & dados numéricos , Transtornos de Enxaqueca/cirurgia , Lesões do Pescoço/complicações , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/etiologia , Medição da Dor/estatística & dados numéricos , Resultado do Tratamento
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