Prevalence of trigeminocervical convergence mechanisms in episodic and chronic migraine

BACKGROUND

Migraine pain location and trigeminocervical convergence have limited diagnostic value and have usually been assessed using non-standard verbal descriptors in a small number of centers.

OBJECTIVE

To use non-verbal descriptors of migraine pain location to determine the prevalence of trigeminocervical convergence mechanisms in patients with episodic and chronic migraine. In addition, we explored the factors associated with the presence of convergence.

METHODS

A multicenter study was carried out. The explicit pain location was explored by asking subjects to indicate, on an electronic form, three points on the anterolateral side and three points on the posterolateral side of the head and neck that represented the common locations of their migraine pain. We evaluated associations of the pain pattern with demographic and psychological features, comorbidities, lifestyle and other headache characteristics.

RESULTS

97 episodic and 113 chronic migraine patients were included. Convergence was present in 116 migraineurs (55%) who indicated dominance of pain in the posterior cervical region. This site was more often involved in the chronic migraine group (21 vs. 33%; p=0.034). The number of migrainous/altered sensitivity symptoms (OR=1.39; 95%CI 1.14-1.71) was associated with convergence independently of the chronification status. In this symptom group, there were statistical associations between convergence and vomiting (p=0.045), tactile allodynia (p<0.001), nuchal rigidity (p<0.001) and movement allodynia (p=0.031).

CONCLUSIONS

Trigeminocervical convergence is common in migraineurs and, in practice, it might be found frequently in chronic migraineurs. Some features commonly found in this group, such as altered sensitivity symptoms, are associated with this phenomenon.

Migrânea e comportamento suicida: cronificação como mecanismo intermediário e associação com depressão e sintomas cognitivo-comportamentais no ataque

Introdução A migrânea é frequentemente associada à ideação/tentativa de suicídio na literatura, porém, há uma carência de estudos nacionais. Objetivos Explorar a associação entre comportamento suicida e migrânea em três centros nacionais. Material e métodos Estudo transversal em ambulatórios especializados. Pacientes com migrânea episódica (ME) e crônica (MC) foram convidados consecutivamente. Acompanhantes, funcionários e pacientes de ambulatórios de Dermatologia sem cefaleia foram convidados como controles. A ideação suicida (IS) foi pesquisada pelas escalas Patient Health Questionnaire-9 (PHQ-9, últimas duas semanas) e Columbia-Suicide Severity Rating Scale (C-SSRS, últimos dois meses). A tentativa de suicídio (TS) ao longo da vida foi explorada pela C-SSRS. Aprovado pelo CEP/HC/UFPR 2.732.610. Resultados Incluímos 297 indivíduos (MC 116, ME 101, controle 80) dos quais 41-57 (PHQ-9 e C-SSRS; 13,8-19,2%) com IS e 35 (11,8%) com TS. A proporção de IS foi maior no grupo MC em relação aos controles (PHQ-9: 21,6% vs. 6,2% p=0,006; C-SSRS: 26,7% vs. 10,0% p=0,005; regressão simples) e, pela PHQ-9, em comparação com ME (21,6% vs. 10,9% p=0,038). A proporção de TS foi marginalmente superior em MC comparados com controles (17,2% vs. 7,5% p=0,054). Para a análise multivariada agregamos a ocorrência de IS e/ou TS como comportamento suicida (CS) e, para fins de inferência causal, ajustamos cinco confundidores de acordo com um gráfico acíclico dirigido. A probabilidade de CS sofre efeito da MC em comparação com controles (OR 2,69; IC95% 1,23-6,24). Um modelo preditivo com o subgrupo migranoso demonstrou que depressão (OR 4,48; IC95% 2,12-9,78) e piora de sintomas cognitivo-comportamentais (OR 1,42; IC95% 1,12-1,83) no ataque estão associados com CS. Conclusões A cronificação parece ter um papel no surgimento do comportamento suicida em migranosos. Depressão e sintomas cognitivo-comportamentais no ataque servem como sinais de alerta.

Association between sleep and awake bruxism in patients with migraine

IntroductionWhen migraine undergoes transformation from episodic to chronic form it becomes more disabling due to the refractoriness in treatment and the emergence of comorbidities, with the establishment of a bidirectional relationship between sleep bruxism and chronic migraine. This study aimed to assess whether sleep and awake bruxism are more prevalent in chronic migraine when compared to episodic migraine and also to establish possible clinical correlations with the process of chronification.Methods210 patients were allocated to the study, 97 with episodic migraine and 113 with chronic migraine, who underwent face-to-face interviews with the completion of the scales: specific questionnaire for the diagnosis of sleep and awake bruxism, PHQ-9 (depression), GAD-7 (anxiety), Epworth Scale (daytime sleepiness), MIDAS (migraine incapacity) and HIT-6 (impact of headache). ResultsThe prevalence of sleep and awake bruxism was similar in patients with episodic versus chronic migraine (p = 0.300 and p = 0.238). The correlation of patients with concomitant awake and sleep bruxism and with high scores on the migraine incapacity (MIDAS) and headache impact (HIT-6) scales was higher among patients with chronic migraine than in patients with episodic migraine. (p <0.001 and p <0.001). ConclusionSleep and awake bruxism alone are not more prevalent in chronic migraine when compared to episodic migraine, although bruxism causes greater impact and disability on individuals with chronic migraine.

Cutaneous tuberculosis on the scalp: a case report

Tuberculosis is a disease that usually affects the lungs, although other systems may also be infected, resulting in atypical clinical presentations. We report the case of a 76-year-old man who was admitted to the hospital in Brazil with a 3-week history of a painful, enlarging ulcer on the scalp and cough. His medical history was notable for non-metastatic prostatic adenocarcinoma and esophageal squamous cell carcinoma. On physical examination, the ulcer measured 10 cm in diameter and was tender, with a firm border and yellow crusts. A punch-biopsy specimen of the edge of the ulcer showed acute and chronic non-specific inflammation and neutrophilic infiltrates. Acid-fast bacilli were seen on microscopic examination, molecular testing detected Mycobacterium tuberculosis DNA and pan-sensitive M. tuberculosis was cultured. Computed tomography (CT) scan of the head showed a frontoparietal osteolytic lesion under the ulcer, chest CT revealed areas of consolidation in the lower lobes and M. tuberculosis was also identified in a bronchoalveolar lavage specimen. After one month of combination therapy with rifampin, isoniazid, pyrazinamide and ethambutol his symptoms were found to be improving and the size of the ulcer was markedly reduced.