Brazilian headache registry: methods and preliminary data of the pilot study

BACKGROUND

Evaluation and treatment of primary and secondary headaches is a global public health challenge. Recognizing the epidemiological impact of headaches, a group of researchers linked to the Brazilian Headache Society proposed the Brazilian Headache Registry and drew up its initial protocol.

OBJECTIVE

Here we describe the methods and preliminary data obtained from the pilot study.

METHODS

This was a multicenter longitudinal observational study conducted between September 2020 and August 2021. Prospective data were collected in three specialist centers for headache care in states in southern and southeastern Brazil. Patients aged 18 years or older who sought care for headache in tertiary centers and who agreed to participate in the study, were considered eligible.

RESULTS

Sixty-six patients were included in the pilot study: 43 (65%) from Rio Grande do Sul state and 23 (35%) from Minas Gerais state. Overall, 90% were female, and the subjects' mean age was 38.2 ± 11.2 years. Primary headaches accounted for 85.3% of the diagnoses made. Among secondary headaches, medication overuse headache was the most frequent type (7.1%).

CONCLUSIONS

The pilot study showed the feasibility of the research protocol developed for tertiary centers. The Brazilian Headache Registry will form a source of longitudinal data with the aim of contributing to better characterization of the various phenotypes of patients with primary and secondary headaches, and to detailing the use of health resources and identifying predictors of better clinical outcomes.

Consensus of the Brazilian Headache Society (SBCe) for prophylactic treatment of episodic migraine: part II

BACKGROUND

Migraine affects 1 billion people worldwide and > 30 million Brazilians; besides, it is an underdiagnosed and undertreated disorder.

OBJECTIVE

The need to disseminate knowledge about the prophylactic treatment of migraine is known, so the Brazilian Headache Society (SBCe, in the Portuguese acronym) appointed a committee of authors with the objective of establishing a consensus with recommendations on the prophylactic treatment of episodic migraine based on articles from the world literature as well as from personal experience.

METHODS

Meetings were held entirely online, with the participation of 12 groups that reviewed and wrote about the pharmacological categories of drugs and, at the end, met to read and finish the document. The drug classes studied in part II of this Consensus were: antihypertensives, selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, calcium channel blockers, other drugs, and rational polytherapy.

RESULTS

From this list of drugs, only candesartan has been established as effective in controlling episodic migraine. Flunarizine, venlafaxine, duloxetine, and pizotifen were defined as likely to be effective, while lisinopril, enalapril, escitalopram, fluvoxamine, quetiapine, atorvastatin, simvastatin, cyproheptadine, and melatonin were possibly effective in prophylaxis of the disease.

CONCLUSIONS

Despite an effort by the scientific community to find really effective drugs in the treatment of migraine, given the large number of drugs tested for this purpose, we still have few therapeutic options.

Consensus of the Brazilian Headache Society (SBCe) for the Prophylactic Treatment of Episodic Migraine: part I

The Brazilian Headache Society (Sociedade Brasileira de Cefaleia, SBCe, in Portuguese) nominated a Committee of Authors with the aim of establishing a consensus with recommendations regarding prophylactic treatment for episodic migraine based on articles published in the worldwide literature, as well as personal experience. Migraine affects 1 billion people around the world and more than 30 million Brazilians. In addition, it is an underdiagnosed and undertreated disorder. It is well known within the medical community of neurologists, and especially among headache specialists, that there is a need to disseminate knowledge about prophylactic treatment for migraine. For this purpose, together with the need for drug updates and to expand knowledge of the disease itself (frequency, intensity, duration, impact and perhaps the progression of migraine), this Consensus was developed, following a full online methodology, by 12 groups who reviewed and wrote about the pharmacological categories of the drugs used and, at the end of the process, met to read and establish conclusions for this document. The drug classes studied were: anticonvulsants, tricyclic antidepressants, monoclonal anti-calcitonin gene-related peptide (anti-CGRP) antibodies, beta-blockers, antihypertensives, calcium channel inhibitors, other antidepressants (selective serotonin reuptake inhibitors, SSRIs, and dual-action antidepressants), other drugs, and polytherapy. Hormonal treatment and anti-inflammatories and triptans in minimum prophylaxis schemes (miniprophylaxis) will be covered in a specific chapter. The drug classes studied for part I of the Consensus were: anticonvulsants, tricyclic antidepressants, monoclonal anti-CGRP antibodies, and beta-blockers.

Headache-related cognitive distortions questionnaire

Background. - Cognitive distortions are systematic errors in thinking and can be observed in the relationship of headache patients with their own disease and treatment. Objective. - To construct and validate an instrument to evaluate headache-related cognitive distortions in those with primary headache disorders; and to investigate the psychometric properties of this new instrument. Methods. - One hundred thirty-six (136) migraine outpatients from three Brazilian specialized headache hospital services completed the Headache-related Cognitive Distortions Inventory (HCDQ) and validated measures of psychological symptoms, pain catastrophizing, mood disorders, quality of life and headache-related disability. Results. - All hypothesized study measures’ correlations were statistically significant, supporting construct validity. HCDQ scores were positively correlated with headache frequency, headache intensity, psychological symptoms, depression, anxiety, and pain catastrophizing; and negatively correlated with 7 of 8 quality of life domains and time the patient was in treatment. Cronbach’s alpha demonstrated excellent internal consistency for the 17-item total scale (alpha=.92). Along with headache intensity and depression, HCDQ Pain subscale accounted for 46% of variance in the prediction of headache-related disability. Conclusions. - HCDQ is a valid and reliable measure of migraine patients´ cognitive distortions about their headaches and headache treatment.

Brazilian version of headache management self-efficacy scale

Background Headache-management self-efficacy has been associated with pain severity and headache-related disability. Objective The aim of this study was to test the cross-cultural adaptation and psychometric properties of a Brazilian version of the Headache Management Self-Efficacy Scale (HMSE) in a sample of patients coming from three tertiary headache centers in Brazil. Methods 137 migraine outpatients completed the Headache Management Self-Efficacy Scale (HMSE) and measures of psychopathological symptoms, pain catastrophizing, depression, anxiety, quality of life and headache-related disability. Results HMSE-10 showed good reliability (α = 0.84) and adequate corrected item-total correlation, ranging from 0.46 to 0.64. HMSE-10 was positively correlated with 6 of 8 domains of overall health status and negatively correlated with psychopathological symptoms, depression, anxiety, pain catastrophizing, headache-related disability, headache frequency and headache intensity. The difference between the means of the episodic and chronic headache patients had a magnitude of moderate effect in all the study measures, being headache-related disability the largest one found (d = 0.68). Along with headache intensity and depression, Efficacy Scale beliefs were predictors of headache-related disability. Conclusions The Brazilian short version of Headache Management Self-Efficacy Scale (HMSE-10) was revealed as a valid and reliable measure of headache-specific Efficacy Scale beliefs.

Who is in charge when I have a headache? Brazilian version of the Headache-Specific Locus of Control Scale

BACKGROUND

Headache-Specific Locus of Control (LOC) refers to individuals' beliefs about their control over the onset, course and consequences of headaches. LOC beliefs have been associated with depression, coping strategies, headache-related disability and treatment outcomes.

OBJECTIVE

To test the cross-cultural adaptation and psychometric properties of a Brazilian version of the Headache-Specific Locus of Control Scale (HSLC).

METHODS

One hundred and thirty-four migraine outpatients completed the HSLC and provided measurements of psychopathological symptoms, pain catastrophizing, depression, anxiety, quality of life and headache-related disability.

RESULTS

The three-factor structure of the HSLC (LOC-P, LOC-C and LOC-I) was confirmed in the Brazilian sample. The instrument showed good internal consistency, with Cronbach's α of 0.77 for total HSLC and 0.70, 0.83 and 0.87, for LOC-P, LOC-C and LOC-I, respectively. LOC-C correlated with headache frequency and headache intensity. Along with headache intensity, depression and pain catastrophizing, LOC-I accounted for 45% of the variance (adjusted R2=0.45; F=12.97; p<0.01) in headache-related disability.

CONCLUSIONS

The Brazilian version of the HSLC is a valid and reliable measure of headache-specific LOC beliefs. It is important to consider the balance between the three LOCs for each individual, instead of interpreting them separately.

The worst is yet to come: probable sporadic Creutzfeldt-Jakob disease in a well-controlled HIV patient

We describe a case of probable sporadic Creutzfeldt-Jakob disease in the setting of well-controlled HIV and discuss whether exist, in fact, HIV-related factors that may predispose to the development of prion disease. To the best of our knowledge, this is the third report of this association.

Resolution of headache after reduction of prolactin levels in hyperprolactinemic patients

METHODS

Prolactin (PRL) secreting adenomas are associated with high incidence of headache. The role of hyperprolactinemia in the headache context is not clear, nor is the effect of its treatment on headache. The present longitudinal study evaluated hyperprolactinemic patients (69), in terms of presence and characteristics of headache before and after hyperprolactinemia treatment.

RESULTS

Headache was reported by 45 (65.2%) patients, independent of the etiology of hyperprolactinemia. The migraine phenotype was the most prevalent (66.6%). Medications used in the treatment of headache not changed during the study. The first line of treatment of hyperprolactinemia was dopaminergic agonists. In the last reevaluation, PRL level under treatment was within the reference range in 54.7% of the cases, and it was observed complete or partial resolution of the headache in 75% of the cases. The median PRL at this time in patients with complete headache resolution was 17 ng/mL, in those who reported partial recovery was 21 ng/mL, and in those in whom the headache did not change was 66 ng/mL, with a significant difference between the group with complete headache resolution vs. the group with unchanged headache (p=0.022). In the cases with complete headache resolution, the median fall on PRL levels was 89% and in those cases with partial headache resolution 86%, both significantly different (p<0.001) from the fall in the cases with an unchanged headache.

CONCLUSION

Data allow us to conclude that, in this series, in the majority of cases the reduction in the level of PRL was followe3d by cessation or relief of the pain.

Consensus of the Brazilian Headache Society on the treatment of chronic migraine

Chronic migraine poses a significant personal, social and economic burden and is characterized by headache present on 15 or more days per month for at least three months, with at least eight days of migrainous headache per month. It is frequently associated with analgesic or acute migraine medication overuse and this should not be overlooked. The present consensus was elaborated upon by a group of members of the Brazilian Headache Society in order to describe current evidence and to provide recommendations related to chronic migraine pharmacological and nonpharmacological treatment. Withdrawal strategies in medication overuse headache are also described, as well as treatment risks during pregnancy and breastfeeding. Oral topiramate and onabotulinum toxin A injections are the only treatments granted Class A recommendation, while valproate, gabapentin, and tizanidine received Class B recommendation, along with acupuncture, biofeedback, and mindfulness. The anti-CGRP or anti-CGRPr monoclonal antibodies, still unavailable in Brazil, are promising new drugs already approved elsewhere for migraine prophylactic treatment, the efficacy of which in chronic migraine is still to be definitively proven.

Association between neurological injury and the severity of oropharyngeal dysphagia after stroke

Purpose

To associate the degree of biomechanical impairment in the swallowing process with the severity (National Institute of Health Stroke Scale - NIHSS) and type of neurological injury in patients post stroke.

Methods

A cross-sectional, descriptive study conducted with 42 patients (22 females), aged 65.7 years on average diagnosed with stroke. All patients underwent clinical neurological evaluation and application of the NIHSS in the first 48 hours after stroke. The swallowing function was evaluated using the Functional Oral Intake Scale (FOIS) and the Protocol for the Investigation of Oropharyngeal Dysphagia in Adults. The Fisher's Exact Probability Test was used to assess the correlation between the degree of swallowing impairment and the severity (NIHSS score) and type of stroke. The study results were statistically analyzed at 5% significance level (p≤0.05).

Results

92.9% of the patients presented ischemic stroke; 59.5% presented impairment of the anterior cerebral circulation. Statistically significant correlation was found between the neurological scale (NIHSS) scores and the swallowing impairment scale (p=0.016).

Conclusion

An association between stroke severity and oropharyngeal dysphagia severity was observed. A high proportion of patients with ischemic stroke with circulation affected in the anterior cerebral region presented severe oropharyngeal dysphagia. No statistically significant correlation was observed between the FOIS scale and stroke severity.

An Epidemiological Study of Headache in Florianopolis, Brazil

The aim of this study was to estimate the 1-year prevalence of headache, migraine, tension-type headache (TTH) and chronic daily headache (CDH), and the degree of association of migraine with some sociodemographic characteristics of the population of Florianopolis, Brazil. This is a cross-sectional, door-to-door, population-based study. In 300 randomly selected households, 625 subjects, aged 15–64 years, responded to a structured questionnaire. The 1-year prevalence of headache was 80.8%, of migraine 22.1%, of TTH 22.9%, and of CDH 6.4%. Migraine and CDH were significantly more prevalent in females than in males. Migraine was significantly associated with the following variables: low household income, low electricity consumption, and divorced or widowed marital status. We have shown high prevalences of migraine and CDH in Florianopolis, close to the higher rates of previous studies. There was a preponderance of migraine in females, divorced  or  widowed,  with  a  low  socioeconomic  level.

Recommendations for the treatment of migraine attacks - a Brazilian consensus

ABSTRACT In this article, a group of experts in headache management of the Brazilian Headache Society developed through a consensus strategic measurements to treat a migraine attack in both the child and the adult. Particular emphasis was laid on the treatment of migraine in women, including at pregnancy, lactation and perimenstrual period.

Bruns' syndrome and racemose neurocysticercosis: a case report

Cysticercosis is an infection caused by the larval stage of the tapeworm Taenia solium. The parasite may infect the central nervous system, causing neurocysticercosis (NCC). The clinical manifestations depend on load, type, size, location, stage of development of the cysticerci, and the host's immune response against the parasite. The racemose variety occurs in the ventricles or basal cisterns and is a malignant form. Mobile ventricular mass can produce episodic hydrocephalus on changing head posture with attacks of headache, vomiting, and vertigo, triggered by abrupt movement of the head, a phenomenon called Bruns' syndrome (BS). We report a patient with racemose NCC and BS.

Dysphagia and cerebrovascular accident: relationship between severity degree and level of neurological impairment

The aim of this case study was to verify the occurrence of dysphagia in acute ischemic stroke within 48 hours after the onset of the first symptoms, in order to establish a possible relationship between the level of neurologic impairment and the severity degree of dysphagia. After emergency hospital admission, three patients underwent neurological clinical evaluation (general physical examination, neurological examination, and application of the National Institute of Health Stroke Scale - NIHSS), and clinical assessment of swallowing using the Protocolo Fonoaudiológico de Avaliação do Risco para Disfagia (PARD--Speech-Language Pathology Protocol for Risk Evaluation for Dysphagia). One of the patients presented functional swallowing (NIHSS score 11), while the other two had mild and moderate oropharyngeal dysphagia (NIHSS scores 15 and 19, respectively). The service flow and the delay on the patients' search for medical care determined the small sample. The findings corroborate literature data regarding the severity of the neurological condition and the manifestation of dysphagia.

[Infantile neuroaxonal dystrophy: report of 2 cases]

We describe two cases of infantile neuroaxonal dystrophy, which is a rare, neurodegenerative disease, with autosomal recessive inheritance. The first case was an 8 year old boy, with arrested motor and mental development, ataxia and muscle weakness. On physical examination there was horizontal and vertical nystagmus, optic disc atrophy, hypotonia; deep tendon reflexes were absent. The second case was a 1.6 year old boy with arrested motor and mental development, and seizures. On physical examination there was optic atrophy, hypertonia and hyperreflexia. Both patients had on sural nerve biopsy neuronal enlargement, consistent with neuroaxonal dystrophy. Diagnosis without pathological confirmation with neuroaxonal spheroids is very difficult, because the clinical picture is variable and the neurophysiological findings are non specific.

Analgesic use for headache treatment by schoolchildren of southern Brazil

The importance of the use of analgesic medication for the symptomatic relief of pain has been underestimated in medical practice. The objective of this study was to determine the prevalence of tension-type and migraine-type headaches and the associated analgesic consumption for its treatment within elementary school students from Porto Alegre (Brazil). A systematic random sample of 538 students from 5th to 8th grades was produced to complete the cross-sectional delineation. Subjects were individually submitted to a structured interview on headache and to general physical and neurological examination. Lifetime prevalence for headaches was 93.3%, 82.9% of the students recalled having headaches during the last year and 31.4% reported headaches in the last week. The prevalence for headaches in the previous 24 h was 8.9%. There was a significant prevalence of headache in females. The prevalence of analgesic consumption was 84.1% throughout life, 85.7% in the last year, and 54% in the last 3 months. A significantly higher prevalence of headache medication consumption was also depicted for females. However, the small age differences within the sample did not appear to be an important factor in influencing analgesic use for headaches. Different agents composed the individual treatment of headaches, with predominant use of over-the-counter preparations. Acetylsalicylic acid, consumed by 58.3% of the children, was the drug most frequently used for both tension-type and migraine-type headache treatments. In spite of the verification that headache was very frequently experienced by the children composing this sample accompanied by a consequent use of analgesics, no medication abuse was diagnosed.

An epidemiologic study of headache among children and adolescents of southern Brazil

To study the epidemiology of pediatric headache, we conducted a cross-sectional study of a randomized and proportional sample of 538 male and female students, 10 to 18 years old. They were in the 5th to 8th grade of the schools of Porto Alegre, RS, Brazil. The headache disorders were classified on the basis of clinical interview as well as a physical and neurological examination using the operational diagnostic criteria of the International Headache Society (IHS). The following headache prevalences were found: lifetime, 93.2%; last year, 82.9%; last week, 31.4%; last 24 h, 8.9%. Last week and last 24 h headache complaints were twice as prevalent in the female group. During the last year the prevalence of headache disorders was 72.8% for tension-type and 9.9% for migraine headache and was not associated with age distribution. Only the last year and last week prevalences of tension-type headache were significantly higher in the female group. The last year prevalence of headache disorders proved to be positively associated with sex and age variables. The prevalence of headache disorders was found to be extremely high in this population group, requiring more attention on the part of investigators as a public health problem.