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García-Ull J, González-García N, Torres-Ferrús M, García-Azorín D, Molina-Martínez IFJ, Beltrán-Blasco I, Santos-Lasaosa S, Latorre G, Gago-Veiga AB, Láinez JM, Porta-Etessam J, Nieves-Castellanos C, Mínguez-Olaondo A, López-Bravo A, Quintas S, Morollón N, Díaz-Insa S, Belvís R, Irimia P. Diagnosis and treatment of disorders of intracranial pressure: consensus statement of the Spanish Society of Neurology's Headache Study Group. Neurologia 2024:S2173-5808(24)00048-8. [PMID: 38431253 DOI: 10.1016/j.nrleng.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Primary intracranial pressure disorders include idiopathic intracranial hypertension and spontaneous intracranial hypotension. Remarkable advances have been made in the diagnosis and treatment of these 2entities in recent years. Therefore, the Spanish Society of Neurology's Headache Study Group (GECSEN) deemed it necessary to prepare this consensus statement, including diagnostic and therapeutic algorithms to facilitate and improve the management of these disorders in clinical practice. This document was created by a committee of experts belonging to GECSEN, and is based on a systematic review of the literature, incorporating the experience of the participants, and establishes practical recommendations with levels of evidence and grades of recommendation.
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Affiliation(s)
- J García-Ull
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valencia, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain.
| | - N González-García
- Unidad de Cefaleas, Servicio de Neurología, Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos, Madrid, Spain
| | - M Torres-Ferrús
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - D García-Azorín
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Spain
| | - I F J Molina-Martínez
- Servicio de Neurología, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - I Beltrán-Blasco
- Unidad de Cefaleas, Servicio de Neurología, Hospital General Universitario Dr. Balmis de Alicante, Spain
| | - S Santos-Lasaosa
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - G Latorre
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - A B Gago-Veiga
- Unidad de Cefaleas, Servicio de Neurología, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Madrid, Spain
| | - J M Láinez
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valencia, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - J Porta-Etessam
- Unidad de Cefaleas, Servicio de Neurología, Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos, Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - C Nieves-Castellanos
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario y Politécnico la Fe, Instituto de Investigación Sanitaria la Fe, Valencia, Spain
| | - A Mínguez-Olaondo
- Servicio de Neurología, Hospital Universitario Donostia, Instituto de Investigación Biodonostia, Athenea Neuroclinicis, Donostia, Facultad de Ciencias de la Salud, Universidad de Deusto, Bilbao, Spain
| | - A López-Bravo
- Servicio de Neurología, Hospital Reina Sofía de Tudela, Navarra, Spain
| | - S Quintas
- Unidad de Cefaleas, Servicio de Neurología, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Madrid, Spain
| | - N Morollón
- Unidas de Cefaleas, Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - S Díaz-Insa
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario y Politécnico la Fe, Instituto de Investigación Sanitaria la Fe, Valencia, Spain
| | - R Belvís
- Unidas de Cefaleas, Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - P Irimia
- Unidad de Cefaleas, Servicio de Neurología, Clínica Universitaria de Navarra, Pamplona, Spain
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Torres-Ferrus M, López-Veloso AC, Gonzalez-Quintanilla V, González-García N, Díaz de Teran J, Gago-Veiga A, Camiña J, Ruiz M, Mas-Sala N, Bohórquez S, Gallardo VJ, Pozo-Rosich P. The MIGREX study: Prevalence and risk factors of sexual dysfunction among migraine patients. Neurologia 2023; 38:541-549. [PMID: 37802552 DOI: 10.1016/j.nrleng.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/07/2021] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Migraine attacks have a high impact on daily activities. There is limited research on the burden of migraine on sexual functioning. OBJECTIVE To determine the prevalence of sexual dysfunction in patients with migraine and its relationship with migraine features and comorbidities. METHOD This is a cross-sectional study. We included migraine patients between 18 and 60 years-old from 8 Headache Clinics in Spain. We recorded demographic data and migraine features. Patients fulfilled a survey including comorbidities, Arizona Sexual Experiences Scale, Hospital Anxiety and Depression Scale and a questionnaire about migraine impact on sexual activity. A K-nearest neighbor supervised learning algorithm was used to identify differences between migraine patients with and without sexual dysfunction. RESULTS We included 306 patients (85.6% women, mean age 42.3±11.1 years). A 41.8% of participants had sexual dysfunction. Sexual dysfunction was associated with being female (OR [95% CI]: 2.42 [1.17-5.00]; p<0.001), being older than 46.5 years (4.04 [2.48-6.59]; p<0.001), having chronic migraine (2.31 [1.41-3.77]; p=0.001), using preventive medication (2.45 [1.35-4.45]; p=0.004), analgesic overusing (3.51 [2.03-6.07]; p<0.001), menopause (4.18 [2.43-7.17]; p<0.001) and anxiety (2.90 [1.80-4.67]; p<0.001) and depression (6.14 [3.18-11.83]; p<0.001). However, only female gender, age, menopause and depression were the statistically significant variables selected in the model to classify migraine patients with or without sexual dysfunction (Accuracy [95% CI]: 0.75 (0.62-0.85), Kappa: 0.48, p=0.005). CONCLUSIONS Sexual dysfunction is frequent in migraine patients visited in a headache clinic. However, migraine characteristics or use of preventive medication are not directly associated with sexual dysfunction. Instead, risk factors for sexual dysfunction were female gender, higher age, menopause and depression.
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Affiliation(s)
- M Torres-Ferrus
- Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.
| | - A C López-Veloso
- Neurology Department, Gran Canaria Dr. Negrín University Hospital, Las Palmas de Gran Canaria, Spain
| | | | | | - J Díaz de Teran
- Neurology Department, La Paz University Hospital, Madrid, Spain
| | - A Gago-Veiga
- Neurology Department, La Princesa University Hospital, Madrid, Spain
| | - J Camiña
- Neurology Department, Rotger Clinic, Palma de Mallorca, Spain
| | - M Ruiz
- Neurology Department, San Juan Hospital, Alicante, Spain
| | - N Mas-Sala
- Neurology Department, Althaia Hospital, Red Asistencial Universitaria de Manresa, Spain
| | - S Bohórquez
- Neurology Department, Sabana University, Bogotá, Colombia
| | - V J Gallardo
- Neurology Department, Sabana University, Bogotá, Colombia
| | - P Pozo-Rosich
- Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
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Irimia P, Belvís R, González-García N, García-Ull J, Lainez JM. Inequity of access to new migraine treatments. Neurologia 2023; 38:599-600. [PMID: 37517551 DOI: 10.1016/j.nrleng.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/07/2022] [Indexed: 08/01/2023] Open
Affiliation(s)
- P Irimia
- Clínica Universidad de Navarra, Pamplona, Spain.
| | - R Belvís
- Unidad de Cefaleas, Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - J García-Ull
- Jessica Garcia Ull. Servicio de Neurología, Hospital Clínico Universitario de Valencia, Universidad Católica de Valencia, Valencia, Spain
| | - J M Lainez
- Servicio de Neurología, Hospital Clínico Universitario de Valencia, Universidad Católica de Valencia, Valencia, Spain
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Latorre G, González-García N, García-Ull J, González-Oria C, Porta-Etessam J, Molina FJ, Guerrero-Peral AL, Belvís R, Rodríguez R, Bescós A, Irimia P, Santos-Lasaosa S. Diagnosis and treatment of trigeminal neuralgia: consensus statement from the Spanish Society of Neurology's Headache Study Group. Neurologia 2023:S2173-5808(23)00027-5. [PMID: 37116695 DOI: 10.1016/j.nrleng.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 09/25/2021] [Indexed: 04/30/2023] Open
Abstract
INTRODUCTION Trigeminal neuralgia (TN) is a chronic neuropathic pain disorder affecting one or more branches of the trigeminal nerve. Despite its relatively low global prevalence, TN is an important healthcare problem both in neurology departments and in emergency departments due to the difficulty of diagnosing and treating the condition and its significant impact on patients' quality of life. For all these reasons, the Spanish Society of Neurology's Headache Study Group has developed a consensus statement on the management of TN. DEVELOPMENT This document was drafted by a panel of neurologists specialising in headache, who used the terminology of the International Headache Society. We analysed the published scientific evidence on the diagnosis and treatment of TN and establish practical recommendations with levels of evidence. CONCLUSIONS The diagnosis of TN is based on clinical criteria. Pain attributed to a lesion or disease of the trigeminal nerve is divided into TN and painful trigeminal neuropathy, according to the International Classification of Headache Disorders, third edition. TN is further subclassified into classical, secondary, or idiopathic, according to aetiology. Brain MRI is recommended in patients with clinical diagnosis of TN, in order to rule out secondary causes. In MRI studies to detect neurovascular compression, FIESTA, DRIVE, or CISS sequences are recommended. Pharmacological treatment is the initial choice in all patients. In selected cases with drug-resistant pain or poor tolerance, surgery should be considered. [[es]]Resumen INTRODUCCIóN: la neuralgia del trigémino (NT) es un tipo de dolor neuropático que afecta a una o más ramas del nervio trigémino. Aunque su prevalencia poblacional es relativamente baja, la NT supone un problema muy importante tanto en las consultas de neurología como en las urgencias por la dificultad para el diagnóstico y tratamiento y el elevado impacto sobre la calidad de vida de las personas que la padecen. Por estos motivos, el Grupo de Estudio de Cefaleas de la Sociedad Española de Neurología ha elaborado un documento de consenso sobre el manejo de esta patología. DESARROLLO: este documento ha sido redactado por un comité de expertos utilizando la nomenclatura de la clasificación de la International Headache Society (IHS), analizando la evidencia científica publicada sobre diagnóstico y tratamiento y estableciendo unas recomendaciones prácticas con niveles de evidencia. CONCLUSIONES El diagnóstico de la NT es clínico. La International Classification of Headache Disorders en su tercera edición (ICHD-3) clasifica el dolor atribuible a una lesión o enfermedad del nervio trigémino en NT y neuropatía trigeminal dolorosa. A su vez la NT puede dividirse en tres tipos principales según la etiología del dolor: clásica, idiopática y secundaria. Es recomendable la realización de una resonancia magnética (RM) craneal a todo paciente con diagnóstico clínico de NT para descartar causas secundarias. Para estudiar la presencia de una compresión neurovascular con RM se recomienda la aplicación de los protocolos de imagen FIESTA, DRIVE o CISS. El tratamiento inicialmente será farmacológico y en pacientes seleccionados con respuesta insuficiente o mala tolerancia a fármacos se debe valorar el tratamiento quirúrgico.
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Affiliation(s)
- G Latorre
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, Spain.
| | - N González-García
- Unidad de Cefaleas, Servicio de Neurología, Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos, Madrid, Spain
| | - J García-Ull
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valencia, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - C González-Oria
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J Porta-Etessam
- Unidad de Cefaleas, Servicio de Neurología, Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos, Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - F J Molina
- Servicio de Neurología, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - A L Guerrero-Peral
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Departamento de Medicina, Universidad de Valladolid, Valladolid, Spain
| | - R Belvís
- Unidad de Cefaleas y Neuralgias, Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - R Rodríguez
- Servicio de Neurocirugía, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - A Bescós
- Servicio de Neurocirugía, Hospital Vall d´Hebron, Barcelona, Spain
| | - P Irimia
- Departamento de Neurología, Clínica Universitaria de Navarra, Pamplona, Spain
| | - S Santos-Lasaosa
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria Aragón (IIS-Aragón), Zaragoza, Spain
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García-Azorín D, Abelaira-Freire J, Rodriguez-Adrada E, González-García N, Guerrero ÁL, Porta-Etessam J, Martín-Sánchez FJ. Study about the Manchester Triage System subtriage in patients that visited the Emergency Department due to headache. Neurología (English Edition) 2023; 38:270-277. [PMID: 37030513 DOI: 10.1016/j.nrleng.2020.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/14/2020] [Indexed: 04/08/2023] Open
Abstract
INTRODUCTION Headache is a frequent cause of consultation; it is important to detect patients with secondary headache, particularly high-risk secondary headache. Such systems as the Manchester Triage System (MTS) are used for this purpose. This study aims to evaluate the frequency of sub-triage in patients attending the emergency department due to headache. MATERIAL AND METHODS We studied a series of consecutive patients who came to the emergency department with headache and presenting some warning sign, defined as the presence of signs leading the physician to request an emergency neuroimaging study and/or assessment by the on-call neurologist. The reference diagnosis was established by neurologists. We evaluated the MTS triage level assigned and the presence of warning signs that may imply a higher level than that assigned. RESULTS We registered a total of 1120 emergency department visits due to headache, and 248 patients (22.8%) were eligible for study inclusion. Secondary headache was diagnosed in 126 cases (50.8% of the sample; 11.2% of the total), with 60 cases presenting high-risk secondary headache (24.2%; 5.4%). According to the MTS, 2 patients were classified as immediate (0.8%), 26 as very urgent (10.5%), 147 as urgent (59.3%), 68 as normal (27.4%), and 5 as not urgent (2%). The percentage of patients under-triaged was 85.1% in the very urgent classification level and 23.3% in the urgent level. CONCLUSION During the study period, at least one in 10 patients attending the emergency department due to headache had secondary headache; one in 20 had high-risk secondary headache. The MTS under-triaged most patients with warning signs suggesting a potential emergency.
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Affiliation(s)
- D García-Azorín
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - J Abelaira-Freire
- Servicio de Emergencias, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | | | - N González-García
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Á L Guerrero
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
| | - J Porta-Etessam
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario San Carlos, Madrid, Spain; Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain.
| | - F J Martín-Sánchez
- Servicio de Emergencias, Hospital Clínico Universitario San Carlos, Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
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Casas-Muñoz A, Velasco-Rojano ÁE, González-García N, Benjet C, Caraveo-Anduaga JJ, Martínez-Vélez NA, Loredo-Abdalá A. ISPCAN Child Abuse Screening Tool for Children (ICAST-C): Translation and adaptation to Mexican Spanish, and psychometric properties tested in Mexico City adolescents. Child Abuse Negl 2022; 133:105826. [PMID: 35987050 DOI: 10.1016/j.chiabu.2022.105826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/20/2022] [Accepted: 07/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Research using the IPSCAN Child Abuse Screening Tool for Children (ICAST-C), has provided ample evidence of the magnitude of violence against children. Knowledge about its psychometric characteristics and validity is limited. Hence, our objective was to translate and culturally adapt the ICAST-C in adolescents from Mexico City and determine its psychometric properties. PARTICIPANTS AND SETTING To determine the psychometric properties of the instrument 723 adolescents between 11 and 18 years of age from 9 public secondary schools in Mexico City participated. METHODS The study was carried out in two phases: 1) translation and adaptation of the instrument (in 5 steps) and 2) pilot evaluation of the psychometric properties. Total and factor reliabilities were determined, Pearson correlation was used for temporal stability while construct validity was determined by Confirmatory Factor Analysis (CFA), and final adequacy of the items eliminated by the CFA. RESULTS We developed the culturally relevant Mexican Spanish version of the ICAST-C. The CFA confirmed the six-factor structure hypothesis. To improve the original model we eliminated ten items, the final model showed good global fit indices (χ2(1310) = 2207.68, p < .01, χ2/df = 1.68; CFI =0.95; RMSEA = 0.02 [CI95% 0.02-0.03]; SRMR = 0.08). Total and factor reliabilities were adequate (Alpha = 0.79-0.92, r = 0.52-0.75), except for the non-violent discipline factor (Alpha = 0.59, r = 0.38). CONCLUSIONS While these data suggest that this version of the ICAST-C is valid and reliable for adolescents in Mexico City public secondary schools, further research should evaluate the psychometric properties in a national sample.
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Affiliation(s)
- Abigail Casas-Muñoz
- Center for Advanced Studies on Violence - Prevention, National Pediatric Institute, México City, México (Centro de Estudios Avanzados sobre Violencia - Prevención, Instituto Nacional de Pediatría), Ciudad de México, Mexico.
| | - Ángel Eduardo Velasco-Rojano
- Center for Advanced Studies on Violence - Prevention, National Pediatric Institute, México City, México (Centro de Estudios Avanzados sobre Violencia - Prevención, Instituto Nacional de Pediatría), Ciudad de México, Mexico
| | - Noé González-García
- Center for Advanced Studies on Violence - Prevention, National Pediatric Institute, México City, México (Centro de Estudios Avanzados sobre Violencia - Prevención, Instituto Nacional de Pediatría), Ciudad de México, Mexico
| | - Corina Benjet
- National Institute of Psychiatry Ramón de la Fuente Muñiz, México City, México (Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz), Ciudad de México, Mexico
| | - Jorge Javier Caraveo-Anduaga
- National Institute of Psychiatry Ramón de la Fuente Muñiz, México City, México (Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz), Ciudad de México, Mexico
| | - Nora Angélica Martínez-Vélez
- National Institute of Psychiatry Ramón de la Fuente Muñiz, México City, México (Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz), Ciudad de México, Mexico
| | - Arturo Loredo-Abdalá
- Center for Advanced Studies on Violence - Prevention, National Pediatric Institute, México City, México (Centro de Estudios Avanzados sobre Violencia - Prevención, Instituto Nacional de Pediatría), Ciudad de México, Mexico
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González-García N, Díaz de Terán J, López-Veloso AC, Mas-Sala N, Mínguez-Olaondo A, Ruiz-Piñero M, Gago-Veiga AB, Santos-Lasaosa S, Viguera-Romero J, Pozo-Rosich P. Headache: pregnancy and breastfeeding Recommendations of the Spanish Society of Neurology's Headache Study Group. Neurologia 2022; 37:1-12. [PMID: 31047730 DOI: 10.1016/j.nrl.2018.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 12/22/2018] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Headache is one of the most common neurological complaints, and is most frequent during reproductive age. As a result, we are routinely faced with pregnant or breastfeeding women with this symptom in clinical practice. It is important to know which pharmacological choices are the safest, which should not be used, and when we should suspect secondary headache. To this end, the Spanish Society of Neurology's Headache Study Grouphas prepared a series of consensus recommendations on the diagnostic and therapeutic algorithms that should be followed during pregnancy and breastfeeding. DEVELOPMENT This guide was prepared by a group of young neurologists with special interest and experience in headache, in collaboration with the Group's Executive Committee. Recommendations focus on which drugs should be used for the most frequent primary headaches, both during the acute phase and for prevention. The second part addresses when secondary headache should be suspected and which diagnostic tests should be performed in the event of possible secondary headache during pregnancy and breastfeeding. CONCLUSIONS We hope this guide will be practical and useful in daily clinical practice and that it will help update and improve understanding of headache management during pregnancy and breastfeeding, enabling physicians to more confidently treat these patients.
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Affiliation(s)
| | - J Díaz de Terán
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario La Paz, IdiPAZ, Instituto de Investigación Sanitaria, Madrid, España
| | - A C López-Veloso
- Servicio de Neurología, Hospital Universitario de Gran Canaria Dr. Negrín, Gran Canaria, España
| | - N Mas-Sala
- Servicio de Neurología, Hospital Universitario Sant Joan de Déu, Fundación Althaia, Manresa, Barcelona, España
| | - A Mínguez-Olaondo
- Servicio de Neurología, Hospital Universitario Donostia, Donostia, España; Servicio de Neurología, Clínica Universidad de Navarra, Pamplona, España
| | - M Ruiz-Piñero
- Servicio de Neurología, Hospital Universitario San Juan de Alicante, Alicante, España
| | - A B Gago-Veiga
- Unidad de Cefaleas, Servicio de Neurología, Instituto de Investigación Sanitaria Princesa, Hospital Universitario de la Princesa, Madrid, España
| | - S Santos-Lasaosa
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - J Viguera-Romero
- Unidad Gestión Clínica de Neurología, Hospital Virgen Macarena, Sevilla, España
| | - P Pozo-Rosich
- Unidad de Cefalea, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España, Grupo de Investigación en Cefalea, VHIR, Universitat Autònoma Barcelona, España
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Latorre G, González-García N, García-Ull J, González-Oria C, Porta-Etessam J, Molina F, Guerrero-Peral A, Belvís R, Rodríguez R, Bescós A, Irimia P, Santos-Lasaosa S. Diagnóstico y tratamiento de la neuralgia del trigémino: documento de consenso del Grupo de Estudio de Cefaleas de la Sociedad Española de Neurología. Neurologia 2022. [DOI: 10.1016/j.nrl.2021.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Torres-Ferrus M, López-Veloso AC, Gonzalez-Quintanilla V, González-García N, Díaz de Teran J, Gago-Veiga A, Camiña J, Ruiz M, Mas-Sala N, Bohórquez S, Gallardo VJ, Pozo-Rosich P. The MIGREX study: Prevalence and risk factors of sexual dysfunction among migraine patients. Neurologia 2021; 38:S0213-4853(21)00036-0. [PMID: 33766414 DOI: 10.1016/j.nrl.2021.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/04/2021] [Accepted: 02/07/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Migraine attacks have a high impact on daily activities. There is limited research on the burden of migraine on sexual functioning. OBJECTIVE To determine the prevalence of sexual dysfunction in patients with migraine and its relationship with migraine features and comorbidities. METHOD This is a cross-sectional study. We included migraine patients between 18 and 60 years-old from 8 Headache Clinics in Spain. We recorded demographic data and migraine features. Patients fulfilled a survey including comorbidities, Arizona Sexual Experiences Scale, Hospital Anxiety and Depression Scale and a questionnaire about migraine impact on sexual activity. A K-nearest neighbor supervised learning algorithm was used to identify differences between migraine patients with and without sexual dysfunction. RESULTS We included 306 patients (85.6% women, mean age 42.3±11.1 years). A 41.8% of participants had sexual dysfunction. Sexual dysfunction was associated with being female (OR [95% CI]: 2.42 [1.17-5.00]; p<0.001), being older than 46.5 years (4.04 [2.48-6.59]; p<0.001), having chronic migraine (2.31 [1.41-3.77]; p=0.001), using preventive medication (2.45 [1.35-4.45]; p=0.004), analgesic overusing (3.51 [2.03-6.07]; p<0.001), menopause (4.18 [2.43-7.17]; p<0.001) and anxiety (2.90 [1.80-4.67]; p<0.001) and depression (6.14 [3.18-11.83]; p<0.001). However, only female gender, age, menopause and depression were the statistically significant variables selected in the model to classify migraine patients with or without sexual dysfunction (Accuracy [95% CI]: 0.75 (0.62-0.85), Kappa: 0.48, p=0.005). CONCLUSIONS Sexual dysfunction is frequent in migraine patients visited in a headache clinic. However, migraine characteristics or use of preventive medication are not directly associated with sexual dysfunction. Instead, risk factors for sexual dysfunction were female gender, higher age, menopause and depression.
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Affiliation(s)
- M Torres-Ferrus
- Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.
| | - A C López-Veloso
- Neurology Department, Gran Canaria Dr. Negrín University Hospital, Las Palmas de Gran Canaria, Spain
| | | | | | - J Díaz de Teran
- Neurology Department, La Paz University Hospital, Madrid, Spain
| | - A Gago-Veiga
- Neurology Department, La Princesa University Hospital, Madrid, Spain
| | - J Camiña
- Neurology Department, Rotger Clinic, Palma de Mallorca, Spain
| | - M Ruiz
- Neurology Department, San Juan Hospital, Alicante, Spain
| | - N Mas-Sala
- Neurology Department, Althaia Hospital, Red Asistencial Universitaria de Manresa, Spain
| | - S Bohórquez
- Neurology Department, Sabana University, Bogotá, Colombia
| | - V J Gallardo
- Neurology Department, Sabana University, Bogotá, Colombia
| | - P Pozo-Rosich
- Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
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10
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Porta-Etessam J, González-García N, Guerrero ÁL, García-Azorín D. Failure to monoclonal antibodies against CGRP or its receptor does not preclude lack of efficacy to other drugs from the same therapeutic class. Neurologia 2020; 36:S0213-4853(20)30312-1. [PMID: 33176918 DOI: 10.1016/j.nrl.2020.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 10/13/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- J Porta-Etessam
- Unidad de Cefaleas, Servicio de Neurología. Hospital Clínico Universitario San Carlos, Madrid, España; Departamento de Medicina, Universidad Complutense de Madrid, Madrid, España; Instituto de Investigación Biomédica, Hospital Clínico San Carlos, Madrid, España.
| | - N González-García
- Unidad de Cefaleas, Servicio de Neurología. Hospital Clínico Universitario San Carlos, Madrid, España
| | - Á L Guerrero
- Unidad de Cefaleas, Servicio de Neurología. Hospital Clínico Universitario de Valladolid, Valladolid, España; Departamento de Medicina, Universidad de Valladolid, Valladolid, España; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
| | - D García-Azorín
- Unidad de Cefaleas, Servicio de Neurología. Hospital Clínico Universitario de Valladolid, Valladolid, España; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
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11
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García-Azorín D, Abelaira-Freire J, Rodriguez-Adrada E, González-García N, Guerrero ÁL, Porta-Etessam J, Martín-Sánchez FJ. Study about the Manchester Triage System subtriage in patients that visited the Emergency Department due to headache. Neurologia 2020; 38:S0213-4853(20)30275-9. [PMID: 33268106 DOI: 10.1016/j.nrl.2020.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/07/2020] [Accepted: 06/14/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Headache is a frequent cause of consultation; it is important to detect patients with secondary headache, particularly high-risk secondary headache. Such systems as the Manchester Triage System (MTS) are used for this purpose. This study aims to evaluate the frequency of sub-triage in patients attending the Emergency Department due to headache. MATERIAL AND METHODS We studied a series of consecutive patients who came to the Emergency Department with headache and presenting some warning sign, defined as the presence of signs leading the physician to request an emergency neuroimaging study and/or assessment by the on-call neurologist. The reference diagnosis was established by neurologists. We evaluated the MTS triage level assigned and the presence of warning signs that may imply a higher level than that assigned. RESULTS We registered a total of 1,120 emergency department visits due to headache, and 248 patients (22.8%) were eligible for study inclusion. Secondary headache was diagnosed in 126 cases (50.8% of the sample; 11.2% of the total), with 60 cases presenting high-risk secondary headache (24.2%; 5.4%). According to the MTS, two patients were classified as immediate (0.8%), 26 as very urgent (10.5%), 147 as urgent (59.3%), 68 as normal (27.4%), and five as not urgent (2%). The percentage of patients under-triaged was 85.1% in the very urgent classification level and 23.3% in the urgent level. CONCLUSION During the study period, at least one in 10 patients attending the Emergency Department due to headache had secondary headache; one in 20 had high-risk secondary headache. The MTS under-triaged most patients with warning signs suggesting a potential emergency.
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Affiliation(s)
- D García-Azorín
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, España; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
| | - J Abelaira-Freire
- Servicio de Emergencias, Hospital Clínico Universitario San Carlos, Madrid, España
| | | | - N González-García
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario San Carlos, Madrid, España
| | - Á L Guerrero
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, España; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España; Departamento de Medicina, Facultad de Medicina, Universidad de Valladolid, Valladolid, España
| | - J Porta-Etessam
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario San Carlos, Madrid, España; Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, España.
| | - F J Martín-Sánchez
- Servicio de Emergencias, Hospital Clínico Universitario San Carlos, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España; Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, España
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Castillo-Álvarez F, González-García N, Cuadrado M, Porta-Etessam J. Drug-resistant secondary headache associated with administration of biological drugs. Neurología (English Edition) 2020. [DOI: 10.1016/j.nrleng.2018.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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13
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Castillo-Álvarez F, González-García N, Cuadrado M, Porta-Etessam J. Cefalea secundaria farmacorresistente asociada a fármacos biológicos. Neurologia 2020; 35:425-426. [DOI: 10.1016/j.nrl.2018.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/17/2018] [Accepted: 05/25/2018] [Indexed: 10/28/2022] Open
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González-García N, García-Azorín D, Porta-Etessam J. Eagle syndrome: Toward a clinical delimitation. Neurologia 2018. [PMID: 30032933 DOI: 10.1016/j.nrl.2018.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVES Orofacial and cervical pain are a frequent reason for neurology consultations and may be due to multiple pathological processes. These include Eagle syndrome (ES), a very rare entity whose origin is attributed to calcification of the stylohyoid ligament or elongation of the temporal styloid process. We present a series of five patients diagnosed with ES. MATERIAL AND METHODS We describe the demographic and clinical characteristics and response to treatment of 5 patients who attended the headache units of two tertiary hospitals for symptoms compatible with Eagle syndrome. RESULTS The patients were three men and two women aged between 24 and 51, presenting dull, intense pain, predominantly in the inner ear and the ipsilateral tonsillar fossa. All patients had chronic, continuous pain in the temporal region, with exacerbations triggered by swallowing. Four patients had previously consulted several specialists at otorhinolaryngology departments; one had been prescribed antibiotics for suspected Eustachian tube inflammation. In all cases, the palpation of the tonsillar fossa was painful. Computed tomography scans revealed an elongation of the styloid process and/or calcification of the stylohyoid ligament in three patients. Four patients improved with neuromodulatory therapy (duloxetine, gabapentin, pregabalin) and only one required surgical excision of the styloid process. CONCLUSIONS Eagle syndrome is a rare and possibly underdiagnosed cause of craniofacial pain. We present five new cases that exemplify both the symptoms and the potential treatments of this entity.
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Affiliation(s)
| | - D García-Azorín
- Hospital Clínico Universitario de Valladolid, Valladolid, España
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Gago-Veiga AB, Díaz de Terán J, González-García N, González-Oria C, González-Quintanilla V, Minguez-Olaondo A, Santos-Lasaosa S, Viguera Romero J, Pozo-Rosich P. How and when to refer patients diagnosed with secondary headache and other craniofacial pain in the Emergency Department and Primary Care: Recommendations of the Spanish Society of Neurology's Headache Study Group. Neurologia 2017; 35:323-331. [PMID: 28870392 DOI: 10.1016/j.nrl.2017.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 08/01/2017] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION When secondary headache is suspected and the patient is referred to the emergency department or to the outpatient neurology clinic, it is important to know which are the appropriate complementary examinations to perform and the suitable referral pathway for patients to follow. In order to establish recommendations on this matter, the Spanish Society of Neurology's Headache Study Group (GECSEN) has decided to issue a series of agreed recommendations constituting a referral protocol for patients with headache and/or craniofacial neuralgias. DEVELOPMENT Young neurologists with an interest and experience in headache were invited to draft a series of practical guidelines in collaboration with GECSEN's Executive Committee. For practical reasons, the document was divided into 2 articles: the first focuses on primary headaches and craniofacial neuralgias and this second article on secondary headaches and other craniofacial pain. In order for the recommendations to be helpful for daily practice, they follow a practical approach, with tables summarising referral criteria, examinations to be performed, and referral to other specialists. CONCLUSIONS We hope to offer a guide and tools to improve decision-making regarding patients with headache, identifying complementary tests to prioritise and referral pathways to be followed, in order to avoid duplicated consultations and delayed diagnosis and treatment.
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Affiliation(s)
- A B Gago-Veiga
- Unidad de Cefaleas, Servicio de Neurología, Instituto de Investigación Sanitaria Princesa, Hospital Universitario de la Princesa, Madrid, España.
| | - J Díaz de Terán
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario La Paz, IdiPAZ, Instituto de Investigación Sanitaria, Madrid, España
| | - N González-García
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico San Carlos, Madrid, España
| | - C González-Oria
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - V González-Quintanilla
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - A Minguez-Olaondo
- Departamento de Neurología, Clínica Universitaria de Navarra, Pamplona, Navarra, España; Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - S Santos-Lasaosa
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - J Viguera Romero
- Unidad Gestión Clínica de Neurología, Hospital Virgen Macarena, Sevilla, España
| | - P Pozo-Rosich
- Unidad de Cefalea, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España; Grupo de Investigación en Cefalea, VHIR, Universitat Autònoma de Barcelona, Barcelona, España
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Pintado MC, Villa P, Luján J, Trascasa M, Molina R, González-García N, de Pablo R. Mortality and functional status at one-year of follow-up in elderly patients with prolonged ICU stay. Med Intensiva 2015; 40:289-97. [PMID: 26706825 DOI: 10.1016/j.medin.2015.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 07/23/2015] [Accepted: 08/07/2015] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To evaluate mortality and functional status at one year of follow-up in patients>75 years of age who survive Intensive Care Unit (ICU) admission of over 14 days. DESIGN A prospective observational study was carried out. SETTING A Spanish medical-surgical ICU. PATIENTS Patients over 75 years of age admitted to the ICU. PRIMARY VARIABLES OF INTEREST ICU admission: demographic data, baseline functional status (Barthel index), baseline mental status (Red Cross scale of mental incapacity), severity of illness (APACHE II and SOFA), stay and mortality. One-year follow-up: hospital stay and mortality, functional and mental status, and one-year follow-up mortality. RESULTS A total of 176 patients were included, of which 22 had a stay of over 14 days. Patients with prolonged stay did not show more ICU mortality than those with a shorter stay in the ICU (40.9% vs 25.3% respectively, P=.12), although their hospital (63.6% vs 33.8%, P<.01) and one-year follow-up mortality were higher (68.2% vs 41.2%, P=.02). Among the survivors, one-year mortality proved similar (87.5% vs 90.6%, P=.57). These patients presented significantly greater impairment of functional status at hospital discharge than the patients with a shorter ICU stay, and this difference persisted after three months. The levels of independence at one-year follow-up were never similar to baseline. No such findings were observed in relation to mental status. CONCLUSIONS Patients over 75 years of age with a ICU stay of more than 14 days have high hospital and one-year follow-up mortality. Patients who survive to hospital admission did not show greater mortality, though their functional dependency was greater.
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Affiliation(s)
- M C Pintado
- Unidad de Cuidados Intensivos, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España.
| | - P Villa
- Unidad de Cuidados Intensivos, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - J Luján
- Unidad de Cuidados Intensivos, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - M Trascasa
- Unidad de Cuidados Intensivos, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - R Molina
- Unidad de Cuidados Intensivos, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - N González-García
- Unidad de Cuidados Intensivos, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - R de Pablo
- Unidad de Cuidados Intensivos, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
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