Migraine stigma

Editoria

Migraine, Dizziness and Motion Sickness: Are we going in straight lines?

Editoria

A melatonina nas cefaleias

Melatonin have diverse physiological functions, including the control of circadian rhythms, sleep regulation, enhancement of immunological functioning, free radical scavenging and antioxidant effects, inhibition of oncogenesis, mood regulation, vasoregulation, regulation of seasonal reproductive activity and analgesia. Melatonin also have several actions within the central nervous system and in the pathophysiology of headaches, which include an anti-inflammatory effect, toxic free radical scavenging, reduction of proinflammatory cytokine up-regulation, nitric oxide synthase activity and dopamine release inhibition, membrane stabilization, GABA and opioid analgesia potentiation, glutamate neurotoxicity protection, neurovascular regulation, serotonin modulation, and the similarity of chemical structure to that of indomethacin. A relation with seasonal and circadian pattern has been observed in cluster an hypnic headache. The literature of headache is convergent in pointing to low levels of melatonin in patients with migraine and cluster headache. Treatment of headache disorders with melatonin and other chronobiotic agents is promising. Some trials showed that melatonin was effective in cluster headache and migraine prevention but future studies are necessary for the better understanding of the role of melatonin in headache disorders treatment.A melatonina tem diversas funções fisiológicas, incluindo o controle de ritmos circadianos, regulação do sono, melhoria do funcionamento imunológico, varredura de radicais livres e efeitos antioxidantes, inibição da oncogênese, regulação do humor, vasoregulação, regulamentação da atividade reprodutiva sazonal e analgesia. A melatonina também tem várias ações dentro do sistema nervoso central e na fisiopatologia das cefaleias, as quais incluem um efeito anti-inflamatório e de limpeza de radicais livres tóxicos, a redução de citocinas pró-inflamatórias, da inibição da atividade da óxido nítrico sintase e da produção de dopamina, a estabilização das membranas, potencialização da analgesia GABA e de opioides, proteção contra a neurotoxicidade do glutamato, regulação neurovascular, modulação da serotonina, além de possuir estrutura química similar à da indometacina. Uma relação com padrão sazonal e circadiano tem sido observada na cefaleia em salvas e hipnica. A literatura de dor de cabeça e melatonina é convergente em apontar a presença de baixos níveis deste hormônio em pacientes com enxaqueca e cefaleia em salvas. O tratamento das cefaleias com melatonina e outros agentes cronobióticos é promissor. Alguns estudos mostraram que a melatonina foi eficaz na cefaleia em salvas e na prevenção da enxaqueca, porém futuros estudos são necessários para comprovar seu beneficio no tratamento das cefaleias

Migraine is the most disabling neurological disease among children and adolescents, and second after stroke among adults: A call to action

Global burden of disease; Migraine; Neurological disordersCarga global de enfermedad; Migraña; Trastornos neurológicosCàrrega global de malaltia; Migranya; Trastorns neurològicsThe Global Burden of Disease (GBD) study is pivotal in shaping health policies by providing comprehensive data on mortality and disability. An updated GBD2021 analysis, published in Lancet Neurology on 14 March 2024, expands the scope of neurological disorders to include 37 conditions, revealing their significant impact on global health. Neurological disorders affect 3.4 billion people, or 43.1% of the global population, making them the leading cause of disability-adjusted life years (DALYs) in 2021, with an 18.2% increase since 1990. The top three causes of DALYs in this category are stroke, neonatal encephalopathy and migraine. Migraine, affecting 1.16 billion people, ranks first among children and adolescents and second among adults aged under 60 years. Despite its substantial impact, migraine often lacks proper attention because of its non-fatal nature, invisibility and historical neglect of neurological disorders. The International Headache Society calls for recognizing migraine as a serious medical condition, promoting research and integrating migraine management into public health strategies. Effective interventions include raising awareness, improving access to treatment, adding migraine to the epidemiological surveillance agenda and exploring new treatment strategies. A coordinated effort among stakeholders is essential to alleviate the burden of migraine on individuals and society

Progressão da doença em enxaqueca crônica: Análise do início dos sintomas de cefaleia, ansiedade e humor

Background: Psychiatric conditions, mostly anxiety and mood disorders, are common in patients with chronic migraine. There has recently been extensive debate on migraine progression, but little is known about the role of psychiatric disorders in this respect. Objective: In order to evaluate the role of psychiatric disorders in migraine progression, we analyzed the temporal profile of migraine, mood and anxiety disorders, and years since onset of symptoms in chronic migraine (CM) patients. Methods: Fifty CM patients diagnosed according to the International Headache Society (2004) criteria were interviewed and diagnosed for mental disorders using the Structured Clinical Interview for DSM-IV (SCID-I/P). Results: Anxiety disorders preceded the onset of episodic migraine, which was followed by depression and daily headaches. Conclusions: Psychiatric comorbidity evaluation in chronic migraine may lead to better patient management and clinical outcomes. Patients with a history of anxiety, episodic migraine, and depression may be at risk of developing CM. Early treatment of anxiety, mood disorders, and episodic migraine may prevent disease progression to CM.Introdução: Ansiedade e depressão são condições clínicas comuns em pacientes com enxaqueca crônica. Um intenso debate em relação ao processo de cronificação da enxaqueca tem acontecido recentemente, mas pouca ênfase tem sido dada a comorbidade psiquiátrica. Objetivos: Para avaliar o papel das comorbidades psiquiátricas na progressão da enxaqueca, analisamos o perfil temporal de início dos sintomas de humor, ansiedade e dor nos pacientes com enxaqueca crônica. Métodos: Cinquenta pacientes diagnosticados de acordo com os critérios da Sociedade Internacional de Cefaleias (2004) foram entrevistados e diagnosticados para transtornos mentais de acordo com a entrevista estruturada para o DSMIV (SCID-I/P). Resultados: Transtornos de ansiedade precederam o início das enxaquecas episódicas, que foram seguidas pelo aparecimento pelos transtornos de humor e sequencialmente a evoluçãoo/transformação para enxaqueca crônica. Conclusões: A avaliação das comorbidades psiquiátricas na enxaqueca crônica podem levar a um melhor diagnóstico e tratamento dos pacientes. Pacientes com história de ansiedade, enxaqueca e depressão podem ter risco de desenvolverem enxaqueca crónica. Tratamento precoce destas condições podem previnir a ocorrência da enxaqueca crônica

Religiousness, Health, and Depression in Older Adults from a Brazilian Military Setting

This study aims to analyze the association between religious attendance, self-reported religiousness, depression, and several health factors in 170 older adults from a Brazilian outpatient setting. A comprehensive assessment was conducted including sociodemographic characteristics, religious attendance, self-reported religiousness, functional status, depression, pain, hospitalization, and mental status. After adjusting for sociodemographics, (a) higher self-reported religiousness was associated with lower prevalence of smoking, less depressive symptoms, and less hospitalization and (b) higher religious attendance was only associated with less depressive symptoms. Religiousness seems to play a role in depression, smoking, and hospitalization in older adults from a Brazilian outpatient setting. Self-reported religiousness was associated with more health characteristics than religious attendance.</jats:p

The impact of anxiety and depression on migraine patients’ journey to a tertiary headache center

Objetivo: Avaliar o papel da comorbidade psiquiátrica no número de procedimentos diagnósticos, tratamentos farmacológicos agudos e preventivos e intervenções não farmacológicas em pacientes com enxaqueca experimentados antes de visitar um Centro Terciário de Cefaleia em São Paulo, Brasil. Métodos: Realizamos um estudo retrospectivo observacional de 465 pacientes consecutivos diagnosticados com enxaqueca e avaliados em um centro especializado em cefaleia terciária em São Paulo, Brasil. Coletamos os dados com base em revisões de prontuários médicos e em um questionário autoaplicado rotineiramente realizado durante a primeira consulta médica. Dois instrumentos padronizados foram utilizados para o diagnóstico de depressão e ansiedade, respectivamente: o Questionário de Saúde do Paciente-9 (PHQ-9) e o Transtorno de Ansiedade Generalizada (GAD-7). Resultados: Foram estudados 465 pacientes com diagnóstico de enxaqueca. A idade média dos pacientes foi de 37,3 anos (± 13,1) e 72,7% dos pacientes eram mulheres. A idade média do início da dor de cabeça foi de 17,1 anos (± 11,4) antes da primeira consulta em nosso Centro Terciário de Cefaleia, e 51,7% dos pacientes apresentavam enxaqueca crônica. A maioria dos pacientes (65,8%) apresentou um PHQ-9 ≥ 5, indicando pelo menos alguns sintomas depressivos, enquanto 152 pacientes (34,2%) foram considerados deprimidos (PHQ-9 ≥ 9). Os sintomas de ansiedade foram observados em 68,2% dos pacientes com base no instrumento GAD-7, e 209 pacientes (47,0%) foram diagnosticados com ansiedade (GAD-7 ≥ 8). As enxaquecas crônicas foram mais comuns que as enxaquecas episódicas em pacientes com comorbidade psiquiátrica: 63,2% dos pacientes depressivos, 61,2% dos ansiosos e 43,5% dos pacientes sem nenhum transtorno psiquiátrico. A maioria dos pacientes foi submetida a exames laboratoriais e imagens cerebrais (62,4% e 70,5%, respectivamente) em proporção semelhante entre os subgrupos com e sem ansiedade ou depressão. O tratamento não farmacológico foi frequente em todos os subgrupos e 342 pacientes (73,5%) realizaram pelo menos uma modalidade. No geral, a acupuntura foi o tratamento não farmacológico mais comum (55,2% dos pacientes), e não encontramos diferença entre os subgrupos. Pacientes depressivos e ansiosos foram submetidos a psicoterapia com mais frequência (54,2% e 50,8%, respectivamente) quando comparados aos pacientes sem depressão nem ansiedade (34,7%). A depressão foi associada a uma probabilidade reduzida de fisioterapia prévia (OR 0,39, IC 0,16 - 0,99). Pacientes com ansiedade grave usavam 10,7 vezes mais medicamentos do que pacientes não graves. Conclusão: Pacientes deprimidos foram submetidos a mais psicoterapia do que pacientes não deprimidos, embora tivessem uma chance reduzida de fisioterapia anterior. A ansiedade também foi associada à psicoterapia anterior e a um risco de 10,7 vezes do uso de tratamento farmacológico agudo, o que pode levar a questões relacionadas ao abuso de analgésicos. Ansiedade e depressão afetam a jornada de pacientes com enxaqueca antes de chegarem a um Centro Terciário de Cefaleia.Objective: To evaluate the role of psychiatric comorbidity in the number of diagnostic procedures, acute and preventive pharmacological treatments, and non-pharmacological interventions in migraine patients experienced before visiting a tertiary headache center in São Paulo, Brazil. Methods: We conducted a retrospective, observational study of 465 consecutive patients diagnosed with migraines and evaluated in a specialized tertiary headache center in São Paulo, Brazil. We collected the data based on medical chart reviews and a self-administered questionnaire routinely performed during the first medical visit. Two standardized instruments were used for the diagnosis of depression and anxiety, respectively: the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder (GAD-7). Results: We studied 465 patients diagnosed with migraines. The patients’ mean age was 37.3 years (±13.1), and 72.7% of patients were women. The average age of headache onset was 17.1 years (±11.4) before the first appointment at our tertiary headache center, and 51.7% of patients had chronic migraines. Most patients (65.8%) had a PHQ-9 ≥ 5, indicating at least some depressive symptoms, whereas 152 patients (34.2%) were considered depressed (PHQ-9 ≥ 9). Anxiety symptoms were observed in 68.2% of patients based on the GAD-7 instrument, and 209 patients (47.0%) were diagnosed with anxiety (GAD-7 ≥ 8). Chronic migraines were more common than episodic migraines among patients with psychiatric comorbidity: 63.2% of depressive patients, 61.2% of anxious patients, and 43.5% of patients without any psychiatric disorder. Most patients underwent laboratory tests and brain imaging (62.4% and 70.5%, respectively) in a similar proportion among subgroups with and without anxiety or depression. Nonpharmacological treatment was frequent in all subgroups, and 342 patients (73.5%) performed at least one modality. Overall, acupuncture was the most common non-pharmacological treatment (55.2% of patients), and we found no difference between the subgroups. Depressive and anxious patients more frequently underwent psychotherapy (54.2% and 50.8%, respectively) when compared to patients with neither depression nor anxiety (34.7%). Depression was associated with a reduced likelihood of previous physiotherapy (OR 0.39, CI 0.16 – 0.99). Patients with severe anxiety used 10.7 times more medicines than non-severe patients. Conclusion: Depressed patients underwent more psychotherapy than non-depressed patients, although they had a reduced chance of previous physiotherapy. Anxiety was also associated with previous psychotherapy and a risk of 10.7 times of using acute pharmacological treatment, which may lead to issues related to analgesic abuse. Anxiety and depression affect the journey of patients with migraines before arriving at a tertiary headache center

Contextual and individual factors associated with dental services utilisation by Brazilian adults: A multilevel analysis

BACKGROUND: Inequalities in the utilisation of dental services in Brazil are remarkable. The aim of this study was to evaluate the association of contextual and individual factors with the utilisation of dental services by Brazilian adults using the Andersen's behavioural model. METHODS: Individual-level data from 27,017 adults residents in the State capitals who were interviewed in the 2013 Brazilian National Health Survey were pooled with contextual city-level data. The outcomes were non-utilisation of dental services and last dental visit over 12 months ago. Individual predisposing variables were age, sex, race/skin colour, schooling and social network. Individual enabling variables included income, health insurance and registration in primary health care. Individual need variables were self-perceived dental health and self-reported missing teeth. Multilevel logistic regression models were performed to estimate odds ratio (OR) and 95% confidence intervals (95% CIs) of the association of contextual and individual predisposing, enabling and need-related variables with dental services outcomes. RESULTS: Predisposing (OR = 0.89; 95% CI 0.81-0.97) and enabling (OR = 0.90; 95% CI 0.85-0.96) contextual factors were associated with non-utilisation of dental services. Individual predisposing (sex, race/skin colour, schooling), enabling (income, health insurance) and need (self-perceived oral health, missing teeth) were associated with non-utilisation of dental services and last dental visit over 12 months ago. The latter was also associated with other individual predisposing (age, social network) and need (eating difficulties due to oral problems) characteristics. CONCLUSIONS: Individual and contextual determinants influenced dental services utilisation in Brazilian adults. These factors should be on the policy agenda and considered in the organisation of health services aiming to reduce oral health inequalities related to access and utilisation of dental services