Phobias, other psychiatric comorbidities and chronic migraine Fobias, outras comorbidades psiquiátricas e enxaqueca crônica

BACKGROUND: Comorbidity of chronic migraine (CM) with psychiatric disorders, mostly anxiety and mood disorders, is a well-recognized phenomenon. Phobias are one of the most common anxiety disorders in the general population. Phobias are more common in migraineurs than non-migraineurs. The clinical profile of phobias in CM has never been studied. METHOD: We investigated the psychiatric profile in 56 patients with CM using the SCID I/P interview. RESULTS: Lifetime criteria for at least one mental disorder was found in 87.5% of the sample; 75% met criteria for at least one lifetime anxiety disorder and 60.7% of our sample fulfilled DSM-IV criteria for lifetime phobic avoidant disorders. Mood and anxiety scores were higher in phobic patients than in non-phobic CM controls. Number of phobias correlated with higher levels of anxiety and depression. CONCLUSION: Phobias are common in CM. Its recognition may influence its management. Early treatment may lead to better prognosis.<br>INTRODUÇÃO: As comorbidades psiquiátricas das enxaquecas crônicas são bem conhecidas. As fobias, transtorno ansioso mais comum, são mais prevalentes entre enxaquecosos do que entre não enxaquecosos. O perfil clínico de fobias em uma população enxaquecosa nunca foi estudado. MÉTODO: Estudamos aspectos psiquiátricos de uma população de 56 pacientes com enxaqueca crônica. RESULTADOS: Usando o SCID I/P para o DSM-IV, critérios diagnósticos para ao menos algum transtorno psiquiátrico durante a vida foram preenchidos por 87,5% de nossa amostra, 75% para ao menos um transtorno ansioso e 60,7% para condições fóbicas em algum momento de suas vidas. Os escores de ansiedade e humor foram maiores entre os fóbicos e o número de fobias teve correlação positiva com o grau de ansiedade e depressão. CONCLUSÃO: Fobias são comuns na enxaqueca crônica e seu reconhecimento poderia influenciar seu manejo e melhorar seu prognóstico

Sensitivity to aversive stimulation, posttraumatic symptoms and migraines: What do they have in common?

Studies have suggested that the high comorbidity observed between chronic migraine and anxiety disorders can be mediated through a third factor namely increased sensitivity to aversive stimulation. This trait may predispose for both chronic migraines, through medication overuse as an avoidance response, and anxiety disorders. Additional studies have shown that hyper sensitivity to aversive stimulation, migraine chronification and anxiety disorders share other characteristics such as serotonergic mediation and personality traits. Preliminary analysis of empirical data comparing the frequency the impact of traumatic events over chronic [EM] and episodic migraine [EM] patients gives further support to this hypothesis. in spite of CM and EM did not differ in terms of the occurrence of traumatic events, CM patients that had experienced at least one traumatic event during their lives had higher scores in re-experiencing and avoidance (but not in hyperarousal) symptoms than CM patients. These observations suggest that traumatic events have greater impact over CM than over EM patients. (C) 2011 Elsevier B.V. All rights reserved.Univ São Paulo, Sch Med, Inst Psychiat, São Paulo, BrazilUniv São Paulo, Sch Med, Dept Psychiat, São Paulo, BrazilHosp Israelita Albert Einstein, Inst Ensino & Pesquisa, São Paulo, BrazilUniversidade Federal de São Paulo, EPM, São Paulo, BrazilUniversidade Federal de São Paulo, EPM, São Paulo, BrazilWeb of Scienc

Randomized, proof-of-principle clinical trial of active transcranial magnetic stimulation in chronic migraine

Background High-frequency repetitive transcranial magnetic stimulation of the left dorsolateral prefrontal cortex (rTMS-DLPFC) is an effective treatment for depression. Preliminary studies indicated beneficial effects of rTMS-DLPFC on pain relief in patients treated for depression, and in patients with chronic migraine.Methods in this randomized, double-blind, parallel-group, single-center, proof-of-principle clinical trial, we tested the hypothesis that 23 sessions of active rTMS-DLPFC delivered over eight weeks would be feasible, safe and superior to sham rTMS to decrease the number of headache days in 18 patients with chronic migraine without severe depression. Per-protocol analysis was performed.Results rTMS-DLPFC applied over eight weeks was feasible and safe in patients with chronic migraine. Contrary to our primary hypothesis, the number of headache days decreased significantly more in the sham group than in the group treated with active rTMS-DLPFC at eight weeks. Average decrease in headache days was >50% in the sham group, indicating a powerful placebo response. Pain intensity improved in both groups to a similar extent.Conclusions Positive results of M1 stimulation in other studies, and the absence of significant benefits of active high-frequency rTMS of the DLPFC in the present study, point to M1 as a more promising target than the DLPFC, for larger trials of noninvasive brain stimulation in patients with chronic migraine.Albert Einstein Israelite Hospital Teaching and Research Institute/Instituto de Ensino e Pesquisa do Hospital Israelita Albert EinsteinConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Hosp Israelita Albert Einstein, Inst Israelita Ensino & Pesquisa, BR-05601901 São Paulo, BrazilUniv São Paulo, Hosp Clin São Paulo Univ, Clin Neurol Div, BR-05508 São Paulo, BrazilUniv São Paulo, Ctr Interdisciplinary Res Appl Neurosci NAPNA, BR-05508 São Paulo, BrazilHosp Clin São Paulo Univ, Inst Radiol, São Paulo, BrazilUniversidade Federal de São Paulo, Neurol & Neurosci Postgrad Program, São Paulo, BrazilUniversidade Federal de São Paulo, Neurol & Neurosci Postgrad Program, São Paulo, BrazilAlbert Einstein Israelite Hospital Teaching and Research Institute/Instituto de Ensino e Pesquisa do Hospital Israelita Albert Einstein: IEP.PE.08-0122CNPq: 472407/2007-4Web of Scienc