Perspectivas atuais da enxaqueca: bases fisiopatológicas e terapêuticas.

Introduction: Migraine is a chronic neurological disorder characterized by recurrent episodes of pulsating headache, often unilateral, associated with symptoms such as nausea, vomiting, photophobia and phonophobia. Objective: To evaluate the pathophysiology and management of migraine. Methodology: This is a bibliographic review that included original articles and systematic reviews in English and Portuguese, which addressed the pathophysiological and therapeutic components of migraine, published between 2012 and 2024, selected from the PubMed, Scopus and SciELO databases. After careful selection, 21 articles were chosen to compose this bibliographic review. Results: Migraine is a neurological disorder characterized by distinct phases. In the premonitory phase, hypothalamic activation occurs, resulting in symptoms such as photophobia, fatigue and increased appetite. The aura phase is marked by cortical spreading depression, involving neuronal depolarization and a decrease in electrical activity. During the headache phase, there is activation of the trigeminovascular system, leading to the release of neurotransmitters such as CGRP, which amplify pain. Migraine management involves preventive therapy with medications such as propranolol, antidepressants, botulinum toxin and topiramate in addition to acute treatments such as triptans and DHE. Considerations: The pathophysiology is broad and involves multiple mechanisms. Treatment involves preventive and abortive therapy aimed at relieving symptoms during attacks. Effective migraine management requires a personalized approach, taking into account the severity of the attacks, the patient's comorbidities and the individual response to the different treatments available.Introdução: A enxaqueca é uma desordem neurológica crônica caracterizada por episódios recorrentes de dor de cabeça pulsátil, muitas vezes unilateral, associada a sintomas como náusea, vômito, fotofobia e fonofobia. Objetivo: Avaliar a fisiopatologia e o manejo da enxaqueca. Metodologia: Trata-se de uma revisão bibliográfica que incluiu artigos originais e revisões sistemáticas em inglês e português, que abordaram os componentes fisiopatológicos e terapêuticos da enxaqueca, publicados entre 2012 e 2024, selecionados nas bases de dados PubMed, Scopus e SciELO. Após a seleção criteriosa, foram escolhidos 21 artigos para compor esta revisão bibliográfica. Resultados: A enxaqueca é um distúrbio neurológico caracterizado por fases distintas. Na fase premonitória, ocorre ativação hipotalâmica, resultando em sintomas como fotofobia, fadiga e aumento do apetite. A fase da aura é marcada pela depressão alastrante cortical, envolvendo despolarização neuronal e diminuição na atividade elétrica. Durante a fase da cefaleia, há ativação do sistema trigeminovascular, levando à liberação de neurotransmissores como CGRP, que amplificam a dor. O manejo da enxaqueca envolve terapia preventiva com medicamentos como propranolol, antidepressivos, toxina botulínica e o topiramato além de tratamentos agudos como triptanos e DHE. Considerações: A fisiopatologia é ampla e envolve múltiplos mecanismos. O tratamento envolve a terapia preventiva e abortiva que visam aliviar os sintomas durante os ataques. O gerenciamento eficaz da enxaqueca requer uma abordagem personalizada, levando em consideração a gravidade dos ataques, as comorbidades do paciente e a resposta individual aos diferentes tratamentos disponíveis

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved