RESUMO
OBJECTIVES: To conduct a population-based study describing school performance in children with episodic migraine (EM), chronic migraine (CM), and probable migraine (PM), relative to controls. METHODS: Children (n = 5,671) from 87 cities and 18 Brazilian states were interviewed by their teachers (n = 124). First, teachers were asked to provide information on the performance of the students while at school, which consisted of the same information provided to the educational board, with measurements of the overall achievement of competencies for the school year. The MTA-SNAP-IV scale was then used to capture symptoms of attention-deficit/hyperactivity disorder, and to provide objective information on the performance of the students. Parents were interviewed using a validated headache questionnaire and the Strengths and Difficulties Questionnaire, which measures behavior in 5 domains. Multivariate models estimated determinants of school performance as a function of headache status. RESULTS: EM occurred in 9% of the children, PM in 17.6%, and CM in 0.6%. Poor performance at school was significantly more likely in children with EM and CM, relative to children without headaches, and was significantly influenced by severity (p < 0.001) and duration (p < 0.001) of headache attacks, by abnormal scores of mental health (p < 0.001), and by nausea (p < 0.001), as well as by headache frequency, use of analgesics, and gender. CONCLUSION: Children with migraine are at an increased risk of having impairments in their school performance and factors associated with impairment have been mapped. Future studies should address the directionality of the association and putative mechanisms to explain it.
Assuntos
Escolaridade , Transtornos da Cefaleia/epidemiologia , Transtornos de Enxaqueca/classificação , Transtornos de Enxaqueca/epidemiologia , Cefaleia do Tipo Tensional/epidemiologia , Criança , Pré-Escolar , Feminino , Transtornos da Cefaleia/classificação , Humanos , Masculino , Fatores de Risco , Índice de Gravidade de Doença , Inquéritos e Questionários/normas , Cefaleia do Tipo Tensional/classificaçãoRESUMO
Tension-type headache (TTH) is the most prevalent of all headaches and also represents one of the most expensive clinical conditions for the health system. Despite the high impact of this disorder and the existence of well-established diagnostic criteria, knowledge about TTH is still quite limited. In most cases in which crises are quite sporadic, the patients call this normal headache. However, there is a group of patients with the chronic subtype of this headache whose quality of life is greatly compromised. According to the second edition of the International Classification of Headache Disorders, TTH is a bilateral headache of the tight band of pressure type of mild-to-moderate intensity that does not worsen with routine physical activities and whose associated symptoms are less intense than those observed in migraine. Its physiopathology still awaits better elucidation but the existence of central and peripheral mechanisms is already recognized. From a therapeutic viewpoint, simple analgesics are used for the acute treatment of the condition, and tricyclic antidepressants are the most effective class of drugs for its prevention. Follow-up of these patients over the years has demonstrated that the course of TTH is quite favorable in most cases.
Assuntos
Analgésicos/uso terapêutico , Antidepressivos/uso terapêutico , Ensaios Clínicos como Assunto/tendências , Cefaleia do Tipo Tensional/diagnóstico , Cefaleia do Tipo Tensional/tratamento farmacológico , Humanos , Cefaleia do Tipo Tensional/classificação , Resultado do TratamentoRESUMO
This study describes the tensio-type headache with an update on mechanisms and treatment (AU)
Assuntos
Humanos , Cefaleia do Tipo Tensional/classificação , Cefaleia do Tipo Tensional/diagnóstico , Cefaleia do Tipo Tensional/epidemiologia , Cefaleias Vasculares/epidemiologia , Cefaleia do Tipo Tensional/patologia , Farmacologia , Transtornos da Cefaleia/prevenção & controle , Transtornos da Cefaleia/terapiaRESUMO
O termo cefaléia do tipo tensional define as cefaléias primárias anteriormente denominadas cefaléias de contração muscular, psicogênicas, psicomiogênicas, de estresse e de tensão. Essas denominações revelavam-se ambíguas e controversas, incluindo simultaneamente aspectos clínicos e propostas de fisiopatologia, não sendo universalmente aceitas e fisiopatologia, não sendo universalmente aceitas e dificultando a realização de estudos aceitos pela comunidade científica. Com a classificação internacional de cefaléias de 1988, as cefaléias do tipo tensional puderam ser melhor definidas e hoje, com a uniformidade de critérios, constituem-se no tipo mais prevalente de cefaléias primárias. Seus mecanismos são controversos e possui fisiopatologia complexa, que envolve processos centrais de disfunção antinociceptiva e periféricos de comprometimento muscular. Apresenta-se nas formas episódica e crônica e o seu tratamento divide-se em preventivo e das crises. O tratamento preventivo inclui o uso de antidepressivos tricíclicos e para algumas correntes o uso de relaxantes musculares de ação central. O tratamento das crises utiliza analgésicos e (ou) cafeína e (ou) relaxantes musculares e deve ser limitado a duas vezes por semana, uma vez que essa dor pode transformar-se em cefaléia crônica diária. Abordagens acessórias, como terapia cognitivo-comportamental, técnicas de relaxamento, biofeedback e a melhora geral das condições de vida, também são preconizadas. Há importante associação, na forma crônica, com distúrbios emocionais e do sono e o prognóstico é bom quando o paciente é corretamente tratado