RESUMO
INTRODUCTION: Headaches are a common reason for visiting neurology clinics. They have their origin in a variety of causes and their specific diagnosis deteriorates as it overlaps with other chronic painful pathologies. Somatic functional syndromes are characterised by chronic painful conditions that have a negative effect on quality of life, and are accompanied by functional symptoms with no organic cause. AIMS: The aim of this study is to evaluate the prevalence of functional symptoms in patients who visited due to headaches. PATIENTS AND METHODS: The sample included all the patients who visited the walk-in neurology clinic because of headaches between March and September 2014. A semi-structured survey was carried out in order to evaluate obsessive personality traits, bruxism, gastrointestinal symptoms, anxiety, depression and sleep disorders. RESULTS: During the period under study, 125 patients visited due to headache. In all, 68.7% of patients with migraine presented functional symptoms and only 32.7% in the case of other headaches (p = 0.0001). CONCLUSIONS: Functional symptoms were prevalent in patients with headache, mainly in those with migraine.
TITLE: Cefalea y sintomas funcionales.Introduccion. Las cefaleas constituyen un motivo de consulta frecuente en los consultorios neurologicos, sus causas puede ser variadas y su diagnostico concreto se empobrece al superponerse con otras patologias dolorosas cronicas. Los sindromes funcionales somaticos se caracterizan por cuadros de dolor cronico que califican en forma negativa la calidad de vida, acompanados de sintomas funcionales sin causa organica. Objetivo. Evaluar la prevalencia de sintomas funcionales en pacientes que consultaron por cefaleas. Pacientes y metodos. Se incorporo a todos los pacientes que consultaron por cefaleas en el consultorio de demanda espontanea de neurologia entre marzo y septiembre de 2014. Se realizo una encuesta semiestructurada para evaluar rasgos de personalidad obsesiva, bruxismo, sintomas gastrointestinales, ansiedad, depresion y trastornos del sueno. Resultados. Durante el periodo de estudio, consultaron por cefalea 125 pacientes. El 68,7% de los pacientes con migrana presento sintomas funcionales, y solo el 32,7% de otras cefaleas (p = 0,0001). Conclusion. Los sintomas funcionales fueron prevalentes en los pacientes con cefalea, principalmente en las migranas.
Assuntos
Transtornos da Cefaleia/complicações , Transtornos Somatoformes/epidemiologia , Adulto , Ansiedade/epidemiologia , Bruxismo/epidemiologia , Transtorno da Personalidade Compulsiva , Depressão/epidemiologia , Feminino , Fibromialgia/epidemiologia , Gastroenteropatias/epidemiologia , Transtornos da Cefaleia/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Adulto JovemRESUMO
UNLABELLED: There are controversial associations between headaches and psychological symptoms. OBJECTIVE: To design a profile of neuroticism, a term that groups variables related to negative personality traits, in patients with chronic daily headache (CDH) when compared to episodic migraine (EM) patients, applying the Factorial Scale of Emotional Adjustment/Neuroticism (NFS). METHOD: One hundred adult patients with CDH and forty with EM answered the NFS. RESULTS: Comorbidities of subtypes of neuroticism (p=0.006) were more common in chronic daily headache patients, with three or more disorders (p=0.0002): dependent personality disorder (p=0.0001), anxiety, reduced concentration and production (p=0.0008), depression (p<0.0001), suicidal ideation (p=0.0008) and hopelessness even without depression (p<0.0001). CONCLUSION: Patients with CDH tend to have dependent personality disorder, low production and concentration, anxiety, depression, suicidal ideation and hopelessness, superimposing two or more psychological disorders. These factors should be pondered for a better resolution in the treatment of CDH.
Assuntos
Transtornos da Cefaleia/psicologia , Transtornos Mentais/psicologia , Transtornos de Enxaqueca/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Transtornos Mentais/etiologia , Pessoa de Meia-Idade , Medição da Dor , Fatores de Risco , Fatores Socioeconômicos , Adulto JovemRESUMO
There are controversial associations between headaches and psychological symptoms. Objective To design a profile of neuroticism, a term that groups variables related to negative personality traits, in patients with chronic daily headache (CDH) when compared to episodic migraine (EM) patients, applying the Factorial Scale of Emotional Adjustment/Neuroticism (NFS). Method One hundred adult patients with CDH and forty with EM answered the NFS. Results Comorbidities of subtypes of neuroticism (p=0.006) were more common in chronic daily headache patients, with three or more disorders (p=0.0002): dependent personality disorder (p=0.0001), anxiety, reduced concentration and production (p=0.0008), depression (p<0.0001), suicidal ideation (p=0.0008) and hopelessness even without depression (p<0.0001). Conclusion Patients with CDH tend to have dependent personality disorder, low production and concentration, anxiety, depression, suicidal ideation and hopelessness, superimposing two or more psychological disorders. These factors should be pondered for a better resolution in the treatment of CDH. .
Há associações controversas entre cefaleia e sintomas psicológicos. Objetivo Traçar um perfil de neuroticismo em portadores de cefaleia crônica diária (CCD) quando comparados aos portadores de migranea episódica (ME), utilizando-se a Escala Fatorial de Ajustamento Emocional/Neuroticismo (EFN). Método Cem pacientes adultos com CCD e quarenta com ME, responderam à EFN. Resultados Comorbidades de subtipos de neuroticismo (p=0,006) destacaram-se na CCD, ultrapassando três transtornos (p=0,0002): transtorno de personalidade dependente (p<0,0001), ansiedade, concentração e produção diminuídas (p=0,0008), depressão (p<0,0001), ideação suicida (p=0,0008) e desesperança (p<0,0001), mesmo sem depressão (p<0,0001). Conclusão Paciente com CCD apresentaram indícios de transtorno de personalidade dependente, baixa capacidade de concentração e produção, ansiedade, depressão, ideação suicida e desesperança, superpondo dois ou mais transtornos psicológicos. Esses fatores devem ser ponderados para maior resolutividade no tratamento da CCD. .
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Transtornos da Cefaleia/psicologia , Transtornos Mentais/psicologia , Transtornos de Enxaqueca/psicologia , Transtornos Mentais/etiologia , Medição da Dor , Fatores de Risco , Fatores SocioeconômicosRESUMO
AIMS: The aim of the present study was to evaluate the association between generalized anxiety disorder, subthreshold anxiety (SubAnx) and anxiety symptoms in the prevalence of primary headache. METHODS: This cross-sectional study evaluated 383 people from a Brazilian low-income community. One-year prevalence rates of migraine, chronic migraine and tension-type headache were calculated. Anxiety symptoms were then separated into the following groups (based on DSM-IV criteria): no anxiety criteria; one anxiety criterion; two anxiety criteria; and generalized anxiety disorder (GAD). The control group (no headaches) was compared with headache sufferers for each anxiety group using an adjusted model controlled for confounding factors. RESULTS: GAD was present in 37.0% of participants and SubAnx in 16.6%. Those with SubAnx had a 2.28-fold increased chance of having migraine; 3.83-fold increased chance of having chronic migraine, a 5.94-fold increased chance of having tension-type headache and a 3.27-fold increased chance of having overall headache. Some anxiety criteria (irritability, difficulty with sleep, concentration problems, muscle tension and fatigue) had similar prevalence to International Classification of Headache Disorders (ICHD-II) headache criteria such as unilateral pain and nausea for migraine and chronic migraine. CONCLUSION: Headache sufferers seem to have a high prevalence of anxiety symptoms and SubAnx. In addition, the presence of two or more anxiety criteria (not necessarily fulfilling all the criteria for GAD) was associated with having a headache disorder.
Assuntos
Transtornos de Ansiedade/epidemiologia , Ansiedade/epidemiologia , Transtornos da Cefaleia/epidemiologia , Cefaleia/epidemiologia , Adolescente , Adulto , Ansiedade/psicologia , Transtornos de Ansiedade/psicologia , Brasil/epidemiologia , Comorbidade , Estudos Transversais , Feminino , Cefaleia/psicologia , Transtornos da Cefaleia/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Pobreza , PrevalênciaRESUMO
Objective of this study to investigate the impact of NCC upon the quality of life (QoL) compared to other chronic neurological diseases, epilepsy and headache. The study group consisted of 114 patients subdivided into four groups: NCC with epilepsy (n = 48), NCC without epilepsy (n = 17), epilepsy without NCC (n = 25) and chronic headache (n = 24). The QoL was evaluated by direct subjective quantification (scale of 0-10) and FACT-HN IV. NCC had impact on QoL, 53.8% patients dependent and needing help. The impact on QoL did not correlate with the classification of NCC, presence of cysts or calcifications and with CSF TP or number of WBCs. The presence of depression had a significant impact on the QoL of patients with NCC. Lack of seizure control tended to produce an adverse effect on the QoL in the group of NCC and epilepsy. NCC is not a benign disease; it has greater adverse effects on QoL of patients than epilepsy and headache, although without statistical significance. The presence of depression and uncontrolled seizures may have impact on QoL. Since asymptomatic patients were not evaluated, the results of this study are not applicable to all individuals with NCC.
Assuntos
Atitude Frente a Saúde , Neurocisticercose/complicações , Neurocisticercose/psicologia , Qualidade de Vida/psicologia , Adulto , Depressão/complicações , Depressão/psicologia , Feminino , Transtornos da Cefaleia/complicações , Transtornos da Cefaleia/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Convulsões/complicações , Convulsões/psicologia , Autoavaliação (Psicologia) , Índice de Gravidade de Doença , Adulto JovemRESUMO
BACKGROUND: Studies using resources of a public family health program to estimate the prevalence of chronic daily headaches (CDH) are lacking. OBJECTIVES: To estimate the 1-year prevalence of CDH, as well as the presence of associated psychiatric and temporomandibular disorders (TMD) comorbidities, on the entire population of a city representative of the rural area of Brazil. METHODS: This was a cross-sectional, population-based, 2-phase study. In the first phase, health agents interviewed all individuals older than 10 years, in a rural area of Brazil. In the second stage, all individuals who reported headaches on 4 or more days per week were then evaluated by a multidisciplinary team. CDH were classified according to the second edition of the International Classification of Headache Disorders (ICHD-2). Medication overuse headache was diagnosed, as per the ICHD-2, after detoxification trials. Psychiatric comorbidities and TMD were diagnosed based on the DSM-IV and on the Research Diagnostic Criteria for Temporomandibular Disorders criteria, respectively. RESULTS: A total of 1631 subjects participated in the direct interviews. Of them, 57 (3.6%) had CDH. Chronic migraine was the most common of the CDH (21, 36.8%). Chronic tension-type headache (10, 17.5%), medication overuse headache (13, 22.8%) and probable medication overuse headache (10, 17.5%) were also common. Psychiatric disorders were observed in 38 (67.3%) of the CDH subjects. TMD were seen in 33 (58.1)% of them. CONCLUSIONS: The prevalence of CDH in the rural area of Brazil is similar to what has been reported in previous studies. A significant proportion of them have psychiatric comorbidities and/or TMD. In this sample, comorbidities were as frequent as reported in convenience samples from tertiary headache centers.
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Transtornos da Cefaleia/epidemiologia , Adolescente , Adulto , Brasil , Criança , Doença Crônica , Estudos de Coortes , Comorbidade , Estudos Transversais , Feminino , Transtornos da Cefaleia/diagnóstico , Transtornos da Cefaleia/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Humor/diagnóstico , Transtornos do Humor/epidemiologia , Transtornos do Humor/psicologia , Vigilância da População/métodos , Prevalência , Transtornos da Articulação Temporomandibular/diagnóstico , Transtornos da Articulação Temporomandibular/epidemiologia , Transtornos da Articulação Temporomandibular/psicologia , Adulto JovemRESUMO
The association of traumatic exposures with posttraumatic stress disorder (PTSD) and other mental health conditions is well known. Patients with chronic pain, particularly headache disorders and fibromyalgia (FM), associated with psychological traumas need a special management strategy. Diagnosis of headache disorders and FM in traumatized patients and collecting the clinical history of a traumatic event or diagnosing PTSD in chronic pain patients is of great importance. Psychotherapy and pharmacotherapeutic options should be started on patients with comorbid PTSD and headache disorders and/or FM.
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Fibromialgia/psicologia , Transtornos da Cefaleia/psicologia , Dor/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Adaptação Psicológica , Doença Crônica , Fibromialgia/complicações , Fibromialgia/terapia , Transtornos da Cefaleia/complicações , Transtornos da Cefaleia/terapia , Humanos , Dor/complicações , Manejo da Dor , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/terapiaRESUMO
There are multiple risk factors for chronic daily headache (CDH), but they are usually assessed in an isolated form without an adequate control for confounders. CDH is considered a variant of episodic headache, but studies have not gathered enough evidence to evaluate simultaneously CDH and episodic in the same population. We set out to establish simultaneously the factors associated with chronic daily or episodic headache in a population setting, using a cross-sectional survey in a random sample of 1505 adult urban inhabitants (Bucaramanga, Colombia). The survey asked questions about headache, family and personal history of disease, and consumption or abuse of caffeine, alcohol, hypnotics and analgesics. The association among independent variables and CDH or episodic headache was made with multinomial logistic regression. Female gender, arterial hypertension or cranial trauma history, and a high score in the depression scale are associated with episodic headache and CDH. Parents with CDH, the complaint of multiple arousals during sleep and use of hypnotics are associated with CDH, but not with episodic headache. Age <36 years, alcoholism and snoring are factors associated only with episodic headache. Chronic daily headache and episodic headache have several common risk factors, but there are other factors not shared by both conditions.
Assuntos
Cefaleia Histamínica/epidemiologia , Transtornos da Cefaleia/epidemiologia , Adolescente , Adulto , Idoso , Cefaleia Histamínica/patologia , Cefaleia Histamínica/psicologia , Colômbia/epidemiologia , Estudos Transversais , Feminino , Transtornos da Cefaleia/patologia , Transtornos da Cefaleia/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fatores SexuaisRESUMO
BACKGROUND: Although major depression and chronic headache are strongly associated, there is insufficient evidence for the use of antidepressants for this specific comorbidity. This trial aimed to investigate the efficacy and tolerability of duloxetine for this indication. METHOD: Thirty outpatients with DSM-IV major depressive disorder and concurrent primary chronic headache (chronic migraine, chronic tension-type headache, or both), 18 to 55 years old, were recruited from April 2006 to March 2007, if they scored > 21 on the Montgomery-Asberg Depression Rating Scale (MADRS) and had no other significant clinical condition. Subjects received duloxetine 60 mg/day for 8 weeks. Scores on the MADRS and a visual analog pain scale (VAS) were the co-primary outcome measures. Scores on the brief version of the World Health Organization Quality of Life scale (WHOQoL-BREF) and number of headache days/week were secondary outcome measures. The study was conducted at the Liaison-Psychiatry Service of SOCOR General Hospital, Belo Horizonte, Brazil. RESULTS: Mean +/- SD MADRS scores decreased significantly from baseline to endpoint (29.5 +/- 5.2 to 8.9 +/- 8.7 points, p < .001), and mean +/- SD VAS scores decreased significantly from 5.8 +/- 1.9 to 1.9 +/- 2.5 points (p < .001). Combined intent-to-treat response rate (> 50% reduction on MADRS and > 40% on VAS) was 66.7% (20/30). Significant improvements in both headache and depression were evident after the first week. Mean +/- SD WHOQoL-BREF scores increased (improved) 18.8 +/- 21.9 points (p < .001), and mean +/- SD number of headache days/week decreased from 5.2 +/- 2.0 to 2.9 +/- 2.5 days/week (p < .001). Two subjects discontinued for side effects and 3 for nonadherence. CONCLUSION: In this preliminary open trial, duloxetine 60 mg/day was effective, fast acting, and well tolerated for the treatment of comorbid major depressive disorder and chronic headache.
Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/tratamento farmacológico , Transtornos da Cefaleia/complicações , Transtornos da Cefaleia/tratamento farmacológico , Tiofenos/uso terapêutico , Adolescente , Adulto , Antidepressivos/efeitos adversos , Brasil , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Cloridrato de Duloxetina , Feminino , Transtornos da Cefaleia/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Inventário de Personalidade , Prognóstico , Qualidade de Vida , Tiofenos/efeitos adversosRESUMO
PURPOSE: The purpose of this study was to evaluate the presence of signs and symptoms of temporomandibular disorders (TMD) in children with headaches in a neuropediatric ambulatory. METHOD: Fifty patients between 4 and 18 years of age were examined: 31 had headaches (24 migraine, 4 tension type and 3 unspecific headache) and 19 formed the control group. The data collection was comprised of a structured questionnaire answered by the children's parents, and a subjective evaluation about the childrens emotional state. A specific questionnaire for TMD was applied, followed by a clinical dental examination of the children. As signs of TMD, mouth opening limitation, mandibular trajectory deviation in opening mouth, and joint noise were considered. As symptoms, pain on palpation of masseter and temporal muscles and on the poromandibular joint. RESULTS: A significant increase in signs and symptoms of TMD was found in patients with headaches when compared to the control group. There was also a significant difference in signs and symptoms of TMD according to age (increased with age) and emotional state (tense>calm). CONCLUSION: There is a higher frequency of TMD in pediatric patients with headaches; thus, it is important to look for TMD signs and symptoms in this population.