RESUMO
Although headaches have recognized impact, there are no public policies in Brazil addressing this problem. The Brazilian Headache Society and the Brazilian Association of Cluster Headache and Migraine promoted a summit to discuss Public Policy and Advocacy for headache disorders. Professionals from various segments, representing various sectors of society, gathered in April 2019 in Brasília, defining the most important points for achieving advances in public policies in headache in Brazil, such as: inclusion in the chronic diseases surveillance agenda; improving public understanding and access to diagnosis and treatment; teaching in colleges and medical residences, structuring care networks, intervention models, clinical protocols and legislation supporting public policies in headache.
Assuntos
Conferências de Consenso como Assunto , Transtornos da Cefaleia Primários/terapia , Política Pública , Brasil , HumanosRESUMO
Abstract Although headaches have recognized impact, there are no public policies in Brazil addressing this problem. The Brazilian Headache Society and the Brazilian Association of Cluster Headache and Migraine promoted a summit to discuss Public Policy and Advocacy for headache disorders. Professionals from various segments, representing various sectors of society, gathered in April 2019 in Brasília, defining the most important points for achieving advances in public policies in headache in Brazil, such as: inclusion in the chronic diseases surveillance agenda; improving public understanding and access to diagnosis and treatment; teaching in colleges and medical residences, structuring care networks, intervention models, clinical protocols and legislation supporting public policies in headache.
Resumo Embora as cefaleias tenham reconhecido impacto, não há no Brasil políticas públicas voltadas para este problema. A Sociedade Brasileira de Cefaleia e Associação Brasileira de Cefaleia e Enxaqueca promoveram um seminário para a discussão de Políticas Públicas e Advocacy (defesa dos direitos dos pacientes) em Cefaleias. Reuniram-se em abril de 2019 em Brasília, profissionais de vários segmentos, representando diversos setores da sociedade, definindo os pontos mais importantes para que se obtenham avanços nas políticas públicas em cefaleias no Brasil, tais como: inclusão na agenda de vigilância das doenças crônicas não transmissíveis; melhora do entendimento do público e seu acesso a diagnóstico e tratamento; ensino em faculdades e residências médicas, estruturação de redes de atendimento, modelos de intervenção, protocolos clínicos e legislação de apoio às políticas públicas em cefaleia.
Assuntos
Humanos , Política Pública , Conferências de Consenso como Assunto , Transtornos da Cefaleia Primários/terapia , BrasilRESUMO
BACKGROUND: The characteristics of primary headaches in patients with ruptured brain aneurysm embolization have not been well understood to date. AIMS OF THE STUDY: This study was conducted to evaluate the influence of endovascular treatment (EVT) of ruptured intracranial aneurysm (RIA) and the pattern of previous primary headache. METHODS: We evaluated the pattern of headache in patients who suffered a RIA and EVT within one year before the rupture, and prospectively evaluated the characteristics of headache for up to 12 months after EVT. Sixty patients were evaluated and a questionnaire about headache was applied at the time of admission. These patients were contacted 3, 6 and 12 months after treatment to complete the study by filling out follow-up questionnaire on the headache. RESULTS: Thirty-seven patients had headache before the rupture, 16 with tension-type headache (TTH), 11 with migraine without aura, nine with migraine with aura with and one with non-specific characteristics. There was a significant reduction in the frequency of pain for up to 12 months for patients with TTH (P < 0.001) and migraine without aura (P = 0.012), but there was a reduction in pain intensity over the same period in TTH (P = 0.002), migraine with aura (P = 0.004) and migraine without aura (P < 0.001). CONCLUSION: There was a reduction of the primary headache after endovascular treatment of ruptured brain aneurysm.
Assuntos
Aneurisma Roto/terapia , Embolização Terapêutica/estatística & dados numéricos , Transtornos da Cefaleia Primários/terapia , Aneurisma Intracraniano/terapia , Avaliação de Resultados em Cuidados de Saúde , Adulto , Aneurisma Roto/epidemiologia , Brasil/epidemiologia , Feminino , Transtornos da Cefaleia Primários/epidemiologia , Humanos , Aneurisma Intracraniano/epidemiologia , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
OBJECTIVES: The aim of this study was to investigate the knowledge and attitudes of orthodontists in the diagnosis and management of migraine without aura. MATERIAL AND METHODS: Participants were dentists, recruited among members of the Brazilian Association of Orthodontics and Facial Orthopedics (ABOR). An e-mail was sent to all ABOR members, with a link to a website, especially prepared for this research. Dentists were presented to a report of a fictional patient fulfilling diagnostic criteria for a primary headache disorder, known as migraine without aura. Participants were asked to describe how they would relieve the patient's pain. Professional procedures were classified as "adequate" or "inadequate" according to the answers given. RESULTS: 161 valid answers were received (18.8 percent response rate). Of them, 36 percent of the actions were considered to be "adequate" procedures, while 64 percent were "inadequate". The results yielded 12 main procedures, based on common characteristics. Eighty-two orthodontists suggested orthodontic treatment with or without orthognathic surgery, and some suggested using stabilization appliances prior to the orthodontic treatment. CONCLUSIONS: The majority of participants proposed inadequate therapies, and 51 percent suggested orthodontic correction of occlusion, including orthognathic surgery. Educational activities on migraine should also target orthodontists.
Assuntos
Humanos , Competência Clínica/estatística & dados numéricos , Transtornos da Cefaleia Primários/diagnóstico , Transtornos da Cefaleia Primários/terapia , Ortodontia , Brasil , Erros de Diagnóstico , Gerenciamento Clínico , Coleta de Dados/métodos , Dor Facial/fisiopatologia , Inquéritos e Questionários , Transtornos da Articulação Temporomandibular/fisiopatologiaRESUMO
OBJECTIVES: The aim of this study was to investigate the knowledge and attitudes of orthodontists in the diagnosis and management of migraine without aura. MATERIAL AND METHODS: Participants were dentists, recruited among members of the Brazilian Association of Orthodontics and Facial Orthopedics (ABOR). An e-mail was sent to all ABOR members, with a link to a website, especially prepared for this research. Dentists were presented to a report of a fictional patient fulfilling diagnostic criteria for a primary headache disorder, known as migraine without aura. Participants were asked to describe how they would relieve the patient's pain. Professional procedures were classified as "adequate" or "inadequate" according to the answers given. RESULTS: 161 valid answers were received (18.8% response rate). Of them, 36% of the actions were considered to be "adequate" procedures, while 64% were "inadequate". The results yielded 12 main procedures, based on common characteristics. Eighty-two orthodontists suggested orthodontic treatment with or without orthognathic surgery, and some suggested using stabilization appliances prior to the orthodontic treatment. CONCLUSIONS: The majority of participants proposed inadequate therapies, and 51% suggested orthodontic correction of occlusion, including orthognathic surgery. Educational activities on migraine should also target orthodontists.
Assuntos
Competência Clínica/estatística & dados numéricos , Transtornos da Cefaleia Primários/diagnóstico , Transtornos da Cefaleia Primários/terapia , Ortodontia , Brasil , Coleta de Dados/métodos , Erros de Diagnóstico , Gerenciamento Clínico , Dor Facial/fisiopatologia , Humanos , Inquéritos e Questionários , Transtornos da Articulação Temporomandibular/fisiopatologiaRESUMO
UNLABELLED: This review focuses on primary headaches, its diagnosis and treatment. For the IHS specialists they are: migraine, tension-type headache (TTH), cluster and others. Migraine: the second in prevalence and the first in morbility, clinical features and differences between migraine with (Ma) and without aura (Mo). EPIDEMIOLOGY: 10% prevalence and 3:1 women to men proportion. Patophysiology: primary central nociception disorder with secondary vascular involvement. TREATMENT: specific and non-specific, acute and preventive. Psychiatric disorders and migraine: there is evidence of clinical and pharmacological links, mainly between Ma and several psychiatric disorders. Migraine in childrens: important clinical and therapeutic differences from adult, importance of family approach. Migraine and hormones: the importance of estrogen drop, as trigger factor, treatment. Migraine and epilepsy: both shares neuronal hyperexcitability pattern. Migraine and stroke: vascular and ischemic factors involved. Evidence-based medicine: improves treatment's results and studies outcome evaluation. TTH: first in prevalence, still highly subdiagnosed. Main clinical presentations: episodic and chronic. EPIDEMIOLOGY: slight female preponderance. Patophysiology and trigger factors: the role of limbic nociceptive system, sedentarism stress and muscular tension. TREATMENT: pharmacological and non-pharmacological. Cluster headache: low prevalence but high daily-living activities impact, effective treatment. Other primary headaches: variability of trigger factors and role of desensitization process. CONCLUSION: we remark the complexity of headache and the of physicians' role: to relief patients suffering, throughout a precise diagnosis and treatment.