Pediatric patients at a high risk or headache of ocular origin: the HAMS Score (Hyperopia, Astigmatism, Myopia, and Strabismus)

Pediatric patients identified at increased risk for headache due to ocular refractive errors were evaluated to produce a diagnostic tool called the HAMS score that will help establish the likelihood of headache due to refractive errors.Methods Data on the ocular diagnosis and headache complaints of 726 pediatric patients of both sexes were obtained from the medical records of an ophthalmological service in Brazil (Hospital de Olhos Santa Luzia). Age, use of glasses, and ocular diagnosis were also considered to create an index based on the number of ocular diagnoses in a given individual (HAMS score) to verify their association with the incidence of headache. Once the database was finalized, it was then analyzed to identify the variables capable of predicting the occurrence of headaches, following which a profile of those at the highest risk was produced by comparison.Results Only the ocular diagnosis was significantly associated with headache as a function of sex, age, use of glasses, farsightedness, astigmatism, myopia, and strabismus, indicating the relative impact of each ocular diagnosis on the probability of headache. According to the HAMS score, strabismus is more likely to have headache (5.21), followed by hyperopia (3.10), myopia (2.67), and, finally, astigmatism (1.86). The findings showed that the presence or absence of refraction errors and strabismus is predictive of the occurrence of headache, particularly in a small group of patients (6.2%) where the probability of headache was 57.8%. Such patients were characterized by being younger, having a combination of strabismus, hyperopia, and astigmatism, and already be using corrective lenses.Conclusion The index based on the most common ocular diagnoses (HAMS score) is effective, and it has practical application in identifying children and adolescent patients with a greater or lesser propensity for headaches of ophthalmic origin.

Analgesic abuse headache: risk factors and causes of poor adherence in the detox process

BackgroundMedication overuse headache (MOH) is characterized by a pre-existing primary or secondary headache associated with medication overuse.AimsTo identify the clinical, epidemiological, and therapeutic profiles associated with MOH and poor adherence to treatment.MethodsA cross-sectional, comparative, descriptive, analytical study was carried out to assess the characteristics of patients with MOH treated at the Hospital Geral de Fortaleza (HGF).Results103 patients participated, 95 (92.2%) women and 8 (7.8%) men. Of these, 55 (53.4%) patients answered that had already been instructed about the MOH, however they continue to abuse medication for many reasons i.e.: difficulty in bearing pain, and fear of worsening the pain. When asked about what could be done to improve adherence to treatment, in a general way, 28 (27.2%) were unable to inform, 37 (35.9%) answered that most frequent consultations could help. Furthermore, 19 (18.4%) believe that psychological counseling wound bring benefits.ConclusionThe lack of guidance or interest in the guidelines provided are real and important obstacles to treat MOH. Changes in the care model that include effective communication, more frequent return, family and psychotherapy support and close monitoring by the physician or nurses are factors that should be considered in headache clinics.

Cluster headache due to intranasal herpes simplex: a case report

Cluster headache is characterized by pain in the first division of trigeminal nerve along with autonomic features, with attacks last from 15 minutes to 180, up to eight times a day. Albeit considered as a primary headache, it may be mimicked by structural diseases like infections, inflammatory, tumoral and vascular. Intranasal and sinus infectious were also reported. Herpes simplex infections are quite common in the general population, and the nerve ganglia are the natural reservoir of the virus. Intranasal herpes, on the other hand, is exceedingly rare, with only few cases reported in the literature. Our main objective is to describe a case report of a 49-year-old male who was diagnosed with intranasal herpes infection during a bout of cluster headache, evaluated by an otolaryngologist. He got free of symptoms after using valacyclovir and melatonin. Thus, herpes simplex might be involved in the mechanisms of secondary or primary cluster headache. Further research is necessary to help elucidate this relationship.

Most prevalent symptoms associated with headache in COVID-19 patients in the acute phase: a systematic review

IntroductionConsidering the frequency of headache among the neurological symptoms of COVID-19, there is a need to understand other manifestations associated with this complaint.ObjectiveTo review the literature regarding the most prevalent symptoms associated with headache in patients diagnosed with COVID-19.MethodA systematic literature review was carried out on studies that evaluated published articles about clinical characteristics and headache associated symptoms in patients diagnosed with COVID-19.ResultsAmong the 1,190 patients in the analyzed studies, the following signs and symptoms were associated with headache: fever, hyposmia, anosmia, ageusia, phonophobia, dehydration, prostration and symptoms of the gastrointestinal tract.ConclusionHeadache was the main neurological symptom of COVID-19, among the main associated symptoms are fever, hyposmia or anosmia, ageusia and phonophobia.

Headache catastrophization and its relationship with disability, depression, anxiety, stress and sleep quality

IntroductionCross-sectional studies on headache have not yet explored the influence of pain catastrophizing and associations with other psychosomatic comorbidities. The migraine-affected group of individuals was frequently associated with other clinical conditions such as depression, anxiety, stress, and poor sleep quality. These conditions exert a significant influence on carrier’s coping with daily pain and helplessness, since disability hampers work and daily living activities and overly burden individual, their family, society and the health system. Identifying the elements that contribute to disability is crucial in assisting interventions that minimize these conditions.ObjectiveThe aim of this cross-sectional study was to evaluate how the combination of migraine and catastrophizing, associated with functional disability, depression, anxiety, stress, and sleep quality in college students, can influence the perception of pain.MethodsThe 340 participants were selected by drawing lots, in which individuals with primary headaches were assigned. Therefore, the final analysis sample consisted of 288 individuals. The sample was divided into Group with migraine and Group with other primary headaches, with the application of scales: HIT-6 and the scale of pain catastrophizing.ResultsOf the 360 participants, 20 losses were recorded due to inadequate completion of scales, leaving out 340 participants. Of these, 52/340 (15.25%) did not suffer from headaches. 288/340 (84.7%) participants that reported headaches were included in this study, of which 133/288 (46.2%) had migraine, and 155/288 (53.8%) had non-migraine headache. Women who had migraine attacks were those with the most intense anxious symptoms, worse sleep quality, and catastrophization. The odds ratio of catastrophizing was higher for the Migraine Group. Linear and multivariate logistic regression revealed that the greater the presence of catastrophizing, the greater the occurrence of migraine. Catastrophizing had a greater power of contribution related to the disability generated by the crises in the group of migrainous (β = 0.564). The migraine group has a greater perception of pain.ConclusionHigher catastrophization was also associated with a greater intensity of depressive and anxiety symptoms, higher perceived stress, and worse quality of sleep in headache-affected individuals in our study.

Higher frequency of medication overuse headache in patients attended by neurologists in Lima, Peru

BackgroundThe type of medical care received (self-medication and/or medical care provided by a general practitioner or a neurologist) may be associated with differences in the frequency of medication overuse headaches.MethodThis cross-sectional analytical study included 222 records of patients with chronic daily headaches seen at the National Institute of Neurological Sciences Outpatient Unit in Lima, Peru. A pre-designed questionnaire was used to assess and categorize patients with frequent and chronic headaches.ResultsNinety-four patients (42.34% of those with chronic daily headaches) met the criteria for medication overuse headache. Of these, 19 (28%) self-medicated, 22 (36%) consulted with the general practitioner, and the highest proportion of subjects, 53 (58%), consulted with a neurologist. On bivariate analysis, subjects who had received care from a general practitioner and self-medicated were 38% and 51% less likely to have MOH than the subjects whoreceived medical care from the neurologist (p=0.012; 95% CI 0.42-0.90 and p=0.001; 95% CI 0.32-0.74). On multivariate analysis adjusting by sociodemographic and clinical factors, the association remained significant in regards to self-medication, but became marginal (p=0.055) in regard to being seen by a general practitioner.ConclusionIn this study, the frequency of the headache due to overuse of medication was higher in patients attending a neurologist than those attending a general practitioner or self-medicated. This cross-sectional design cannot assess whether this reflects more severe cases looking for specialized care or more medication overuse headaches as a result of inappropriate management.

Is it possible to sort the disability of individuals with migraine based on the International Classification of Functioning, Disability and Health? — A Scoping Review

PurposeTo identify the most frequent outcomes related to disability assessed in individuals with migraine and to correlate these findings with the categories of International Classification of Functioning, Disability and Health.Material and methodThis scoping review was developed based on studies with adult population (18-55 years) of both sexes and assessing the disability generated by migraine. We included studies in which patients had a diagnosis of migraine based on International Classification of Headache Disorders.Results52 articles were found with 42 outcomes related to 17 categories of International Classification of Functioning, Disability and Health, including the four main components of the classification, with seven categories in "Body Functions", one in "Body Structures", four in “Activities and Participation” and five in "Environmental Factors".ConclusionThe findings show that disabilities, activity limitation, or participation restriction generated by migraine can be classified by International Classification of Functioning, Disability and Health. The components "body functions", "environmental factors" and "activities and participation" were the most identified in the present study. Thus, this classification is important to classify the disability caused by migraine and to guide a rehabilitation more focused onthe patient's real demands, as well as directing the research involving this population.

Vertebral artery hypoplasia and chronic migraine: is there an association or just an incidental finding?

We describe a 29-year-old woman with chronic migraine and psychiatric comorbidities that presented with new transient left-sided hemiparesis and hemi-hypoesthesia and were found to have right vertebral artery hypoplasia (VAH). We briefly review the association of VAH and migraine and the influence of psychiatric disorders and VAH as possible risk factors for chronification of episodic migraine. Despite uncertain mechanisms, VAH may be one of thecontributing factors for the chronicity of migraine.

Immediate effect of a motor control exercise target to the neck muscles on upper cervical range of motion and motor control in patients with temporomandibular disorder

ObjectiveTo evaluate whether a single specific motor control training session for the neck flexor and deep extensor muscles improves upper cervical range of motion and neck motor control in patients with temporomandibular disorder (TMD) and compare them to a group without TMD. MethodsThis is a before and after, controlled study. The TMD group included women aged between 18-45 years old, complaining of pain in the orofacial region in the last 6 months and diagnosed with masticatory myofascial pain according to Research Diagnostic Criteria (RDC/MD). The control group included match-controls without TMD. The participants were evaluated to global and upper (Flexion Rotation Test - FRT) neck range of motion (ROM) and to neck motor control (Cranio-Cervical Flexion Test - CCFT). They were treated with a protocol of specific motor control exercises targeted to flexor and extensor neck muscles for 30 minutes. One day after the protocol the patients were reevaluated. ResultsA total of 23 volunteers were evaluated. The TMD group showed immediate improvement in left cervical rotation (p=0.043) and right FRT (p=0.036), while the control group did not show any improvement. There was no difference between the groups before and after treatment in relation to cervical movements. Regarding cervical motor control in both groups, the highest prevalence was of results between 24 and 26 mmHg after treatment, different from before the intervention (20 and 22 mmHg) in both groups.ConclusionA single session of specific neck motor control training only improved the left cervical rotation and upper right rotation in the TMD group, but not in the control group. There is no difference at the end of treatment between the groups. Volunteers with TMD showed improvement in the pattern of motor control of the neck when compared to volunteers without TMD.

COVID-19 pandemic impact on headache in healthcare workers: a narrative review

Background: Pandemic of COVID-19, the potentially fatal disease caused by SARS-CoV-2, had caused intangible consequences on global health systems, economy, daily life, education, travel, leisure, work, and mental health. Its impact on mental and physical health, especially in health professionals, has been described. Objective: This study aimed to review and discuss the published evidence regarding the presence of headache on COVID-19 healthcare workers. Methods: In this review, we searched for all articles published in various data bases including PubMed / Medline, Scopus, and Web of Science and all original research studies, letters to editor, case reports, commentaries and reviews published in English, Portuguese or Spanish were searched. Two researchers independently analyzed published articles in order to include/exclude based on inclusion or exclusion criteria. Results: Thirteen articles were included. All studies included in this review were observational; eleven were cross-sectional studies, one was a prospective/cohort and one was a retrospective. Two studies evaluated psychological outcomes, mental health disorders and associated factors, one study investigated symptoms and causes of somatic symptom disorder and all other studies evaluated headaches associated with Personal Protective Equipment (PPI). Conclusions: The present review shows that COVID-19 pandemic has negative impact on physical and mental health in healthcare workers and headache has been associated to psychological stress and work overload during pandemic. Further studies are necessary to better investigate COVID-19 pandemic effects on headaches and other neurological conditions.