Headache Medicine 2020, 11(1):22-24 ISSN 2178-7468, e-ISSN 2763-6178

ASAA

DOI: 10.48208/HeadacheMed.2020.6

Headache Medicine

Original

Sociodemographic characteristics of patients with chronic

headache

Características sociodemográcas dos pacientes portadores de cefaleia crônica

Patrick Giordanni Gomes Sampaio

Hiago Diniz Maracajá

Sara Raquel Nóbrega Figueiredo

Virgínia

Gabriela Nóbrega Figueiredo

Túlio Carneiro Monteiro Temoteo

Nátalia Meg Adijuto de Melo

Neuroconance, Neurologia, Campina Grande, Paraíba, Brazil.

Unifacisa, Medicina, Campina Grande, Paraíba, Brazil.

Abstract

Introduction

Headache is an entity characterized by a painful process in the cephalic segment and may originate

from cranial or facial structures, being considered a common medical complaint. The chronication pro-

cess of the pain can present a decrease in quality, the functional capacity and the patient’s and labor

environment, and also as well as affect their interpersonal relationships, since the chronic cephalalgic

process can lead the patient to moments of social isolation, mood swings, depression.

Methods

The research was conducted through a retrospective cross-sectional study, performing the analysis of

medical records of patients seen at the Unifacisa’s outpatient neurology School Clinic complaining of

chronic headache, from February 1st to August 31, 2019.

Results

With the analysis of the medical records, 684 attendances were obtained, where 30 of the patients

treated had the diagnosis of chronic headache, 29 women and 01 man. These patients received the

following diagnoses: 18 (60%) patients with chronic migraine without aura, 4 (13.3%) patients with

chronic migraine with aura, 12 (40%) patients with chronic daily medication overuse headache, 9 (30%)

patients with chronic tensiontype headache (CTTH), 1 (3.3%) patient with basilar migraine, 2 (6.6%)

patients with secondary headache.

Conclusion

Although a small number of chronic headache patients were obtained, yet we realize that it is the

migraine that leads to a greater demand for specialized medical care. In addition, as expected due

to the latest research, a signicant number of patients with headache due to excessive use of common

painkillers.

Resumo

Introdução

Cefaleia é uma entidade caracterizada por um processo doloroso no segmento cefálico, podendo ter

origem em estruturas cranianas ou faciais, sendo considerada a queixa médica mais comum. O proces-

so de cronicação da dor pode apresentar uma diminuição na qualidade, da capacidade funcional

e laboral do paciente, assim como, também, afetar nas suas relações interpessoais, haja visto que o

processo cefalálgico crônico pode levar o paciente a momentos de isolamento social, mudanças de

humor, depressão.

Métodos

A pesquisa foi realizada através de um estudo transversal retrospectivo, realizando a análise de prontu-

ários de pacientes atendidos no ambulatório de neurologia da Clínica Escola da Unifacisa com queixa

de cefaleia crônica, de 1º de Fevereiro a 31 de Agosto, de 2019.

Resultados

Com a análise dos prontuários, obtevese a quantidade 684 atendimentos, onde 30 dos pacientes

atendidos tinha o diagnóstico de cefaleia crônica, sendo 29 mulheres e 01 homem. Estes pacientes,

receberam os seguintes diagnósticos: migrânea crônica sem aura 60%, migrânea crônica com aura

13,3%, cefaleia crônica diária por uso excessivo de analgésicos 40 %, cefaleia do tipo tensional crônica

(CTT) 30%, enxaqueca basilar 3,3%, cefaleia secundária 6,6%.

Conclusão

Apesar de ter sido obtido um número pequeno de pacientes com cefaleia crônica, ainda assim, perce-

bemos que são as migrâneas que levam a uma maior procura por atendimento médico especializado.

Além disso, constatou-se, como esperado devido as mais recentes pesquisas, um número expressivo de

pacientes portadores de cefaleia por uso excessivo de analgésicos comuns.

Patrick Giordanni Gomes Sampaio

giordannipatrick@gmail.com

Received: March 30, 2020.

Accepted: March 31, 2020.

Edited by

Mario Fernando Prieto Peres

Keywords:

Chronic Headache

Migraine

Painkillers

Palavras-chave:

Transtornos da Cefaleia

Transtornos de Enxaqueca

Analgésicos

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Sampaio PGG et al

Sociodemographic characteristics of patients with chronic headache

Introduction

eadache

is an entity characterized by a painful process in the

cephalic segment, may originate from cranial or facial structures,

being considered a common medical complaint

1,2

. This may also

occur episodically or chronically and may be classied in primary

or secondary.

Chronic headache may be associated with several reasons, one of

them being the abusive use of painkillers. Abusive use is characterized

by the use of simple analgesics for 15 days or more in a month or,

for triptans, ergotamines, opioids, caffeine and combined painkillers

for 10 or more days in a month

3-5

In addition, one can list as risk factors for the painfull process

chronication in the cephalic region: ineffective treatment of hea-

dache, obesity, psychiatric disorders, being female, low education,

daily stresses

. In this perspective, besides the clinical diagnosis of

headache type, it is of extreme importance to identify the potential

comorbidities that are chronifying factors, aiming at treating them

and thus avoiding the aggravation of chronication.

Thus, it was noted the need to analyze the epidemiological prole

of patients attended at the Unifacisa’s outpatient neurology cli-

nic. Mainly to determine if the demand for attendance occurs by

following the global epidemiological pattern or another, as well

as generating knowledge about the patients’ own prole attended

in this service.

Material and Methods

The research was conducted through a retrospective cross-sectional

study, performing the analysis of medical records of patients seen

at the Unifacisa’s outpatient neurology School Clinic complaining of

chronic headache, from February 1st to August 31, 2019, following

the classication criteria of the International Classication of Hea-

daches Disorders (ICHD-3). All patients were included, regardless

of gender or age, that met criteria for chronic headache, whether

primary or secondary, being excluded all patients who had heada-

che but did not meet the ICHD-3 chronication criterion or had not

yet received a diagnosis of headache.

Results

With the analysis of the medical records from February to August With the analysis of the medical records from February to August

2019, 684 attendances were obtained, where 30 of the patients tre-2019, 684 attendances were obtained, where 30 of the patients tre-

ated had the diagnosis of chronic headache, 29 women and 1 man.ated had the diagnosis of chronic headache, 29 women and 1 man.

As for the profession, most were health care professionals, teachers As for the profession, most were health care professionals, teachers

and students. These patients received the following diagnoses: 18 and students. These patients received the following diagnoses: 18

(60%) patients with chronic migraine without aura, 4 (13.3%) patients (60%) patients with chronic migraine without aura, 4 (13.3%) patients

with chronic migraine with aura, 12 (40%) patients with chronic dailywith chronic migraine with aura, 12 (40%) patients with chronic daily

medication overuse headache, 9 (30%) patients with CTTH, 1 (3.3%) medication overuse headache, 9 (30%) patients with CTTH, 1 (3.3%)

patient with basilar migraine, 2 (6.6%) patients with secondary patient with basilar migraine, 2 (6.6%) patients with secondary

headache. Some of these patients received a diagnosis combination headache. Some of these patients received a diagnosis combination

of chronic migraine or CTTH plus a chronic daily headache due toof chronic migraine or CTTH plus a chronic daily headache due to

excessive painkillers.excessive painkillers.

Discussion

Chronic headache is dened when an individual who has a Chronic headache is dened when an individual who has a

cephalalgic process that happens for at least 15 days in a month cephalalgic process that happens for at least 15 days in a month

in 3 or more months in the year and may, in the case of migraine in 3 or more months in the year and may, in the case of migraine

processes, meet chronication criteria with only 8 days of pain per processes, meet chronication criteria with only 8 days of pain per

month at 3 or more months in the yearmonth at 3 or more months in the year

4-5,84-5,8

It is also possible to subdivide the main etiologies of chronic It is also possible to subdivide the main etiologies of chronic

headache: Transformed Migraine (TM), Chronic Tension-Type headache: Transformed Migraine (TM), Chronic Tension-Type

Headache (CTTH), New Daily Persistent Headache and continuous Headache (CTTH), New Daily Persistent Headache and continuous

hemicranial (CH)hemicranial (CH)

One of the main causes of the chronic headache process is the One of the main causes of the chronic headache process is the

abusive use of common painkillers or symptomatic drugs such as abusive use of common painkillers or symptomatic drugs such as

triptans, ergotamines, opioids, and it is estimated that 50% of triptans, ergotamines, opioids, and it is estimated that 50% of

patients who have a headache self-medicate. What leads to an patients who have a headache self-medicate. What leads to an

estimate in Latin America that 55-70% of patients that look for estimate in Latin America that 55-70% of patients that look for

specialized centers due to headache, receive the diagnosis of specialized centers due to headache, receive the diagnosis of

medication overuse headachemedication overuse headache

According to the World Health Organization’s Global Burden According to the World Health Organization’s Global Burden

of Disease, migraine is the second leading cause of disability of Disease, migraine is the second leading cause of disability

among all diseases, falling behind only mental disorders. Among among all diseases, falling behind only mental disorders. Among

people with migraine, within one year, 25% presented the same people with migraine, within one year, 25% presented the same

in episodic form, while 40% will oscillate between chronic and in episodic form, while 40% will oscillate between chronic and

episodicepisodic

“Episodic tension-type headache is the most common of primary “Episodic tension-type headache is the most common of primary

headaches, with peak prevalence in the fourth decade. In Brazil, headaches, with peak prevalence in the fourth decade. In Brazil,

the annual prevalence of migraine is 15.8%, affecting about 22% the annual prevalence of migraine is 15.8%, affecting about 22%

of women and 9% of men, with peak prevalence between 30 and of women and 9% of men, with peak prevalence between 30 and

50 years. Migraine without aura (75% of cases) is more frequent 50 years. Migraine without aura (75% of cases) is more frequent

than with aura (25% of cases)”. (Speciali et al. 2018)than with aura (25% of cases)”. (Speciali et al. 2018)

Due to the incapacitating process of chronic headaches, individuals Due to the incapacitating process of chronic headaches, individuals

affected by this disease tend to have, besides the loss of capacity or affected by this disease tend to have, besides the loss of capacity or

productivity, problems of a personal and social nature, generatedproductivity, problems of a personal and social nature, generated

by the painful process that tends to cause isolation, depression, by the painful process that tends to cause isolation, depression,

seclusionseclusion

6-86-8

Conclusion

Although a small number of chronic headache patients were obtai-

ned, since headache is one of the major medical complaint and the

highest prevalence of CTTHs in the general population, yet we realize

that it is the migraine that leads to a greater demand for specialized

medical care. Therefore, it is evident how migraines compromise

both the functionality of the individual, as well as the quality of life.

Moreover, the high and disproportionate prevalence of females over

males, evading epidemiological patterns for headache, is supposed

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Sampaio PGG et al

Sociodemographic characteristics of patients with chronic headache

to be due to lower male demand for medical appointments, as well as

fewer referrals from primary health care to more specialized centers.

In addition, as expected due to the latest research, a signicant num-

ber of patients with medication overuse headache. Thus, it becomes

evident the importance of the early diagnosis clinical treatment, in ad-

dition to optimal drug treatment and population’s awareness of the use

of painkillers in order to reduce the prevalence of headaches caused

by their abuse.

The small number of chronic headache care, about 4.32%, was at-

tributed to Unifacisa’s school clinic care model. It is in a metropolitan

region and is a reference for the specialized care of the surrounding

city areas where there is often inadequate screening and the com-

plaints of headaches are not referenced appropriately.

Thus, it is noted that the need to better track patients with complaints

of headache and make the service more visible so that more and more

patients can reach the most specialized centers and receive the most

appropriate service for their complaints, thus reducing headaches

related comorbidities.

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