Headache Medicine

Petasites hybridus: scientific evidence A

Eliana Meire Melhado — 2024-12-30

Migraine is the leading cause of disability in individuals aged 15 to 49 worldwide, emphasizing the need for diverse preventive treatments. In 2023, Brazil introduced highly purified Petasites hybridus. This article comment the manuscript Loder and coworkers, 2012 one of the primary studies that positioned Petasites hybridus among the Level A evidence medications in the American Consensus of the episodic migraine preventive treatment in 2012.
Development
A 1990s German study, randomized and placebo-controlled, involved 60 patients using a Petasites hybridus root extract for migraine prevention. Though effective, the study had notable shortcomings. To validate its findings, independent investigators and statisticians conducted a comprehensive efficacy reassessment following International Conference on Harmonisation E9 Guidelines. Results showed a significant -50% reduction in migraine episodes for 45% of the treatment group, compared to 15% in the placebo group. The active treatment group also saw a significant drop in migraine attacks needing acute medication (from 20.6% to 7.1%), unlike the placebo group (12.8% to 11.7%). The reanalysis confirmed the treatment group's superiority across 12 primary efficacy metrics, supporting its effectiveness.
Commentary
Several studies, including this reanalysis and an American study, support Petasites hybridus for migraine prevention, leading to its Level A evidence classification. Its mechanisms include antinociceptive, anti-CGRP, anti-inflammatory, and antispasmodic effects.
Conclusion
The reanalysis confirmed the efficacy of Petasites hybridus from Grossman’s study. The German team minimized bias through rigorous statistical methods. Petasites hybridus should be considered for first-line and subsequent migraine prevention, potentially combined with other medications based on patient needs.

The role of diet in migraine control: deconstructing myths

Adriana de Almeida Soares — 2024-12-30

Introduction: Migraine can be controlled through effective drug treatments, both during headache attacks, as a preventative measure, but also through non-drug treatments, including diet therapy. This treatment consists of eliminating food triggers and adding improvement factors.

Objective: To address the role of diet in controlling migraine, through the elimination of food triggers and the addition of improvement factors, in addition to demystifying some mistaken behaviors.

Method: This study was an integrative and retrospective review of articles on the relationship between food and migraine.

Results: Three relationships were found between diet and migraine attacks: 1) food may be a triggering factor; 2) food may be a mitigating factor; or 3) food may be an aggravating factor. There is no specific diet therapy for migraine, but diets that are based on the pathophysiological mechanisms of migraine.

Conclusions: Food can be a trigger or a factor in improving migraine attacks and diet therapy for controlling migraine consists of removing food triggers and replacing them with a healthy diet.

Quality of life in women with migraine: a systematic review

Adriana de Almeida Soares — 2024-12-30

Introduction: Several chronic diseases interfere with quality of life (QoL), including migraine, especially in women who are the most affected. However, effective therapeutic interventions are capable of modifying the disease.

Objective: Our objective was to review the literature on QoL in women with migraine, before and after treatment.

Methods: This study was a systematic review of clinical trials on migraine in women and QoL published between November 2019 and October 2024. The research was carried out in the online database PubMed, using the descriptors “migraine in women” and “quality of life”.

Results: Eight articles were analyzed. They described 1,337 women with migraine aged 18 to 50 years. There was an improvement in QoL after therapeutic intervention, both drug and non-drug.

Conclusions: Women with migraine have their QoL impaired, but therapeutic interventions can modify the disease.

Patients´ beliefs and headache-related disability

Rebeca Veras de Andrade Vieira — 2024-12-30

Abstract

There is a lack of studies investigating the associations between modifiable psychological factors in migraine more comprehensively. The present study aimed to investigate the associations between self-efficacy and locus of control beliefs, cognitive distortions, depression, anxiety, psychopathological symptoms, headache headache-related disability, headache frequency, and severity in migraine patients. In addition, we compared study measures between chronic and episodic migraine patients. One hundred forty-seven (147) migraine outpatients from three Brazilian specialized headache hospital services completed measures of self-efficacy, locus of control, psychopathological symptoms, cognitive distortions, depression, anxiety, and headache-related disability. Headache-related cognitive distortions were positively correlated with psychopathological symptoms, depression, anxiety, pain catastrophizing, headache-related disability, headache frequency, and headache intensity. Self-efficacy beliefs correlated negatively with all psychological and clinical measures. Chance locus of control correlated positively with depression, anxiety, psychopathological symptoms, pain catastrophizing, headache-related disability, and headache intensity. Compared to episodic migraine patients, those with chronic migraine showed significantly higher levels of cognitive distortions and chance locus of control but lower levels of self-efficacy in headache management. The results brought evidence that patients' cognitive and emotional responses to their headaches are associated with headache-related disability and chronicity. Furthermore, they reinforce the need to evaluate and treat those modifiable psychological factors in daily clinical practice.

Hospital admissions and headache costs in children and adolescents in Brazil: An ecological study from 2013 to 2023.

Giovanna Lourenço Cavagnoli — 2024-12-30

Headaches during childhood and adolescence are highly prevalent in Brazil and influenced by factors such as gender and age. The diagnosis, particularly of migraines, poses significant challenges, while treatment often involves a combination of pharmacological interventions and lifestyle modifications. This ecological, descriptive, and comparative study retrospectively analyzed data on hospitalizations due to headaches among children and adolescents in Brazil between 2013 and 2023, using information from the Departamento de Informática do Sistema Único de Saúde (DATASUS). The analysis examined the number and costs of hospitalizations for migraines and other headache syndromes, focusing on variables such as region, age group, sex, and color/race. The study covered the entire national territory and assessed regional disparities. During the study period, Brazil reported 17,924 hospitalizations, with adolescents aged 15 to 19 years accounting for the highest prevalence (43.88%). Total expenditure reached BRL 6,499,792.90, with this age group incurring the highest costs. Findings underscored regional and gender disparities, with the Southeast region reporting the highest number of hospitalizations and a greater impact observed among females (62.3%). Understanding the epidemiological patterns of headaches in children and adolescents is critical for enhancing public health strategies, improving care delivery, and developing effective preventive measures.

The anxiety, depression, and TMD: Multidisciplinary therapy

Simone Graziani Prada — 2024-12-30

Abstract

Introduction

Temporomandibular disorder (TMD) affects the jaw and muscles, often linked to stress, anxiety, and sleep issues. Comprehensive care addressing physical and psychological factors improves outcomes.

Objective
This study proposed a multidisciplinary approach (psychologists, dentists, and physical therapists) to treat these conditions with non-pharmacological techniques, aiming for a more effective and personalized treatment.

Method
The research was conducted at the Sacomã Basic Health Unit in São Paulo, Brazil, and included 12 healthcare professionals in an active intervention and 6 patients as a control group during 1 month. The intervention consisted of four weekly one-hour sessions and home therapies sent via WhatsApp, utilizing stretching, mindfulness, thermotherapy, self-massage, and cognitive-behavioral therapy. Participants completed pre- and post-intervention questionnaires on depression (PHQ-9), anxiety (GAD-7), bruxism (OBC), and pain (GCPS and Pain Drawing).

Results
The interventions resulted in significant reductions in the PHQ-9 (p=0.028), GAD-7 (p=0.039), OBC (p=0.015), and PD (p=0.016) scales, demonstrating the positive impact of group dynamics. Additionally, there was a decrease in pain and an improvement in the quality of life of the participants.

Conclusion
Despite sample limitations, the data indicate that multidisciplinary interventions can effectively manage TMD, resulting in reduced pain and associated symptoms. The approach showed potential to improve patients' quality of life, highlighting the importance of integrated and personalized treatment. Future studies with larger samples and extended follow-up are necessary to validate these findings and expand the applicability of the

Screening tests for migraine applied to the population of the Bauru campus of the University of São Paulo: a prevalence study

Aline Donata Tanoue — 2024-12-30

Introduction: Migraine is a prevalent neurological disorder marked by recurrent and severe headaches that significantly impacts individuals' quality of life. Objective: This study aims to apply migraine screening tools to the population of the Bauru campus of the University of São Paulo (USP) to estimate the prevalence of migraine and assess the impact of pain on daily life.

Methods: A cross-sectional study involved 216 participants, comprising students, faculty, and staff, who completed online questionnaires, including the “ID Migraine,” “International Headache Society Migraine Diagnosis,” and “Migraine Screen Questionnaire.” The impact of migraine on daily activities was assessed using the “Headache Impact Test. The data were analyzed using the Shapiro-Wilk test, Student's t-test, Mann-Whitney test, and Pearson's correlation, adopting a 5% significance level.

Results: Out of 216 respondents, 69 (31.94%) were diagnosed with migraine using the ID Migraine tool. The International Headache Society questionnaire identified 86 participants (39.81%) as having migraine, while the Migraine Screen Questionnaire indicated 94 participants (43.52%). A combined analysis identified 20.83% of participants (n=45) as having migraine across all questionnaires. A total of 113 participants (52.31%) tested positive for migraine in at least one questionnaire. Results also revealed a strong correlation between positive migraine diagnosis and significant limitations in daily activities, as assessed by the Headache Impact Test (p<0.001).

Conclusion: Using multiple migraine screening questionnaires enhances sensitivity and specificity in identifying individuals with migraine. The findings reveal a substantial population at the USP campus likely affected by migraines, emphasizing the need for further research and intervention strategies.

Translation and validation of MIDAS for Brazilians

Ana Beatriz Vitor de Araújo — 2024-12-30

Background and objective: The Migraine Disability Assessment (MIDAS) is a widely used tool for evaluating disability associated with migraines. However, although a translated version exists in Brazil, its adaptation did not follow the methodological standards recommended by guidelines. Therefore, this study aimed to translate and validate MIDAS for the Brazilian population. Methods: This is a methodological study conducted in two stages: translation and adaptation, following the recommendations of the Professional Society for Health Economics and Outcomes Research, and measurement properties analysis, including intra-rater reliability using the Intraclass Correlation Coefficient (ICC), internal consistency with Cronbach's alpha, content validity through the Content Validity Index (CVI), criterion validity using Spearman's correlation, and content validity evaluated through the CVI based on the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN). A total of 149 individuals participated, comprising both sexes, with a mean age of 38 ± 12 years, all diagnosed with migraine according to the ICHD-3 criteria. Results: During translation and cultural adaptation, minimal changes were made to the original MIDAS structure. The measurement properties demonstrated moderate intra-rater reliability (ICC = 0.612; 95% Confidence Interval = 0.312–0.803; F (25, 25) = 4.286; p < 0.001), internal consistency with a Cronbach's alpha of 0.655, and a weak positive correlation between MIDAS and HIT-6. The global CVI was 0.78, considered satisfactory for content validity. Conclusion: The MIDAS instrument adapted to Brazilian Portuguese is valid for measuring migraine-related disability.