TRATAMENTO DA MIGRANEA REFRATÁRIA NA EMERGÊNCIA

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Autores

DOI:

https://doi.org/10.48208/HeadacheMed.2024.50

Palavras-chave:

Dores de cabeça refratárias, Tratamento da Enxaqueca, Haloperidol, Dexametasona

Resumo

Abstract

One of the primary neurological complaints in emergency care units is headaches, predominantly affecting young women of childbearing age. Among headache subtypes, migraines are highly disabling, significantly impacting quality of life and imposing a substantial burden on healthcare systems. When preventive and acute migraine treatments fail, the condition is classified as refractory, requiring more aggressive approaches.

This study aimed to evaluate the therapeutic response to treatment of refractory migraine in the Emergency Unit of the Barbacena Hospital Complex. It was a prospective observational study involving patients classified as refractory, here defined by failure to respond to at least three adequately dosed medications. After obtaining consent, demographic and medical history data were collected, and patients completed the Visual Analog Scale (VAS) to quantify pain.

The treatment protocol included 5 mg of haloperidol (oral or intravenous) and 4 mg of dexamethasone (oral or intravenous). Pain intensity was reassessed and quantified two hours post-administration. The study was conducted from August 1, 2023, to July 31, 2024, with 16 participants: 15 females and 1 male, with a mean age of 32 years.

The results were favorable, with a reduction of at least 2 points on the pain scale in all patients. This suggests that the combination of haloperidol and dexamethasone is a promising option for treating patients unresponsive to conventional therapies, providing significant pain relief.

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Referências

Robblee J, Grimsrud KW. Emergency Department and Inpatient Management of Headache in Adults. Curr Neurol Neurosci Rep. 2020 Apr 18;20(4):7. Doi: 10.1007/s11910-020-01030-w DOI: https://doi.org/10.1007/s11910-020-01030-w

Minen MT, Tanev K, Friedman BW. Evaluation and Treatment of Migraine in the Emergency Department: A Review. Headache: The Journal of Head and Face Pain. 2014 Jul 4;54(7):1131–45. Doi: 10.1111/head.12399 DOI: https://doi.org/10.1111/head.12399

Silva AV da, Kiy LMC, Alves C de A, Kirylko GC, Bello VA, Poli-Frederico RC. Impact of headache on a supplemental healthcare emergency unit and on use of opioids. Arq Neuropsiquiatr. 2021 Jul;79(7):579–83. Doi: 10.1590/0004-282x-anp-2020-0188 DOI: https://doi.org/10.1590/0004-282x-anp-2020-0188

Benevides ML, Oliveira S de S, Aguilar-Nascimento JE. A Associação de Haloperidol, Dexametasona e Ondansetrona Reduz a Intensidade de Náusea, Dor e Consumo de Morfina após Gastrectomia Vertical Laparoscópica. Brazilian Journal of Anesthesiology. 2013 Sep;63(5):404–9. Doi: 10.1016/j.bjan.2012.07.011 DOI: https://doi.org/10.1016/j.bjan.2012.07.011

Melhado EM, Santos PSF, Kaup AO, Costa ATNM da, Roesler CA de P, Piovesan ÉJ, et al. Consensus of the Brazilian Headache Society (SBCe) for the Prophylactic Treatment of Episodic Migraine: part I. Arq Neuropsiquiatr. 2022 Aug 17;80(08):845–61. Doi: 10.1055/s-0042-1756441 DOI: https://doi.org/10.1055/s-0042-1756441

James SL, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2018 Nov;392(10159):1789–858. Doi: 10.1016/S0140-6736(18)32279-7 DOI: https://doi.org/10.1016/S0140-6736(18)32279-7

Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018 Jan 25;38(1):1–211. Doi: 10.1177/0333102417738202 DOI: https://doi.org/10.1177/0333102417738202

Charles A. The pathophysiology of migraine: implications for clinical management. Lancet Neurol. 2018 Feb;17(2):174–82. Doi: 10.1016/S1474-4422(17)30435-0 DOI: https://doi.org/10.1016/S1474-4422(17)30435-0

Goadsby PJ, Holland PR, Martins-Oliveira M, Hoffmann J, Schankin C, Akerman S. Pathophysiology of Migraine: A Disorder of Sensory Processing. Physiol Rev. 2017 Apr;97(2):553–622. Doi: 10.1152/physrev.00034.2015 DOI: https://doi.org/10.1152/physrev.00034.2015

Noseda R, Burstein R. Migraine pathophysiology: Anatomy of the trigeminovascular pathway and associated neurological symptoms, cortical spreading depression, sensitization, and modulation of pain. Pain. 2013 Dec;154(Supplement 1):S44–53. Doi: 10.1016/j.pain.2013.07.021 DOI: https://doi.org/10.1016/j.pain.2013.07.021

Gelfand AA, Goadsby PJ. A Neurologist’s Guide to Acute Migraine Therapy in the Emergency Room. Neurohospitalist. 2012 Apr 16;2(2):51–9. Doi: 10.1177/1941874412439583 DOI: https://doi.org/10.1177/1941874412439583

Sacco S, Braschinsky M, Ducros A, Lampl C, Little P, van den Brink AM, et al. European headache federation consensus on the definition of resistant and refractory migraine. J Headache Pain. 2020 Dec 16;21(1):76. Doi: 10.1186/s10194-020-01130-5 DOI: https://doi.org/10.1186/s10194-020-01130-5

Martins IP, Sousa L, Monteiro PJM. Enxaqueca crônica, refratária e cefaleias por uso excessivo de medicamentos: Revisão clínica e terapêutica. Sinapse. 2018;18(2):1–12.

Monzillo PH, Nemoto PH, Costa AR, Sanvito WL. Tratamento agudo da crise de enxaqueca refratária na emergência: estudo comparativo entre dexametasona e haloperidol. Resultados preliminares. Arq Neuropsiquiatr. 2004 Jun;62(2b):513–8. Doi: 10.1590/S0004-282X2004000300025 DOI: https://doi.org/10.1590/S0004-282X2004000300025

Steiner TJ, Birbeck GL, Jensen R, Katsarava Z, Martelletti P, Stovner LJ. The Global Campaign, World Health Organization and Lifting The Burden: collaboration in action. J Headache Pain. 2011 Jun 22;12(3):273–4. Doi: 10.1007/s10194-011-0342-4 DOI: https://doi.org/10.1007/s10194-011-0342-4

Bigal ME, Bordini CA, Speciali JG. Intravenous chlorpromazine in the Emergency Department treatment of migraines: a randomized controlled trial. J Emerg Med. 2002 Aug;23(2):141–8. Doi: 10.1016/S0736-4679(02)00502-4 DOI: https://doi.org/10.1016/S0736-4679(02)00502-4

Honkaniemi J, Liimatainen S, Rainesalo S, Sulavuori S. Haloperidol in the Acute Treatment of Migraine: A Randomized, Double‐Blind, Placebo‐Controlled Study. Headache: The Journal of Head and Face Pain. 2006 May 25;46(5):781–7. Doi: 10.1111/j.1526-4610.2006.00438.x DOI: https://doi.org/10.1111/j.1526-4610.2006.00438.x

Woldeamanuel Y, Rapoport A, Cowan R. The place of corticosteroids in migraine attack management: A 65-year systematic review with pooled analysis and critical appraisal. Cephalalgia. 2015 Oct 9;35(11):996–1024. Doi: 10.1177/0333102414566200 DOI: https://doi.org/10.1177/0333102414566200

Godwin SA, Cherkas DS, Panagos PD, Shih RD, Byyny R, Wolf SJ, et al. Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Headache. Ann Emerg Med. 2019 Oct;74(4):e41–74. Doi: 10.1016/j.annemergmed.2019.07.009 DOI: https://doi.org/10.1016/S0196-0644(19)31168-0

Nye BL, Ward TN. Clinic and Emergency Room Evaluation and Testing of Headache. Headache: The Journal of Head and Face Pain. 2015 Oct 30;55(9):1301–8. Doi: 10.1111/head.12648 DOI: https://doi.org/10.1111/head.12648

Kowacs F, Roesler CA de P, Silva-Néto RP. “Migrânea” and “enxaqueca”: not opposite, but complementary words. Arq Neuropsiquiatr. 2021 Mar;79(3):248–50. Doi: 10.1590/0004-282x-anp-2020-0292 DOI: https://doi.org/10.1590/0004-282x-anp-2020-0292

Dodick D. Pearls: Headache. Semin Neurol. 2010 Feb 1;30(01):074–81. Doi: 10.1055/s-0029-1245000 DOI: https://doi.org/10.1055/s-0029-1245000

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Publicado

2024-12-31

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1.
Cunha SLR da, Jurno ME. TRATAMENTO DA MIGRANEA REFRATÁRIA NA EMERGÊNCIA . Headache Med [Internet]. 31º de dezembro de 2024 [citado 7º de junho de 2025];15(4):304-10. Disponível em: https://headachemedicine.com.br/index.php/hm/article/view/1325

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