Enxaqueca em crianças e adolescentes: o impacto clínico da alodínia
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https://doi.org/10.48208/HeadacheMed.2025.24Palavras-chave:
Enxaqueca, Mobilidade do pescoço, Alodínia cutâneaResumo
Introdução
A fisiopatologia da enxaqueca está fortemente associada à sensibilização central, cuja presença está relacionada à alodínia cutânea e à disfunção musculoesquelética cervical. No entanto, esses aspectos permanecem pouco estudados em crianças e adolescentes. Assim, este estudo teve como objetivo avaliar as diferenças nas variáveis clínicas, na sensibilização e nas alterações musculoesqueléticas entre crianças (CR) e adolescentes (AD) com enxaqueca, considerando a presença ou ausência de alodínia cutânea.
Métodos
Cento e um participantes com idades entre 6 e 16 anos e diagnóstico clínico de enxaqueca foram avaliados. Os desfechos incluíram amplitude de movimento cervical (ADM), limiar de dor à pressão (LDP) dos músculos craniocervicais e presença de alodínia cutânea.
Resultados
Diferenças significativas foram observadas entre RC e AD para idade (p<0,001) e LDP dos músculos esternocleidomastoideo (p=0,002), levantador da escápula (p=0,006), suboccipital (p=0,006), trapézio (p<0,001) e escaleno anterior (p<0,001). Os subgrupos RC e AD com e sem alodínia apresentaram diferenças significativas nos LDP dos músculos esternocleidomastoideo (p=0,020), levantador da escápula (p=0,016), suboccipital (p=0,038), trapézio (p<0,001), escaleno anterior (p<0,001) e na amplitude de movimento cervical no plano sagital (p=0,016). As principais diferenças foram observadas entre adolescentes e crianças com e sem alodínia. Não foram encontradas diferenças entre os subgrupos de crianças e adolescentes.
Conclusão
A presença de alodínia cutânea está associada ao aumento da sensibilidade muscular e à redução da mobilidade sagital cervical. Esses achados destacam a importância da avaliação precoce da alodínia e da sensibilidade musculoesquelética em crianças e adolescentes com enxaqueca.
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Referências
Abu-Arafeh I, Razak S, Sivaraman B, Graham C. Prevalence of headache and migraine in children and adolescents: A systematic review of population-based studies. Dev Med Child Neurol 2010;52:1088–97. Doi:10.1111/J.1469-8749.2010.03793.X.
Wöber-Bingöl Ç. Epidemiology of migraine and headache in children and adolescents topical collection on childhood and adolescent headache. Curr Pain Headache Rep 2013;17. Doi:10.1007/S11916-013-0341-Z.
Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2018;38:1–211. Doi: 10.1177/0333102417738202.
Lu G, Xiao S, Wang Y, Jia Q, Liu S, Yu S, et al. Global epidemiology and burden of headache disorders in children and adolescents from 1990 to 2021. Headache 2025;65:1170–9. Doi:10.1111/head.14937.
Ferracini GN, Dach F, Speciali JG. Quality of life and health-related disability in children with migraine. Headache 2014;54:325–34. Doi:10.1111/head.12251.
Goadsby PJ, Holland PR, Martins-Oliveira M, Hoffmann J, Schankin C, Akerman S. Pathophysiology of migraine: A disorder of sensory processing. Physiol Rev 2017;97:553–622. Doi:10.1152/physrev.00034.2015.
Florencio LL, Giantomassi MCM, Carvalho GF, Gonçalves MC, Dach F, Fernández-de-las-Peñas C, et al. Generalized Pressure Pain Hypersensitivity in the Cervical Muscles in Women with Migraine. Pain Medicine (United States) 2015;16:1629–34. Doi:10.1111/pme.12767.
Bevilaqua-Grossi D, Pegoretti KS, Goncalves MC, Speciali JG, Bordini CA, Bigal ME. Cervical mobility in women with migraine. Headache 2009;49:726–31. Doi:10.1111/J.1526-4610.2008.01233.X.
Ferracini GN, Stuginsk-Barbosa J, Dach F, Speciali JG. A Comparison Pressure Pain Threshold in Pericranial and Extracephalic Regions in Children with Migraine. Pain Medicine (United States) 2014;15:702–9. Doi:10.1111/PME.12353.
Oksanen A, Metsähonkala L, Viander S, Jäppilä E, Aromaa M, Anttila P, et al. Strength and mobility of the neck-shoulder region in adolescent headache. Physiother Theory Pract 2006;22:163–74. Doi:10.1080/09593980600822800.
Mathew NT, Kailasam J, Seifert T. Clinical recognition of allodynia in migraine. Neurology 2004;63:848–52. Doi:10.1212/01.wnl.0000137107.27585.F7.
Florencio LL, de Oliveira AS, Pinheiro CF, Will-Lemos T, Dach F, Fernández-de-las-Peñas C, et al. Comparison of cervical muscle isometric force between migraine subgroups or migraine-associated neck pain: a controlled study. Sci Rep 2021;11. Doi:10.1038/S41598-021-95078-4.
May A, Schulte LH. Chronic migraine: Risk factors, mechanisms and treatment. Nat Rev Neurol 2016;12:455–64. Doi:10.1038/nrneurol.2016.93.
Karsan N, Prabhakar P, Goadsby PJ. Extended Phenotyping of Migraine in Children: A Cross-Sectional Study in a Specialist Children’s Headache Clinic. Pediatr Neurol 2024;156:33–40. Doi:10.1016/j.pediatrneurol.2024.03.026.
Raieli V, Pandolfi E, La Vecchia M, Puma D, Calò A, Celauro A, et al. The prevalence of allodynia, osmophobia and red ear syndrome in the juvenile headache: Preliminary data. Journal of Headache and Pain 2005;6:271–3. Doi:10.1007/S10194-005-0205-Y.
Levinsky Y, Zeharia A, Eidlitz-Markus T. Cephalic cutaneous allodynia in children and adolescents with migraine of short duration: A retrospective cohort study. Cephalalgia 2019;39:61–7. Doi:10.1177/0333102418776018.
Raieli V, Trapolino D, Giordano G, Spitaleri C, Consolo F, Santangelo G, et al. Juvenile migraine and allodynia: Results of a retrospective study. Headache 2015;55:413–8. Doi:10.1111/head.12530.
Marchese F, Rocchitelli L, Messina LM, Nardello R, Mangano GD, Vanadia F, et al. Migraine in children under 6 years of age: A long-term follow-up study. European Journal of Paediatric Neurology 2020;27:67–71. Doi:10.1016/j.ejpn.2020.04.005.
Chaves TC, Nagamine HM, Mêlo de Sousa L, Siriani de Oliveira A, Grossi DB. Comparison between the reliability levels of manual palpation and pressure pain threshold in children who reported orofacial pain. Man Ther 2010;15:508–12. Doi:10.1016/J.math.2010.03.010.
Budelmann K, Piekartz H von, Hall T. A normative study of cervical range of motion measures including the flexion–rotation test in asymptomatic children: side-to-side variability and pain provocation. Journal of Manual and Manipulative Therapy 2016;24:185–91. Doi:10.1179/2042618612Y.0000000026.
Lynch-Caris T, Majeske KD, Brelin-Fornari J, Nashi S. Establishing reference values for cervical spine range of motion in pre-pubescent children. J Biomech 2008;41:2714–9. Doi:10.1016/J.jbiomech.2008.06.021.
Eidlitz-Markus T, Shuper A, Gorali O, Zeharia A. Migraine and cephalic cutaneous allodynia in pediatric patients. Headache 2007;47:1219–23. Doi:10.1111/J.1526-4610.2007.00892.X.
Aguila MER, Rebbeck T, Pope A, Ng K, Leaver AM. Six-month clinical course and factors associated with non-improvement in migraine and non-migraine headaches. Cephalalgia 2018;38:1672–86. Doi:10.1177/0333102417744360.
Ferracini GN, Speciali JG. Pressure pain threshold in children with headache. Revista Dor 2011;12:270–3. Doi:10.1590/S1806-00132011000300015.
Dennis M. Developmental plasticity in children: The role of biological risk, development, time, and reserve. J Commun Disord 2000;33:321–32. Doi:10.1016/S0021-9924(00)00028-9.
Zohsel K, Hohmeister J, Oelkers-Ax R, Flor H, Hermann C. Quantitative sensory testing in children with migraine: Preliminary evidence for enhanced sensitivity to painful stimuli especially in girls. Pain 2006;123:10–8. Doi:10.1016/j.pain.2005.12.015.
Ayed H Ben, Yaich S, Trigui M, Hmida M Ben, Jemaa M Ben, Ammar A, et al. Prevalence, Risk Factors and Outcomes of Neck, Shoulders and Low-Back Pain in Secondary-School Children. J Res Health Sci 2019;19:e00440. Doi:10.15171/jrhs.2019.07.
Bevilaqua-Grossi D, Pinheiro-Araujo CF, Carvalho GF, Florencio LL. Neck pain repercussions in migraine – The role of physiotherapy. Musculoskelet Sci Pract 2023;66. Doi:10.1016/j.msksp.2023.102786.
Bevilaqua-Grossi D, Gonçalves MC, Carvalho GF, Florencio LL, Dach F, Speciali JG, et al. Additional Effects of a Physical Therapy Protocol on Headache Frequency, Pressure Pain Threshold, and Improvement Perception in Patients With Migraine and Associated Neck Pain: A Randomized Controlled Trial. Arch Phys Med Rehabil 2016;97:866–74. Doi:10.1016/j.apmr.2015.12.006.
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Copyright (c) 2025 Juliana Pradela, Amanda Rodrigues, Felipe Daniel Sambini, Vitória Carolina Leonel, Nathiely Viana da Silva, Fabiola Dach, Debora Bevilaqua Grossi (Author)
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
