Background / Purpose: To perform the cross-cultural adaptation of the 12 item Allodynia Symptom C... more Background / Purpose: To perform the cross-cultural adaptation of the 12 item Allodynia Symptom Checklist (ASC-12) for the Brazilian population, and to test the reproducibility of this version, since allodynia has been pointed out as a factor of migraine chronification (1). Main conclusion: We made avaiable an easy, quick and reliable questionnaire for the Brazilian population.
Migraine and temporomandibular disorders (TMDs) are reported to be associated. However, there are... more Migraine and temporomandibular disorders (TMDs) are reported to be associated. However, there are no reports on the association among migraines, TMDs and changes in body posture. To assess changes in body posture in women suffering migraines with or without TMD compared with a control group. Sixty-six women with a mean age of 18 to 45 years participated in this study. The groups were composed of 22 volunteers with migraine and TMD (MTMD), 22 volunteers with migraines without TMD (MG) and 22 women in the control group (CG). Static posture was assessed by photogrammetry, and 19 angles were measured. Postural asymmetry was observed in the face for 4 angles measured on the frontal plane in the MG group and for 4 angles of the trunk in the MG and MTMD groups with respect to CG. However, for comparisons between MTMD and CG, clinical relevance was identified for two angles of the sagittal plane (Cervical and Lumbar Lordosis, Effect Size - ES - moderate: 0.53 and 0.60). For comparisons betw...
This study examined the effect of GMP in two models of depression in mice. The immobility times i... more This study examined the effect of GMP in two models of depression in mice. The immobility times in the forced swimming test (FST) and in the tail suspension test (TST) were significantly reduced by GMP (dose range: 5-50 mg/kg and 5-100 mg/kg, i.p., respectively), without accompanying changes in ambulation in an open-field. I.c.v. injection of GMP (320-480 nmol/site) also reduced the immobility in the FST without affecting ambulation. The immobility of mice treated with MK-801 (0.01 mg/kg) + GMP (50 mg/kg) was not significantly different from the result obtained with MK-801 or GMP alone, but GMP (or MK-801) + imipramine (15 mg/kg) treatment induced a stronger effect in FST than administration of either drug alone. Pretreatment with p-chlorophenylalanine (100 mg/kg, 4 days) completely blocked the anti-immobility effect of GMP, MK-801 or fluoxetine (32 mg/kg), but only partially that of imipramine in the FST. The results suggest that the antidepressant-like effects produced by the administration of GMP, like MK-801, may be due to an indirect serotonin activation resulting from blockade of NMDA receptors.
Background.-Migraine, especially migraine with aura (MA), appears to be a risk factor for ischemi... more Background.-Migraine, especially migraine with aura (MA), appears to be a risk factor for ischemic lesions in the posterior fossa. The clinical relevance of the lesions is uncertain. Accordingly, herein, we identified individuals with MA, migraine without aura (MO), and without migraine (controls) in order to investigate their balance and mobility.
Trigeminal neuralgia (TN) is a condition characterized by brief electric shock-like pains in the ... more Trigeminal neuralgia (TN) is a condition characterized by brief electric shock-like pains in the topography of the trigeminal nerve. The most common cause of this disorder is the compression of the trigeminal nerve root by tortuous or aberrant vessels. In this report, we describe a patient who presented due to paroxysmal and excruciating facial pain that was found to be secondary to pancreatic cancer.
Vascular endothelial growth factor (VEGF) production is regulated by growth factors and inflammat... more Vascular endothelial growth factor (VEGF) production is regulated by growth factors and inflammatory cytokines, and VEGF plays a role in migraine. We examined for the first time whether three functional polymorphisms in the promoter region of VEGF gene (C(-2578)A, G(-1154)A, and G(-634)C) and VEGF haplotypes are associated with migraine. We studied 114 healthy women without migraine and 175 women with migraine (129 without aura, and 46 with aura). We found no differences in the distributions of VEGF genotypes and alleles (p > 0.05). However, the CAC haplotype was more frequent in controls than in migraine patients, and the AGC haplotype was more frequent in patients with migraine with aura than in controls (both p < 0.05). These findings suggest that VEGF haplotypes affect susceptibility to migraine.
Background: We compared the circulating levels of matrix metalloproteinase (MMP)-2, MMP-9, tissue... more Background: We compared the circulating levels of matrix metalloproteinase (MMP)-2, MMP-9, tissue inhibitors of metalloproteinase (TIMP)-1, TIMP-2, and MMP-9/TIMP-1 and MMP-2/TIMP-2 ratios in migraine patients without aura (MWA) and in migraine patients with aura (MA) with those found in healthy subjects (controls). Methods: We studied 80 migraine (40 MWA and 40 MA) women and 40 controls. Pro-MMP-2 levels were determined by zymography and MMP-9, TIMP-1, and TIMP-2 levels were determined by ELISA. Results: While we found similar TIMP-2 levels, higher plasma pro-MMP-2 and pro-MMP-2/TIMP-2 ratios were found in MWA and MA patients compared with controls (P b 0.05). Higher TIMP-1 levels and lower MMP-9/TIMP-1 ratios were found in MA, but not in MWA, patients compared with controls (P b 0.05). We found no significant differences when patients without headache attack were compared with patients having a headache attack (all P b 0.05). Conclusions: We showed an increased net MMP-2 activity in MWA and MA. The increased MMP-9/TIMP-1 ratios in MWA patients contrast with the lower MMP-9/TIMP-1 ratios in MA patients and may reflect pathophysiological differences between these conditions.
Chronic migraine is a condition with significant prevalence all around the world and high socioec... more Chronic migraine is a condition with significant prevalence all around the world and high socioeconomic impact, and its handling has been challenging neurologists. Developments for understanding its mechanisms and associated conditions, as well as that of new therapies, have been quick and important, a fact which has motivated the Latin American and Brazilian Headache Societies to prepare the present consensus. The treatment of chronic migraine should always be preceded by a careful diagnosis review; the detection of possible worsening factors and associated conditions; the stratification of seriousness/impossibility to treat; and monitoring establishment, with a pain diary. The present consensus deals with pharmacological and nonpharmacological forms of treatment to be used in chronic migraine.
Due to its high prevalence, TTH accounts for a large part of the socioeconomic impact of headache... more Due to its high prevalence, TTH accounts for a large part of the socioeconomic impact of headaches. Although 60% of the patients with TTH report some disability related to headache, few studies have evaluated TTH individually. A Danish study reports that 43% of migraineurs and 12% of TTH patients (representing 2 and 9% of the population, respectively) took absence from work, the average number of days absent from work was 270 per 1000 migraineurs and 820 per 1000 TTH sufferers [14]. In a study conducted in Canada, 8.3% of the patients with ETTH reported missed days of work due to headache. When missed days of work are added to the reduced ability to work of persons who do not stay home during headache crises, the total is 4.2 days/year lost due to TTH [15]. In a population survey, it was found that half of TTH sufferers discontinued normal activities during their attacks and most required bed rest, preventing them from going to work or working efficiently [16].
Several studies have presented evidence that blocking peripheral nerves is effective for the trea... more Several studies have presented evidence that blocking peripheral nerves is effective for the treatment of some headaches and cranial neuralgias, resulting in reduction of the frequency, intensity, and duration of pain. In this article we describe the role of nerve block in the treatment of headaches and cranial neuralgias, and the experience of a tertiary headache center regarding this issue. We also report the anatomical landmarks, techniques, materials used, contraindications, and side effects of peripheral nerve block, as well as the mechanisms of action of lidocaine and dexamethasone. The nerve block can be used in primary (migraine, cluster headache, and nummular headache) and secondary headaches (cervicogenic headache and headache attributed to craniotomy), as well in cranial neuralgias (trigeminal neuropathies, glossopharyngeal and occipital neuralgias). In some of them this procedure is necessary for both diagnosis and treatment, while in others it is an adjuvant treatment. The block of the greater occipital nerve with an anesthetic and corticosteroid compound has proved to be effective in the treatment of cluster headache. Regarding the treatment of other headaches and cranial neuralgias, controlled studies are still necessary to clarify the real role of peripheral nerve block.
Objective.-To assess the prevalence of depressive symptoms and WCP in individuals with EM and CM,... more Objective.-To assess the prevalence of depressive symptoms and WCP in individuals with EM and CM, as well as to estimate the joint impact of these conditions on the HRQoL of these individuals.
Objective: To estimate the prevalence and evaluate the characteristics and severity of restless l... more Objective: To estimate the prevalence and evaluate the characteristics and severity of restless legs syndrome (RLS) in an urban Brazilian community. Methods: A transversal study was conducted over an 18-month period. A neurologist conducted 1155 interviews using the diagnostic criteria of the International Restless Legs Syndrome Study Group (IRLSSG). Results: The lifetime prevalence of RLS was found to be 6.40%. Prevalence during the last year, the last month, and the last week were found to be 5.71%, 5.36%, and 4.15%, respectively. A greater proportion of women met diagnostic criteria for RLS compared to men (OR: 2.63, CI 95%: 1.54-4.51). Furthermore, participants with low monthly family income (<$1575 USD) had a lower prevalence of disease compared to those with a high monthly family income (>$1575 USD) (OR: 2.91, CI 95%: 1.41-5.98). Conclusions: This is the first epidemiologic study of RLS conducted in a Brazilian population. The overall prevalence of disease and the greater proportion of RLS in women found in this study are similar to the findings of other studies conducted in western countries. The association of RLS with high family income is unpublished and should be confirmed in subsequent studies.
sUNct is one of the rarest and least known primary headache disorders. Although its pathogenesis ... more sUNct is one of the rarest and least known primary headache disorders. Although its pathogenesis has been partially understood by functional neuroimaging and reports of secondary cases, there is limited understanding of its cause. We report a case of sUNct in a 54-years-old man, that could not be strictly classified as secondary sUNct; however, the time lag of pain onset suggests a new theory in which neuroplasticity could be involved in the origin and duration of the pain in sUNct syndrome.
Background / Purpose: To perform the cross-cultural adaptation of the 12 item Allodynia Symptom C... more Background / Purpose: To perform the cross-cultural adaptation of the 12 item Allodynia Symptom Checklist (ASC-12) for the Brazilian population, and to test the reproducibility of this version, since allodynia has been pointed out as a factor of migraine chronification (1). Main conclusion: We made avaiable an easy, quick and reliable questionnaire for the Brazilian population.
Migraine and temporomandibular disorders (TMDs) are reported to be associated. However, there are... more Migraine and temporomandibular disorders (TMDs) are reported to be associated. However, there are no reports on the association among migraines, TMDs and changes in body posture. To assess changes in body posture in women suffering migraines with or without TMD compared with a control group. Sixty-six women with a mean age of 18 to 45 years participated in this study. The groups were composed of 22 volunteers with migraine and TMD (MTMD), 22 volunteers with migraines without TMD (MG) and 22 women in the control group (CG). Static posture was assessed by photogrammetry, and 19 angles were measured. Postural asymmetry was observed in the face for 4 angles measured on the frontal plane in the MG group and for 4 angles of the trunk in the MG and MTMD groups with respect to CG. However, for comparisons between MTMD and CG, clinical relevance was identified for two angles of the sagittal plane (Cervical and Lumbar Lordosis, Effect Size - ES - moderate: 0.53 and 0.60). For comparisons betw...
This study examined the effect of GMP in two models of depression in mice. The immobility times i... more This study examined the effect of GMP in two models of depression in mice. The immobility times in the forced swimming test (FST) and in the tail suspension test (TST) were significantly reduced by GMP (dose range: 5-50 mg/kg and 5-100 mg/kg, i.p., respectively), without accompanying changes in ambulation in an open-field. I.c.v. injection of GMP (320-480 nmol/site) also reduced the immobility in the FST without affecting ambulation. The immobility of mice treated with MK-801 (0.01 mg/kg) + GMP (50 mg/kg) was not significantly different from the result obtained with MK-801 or GMP alone, but GMP (or MK-801) + imipramine (15 mg/kg) treatment induced a stronger effect in FST than administration of either drug alone. Pretreatment with p-chlorophenylalanine (100 mg/kg, 4 days) completely blocked the anti-immobility effect of GMP, MK-801 or fluoxetine (32 mg/kg), but only partially that of imipramine in the FST. The results suggest that the antidepressant-like effects produced by the administration of GMP, like MK-801, may be due to an indirect serotonin activation resulting from blockade of NMDA receptors.
Background.-Migraine, especially migraine with aura (MA), appears to be a risk factor for ischemi... more Background.-Migraine, especially migraine with aura (MA), appears to be a risk factor for ischemic lesions in the posterior fossa. The clinical relevance of the lesions is uncertain. Accordingly, herein, we identified individuals with MA, migraine without aura (MO), and without migraine (controls) in order to investigate their balance and mobility.
Trigeminal neuralgia (TN) is a condition characterized by brief electric shock-like pains in the ... more Trigeminal neuralgia (TN) is a condition characterized by brief electric shock-like pains in the topography of the trigeminal nerve. The most common cause of this disorder is the compression of the trigeminal nerve root by tortuous or aberrant vessels. In this report, we describe a patient who presented due to paroxysmal and excruciating facial pain that was found to be secondary to pancreatic cancer.
Vascular endothelial growth factor (VEGF) production is regulated by growth factors and inflammat... more Vascular endothelial growth factor (VEGF) production is regulated by growth factors and inflammatory cytokines, and VEGF plays a role in migraine. We examined for the first time whether three functional polymorphisms in the promoter region of VEGF gene (C(-2578)A, G(-1154)A, and G(-634)C) and VEGF haplotypes are associated with migraine. We studied 114 healthy women without migraine and 175 women with migraine (129 without aura, and 46 with aura). We found no differences in the distributions of VEGF genotypes and alleles (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). However, the CAC haplotype was more frequent in controls than in migraine patients, and the AGC haplotype was more frequent in patients with migraine with aura than in controls (both p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). These findings suggest that VEGF haplotypes affect susceptibility to migraine.
Background: We compared the circulating levels of matrix metalloproteinase (MMP)-2, MMP-9, tissue... more Background: We compared the circulating levels of matrix metalloproteinase (MMP)-2, MMP-9, tissue inhibitors of metalloproteinase (TIMP)-1, TIMP-2, and MMP-9/TIMP-1 and MMP-2/TIMP-2 ratios in migraine patients without aura (MWA) and in migraine patients with aura (MA) with those found in healthy subjects (controls). Methods: We studied 80 migraine (40 MWA and 40 MA) women and 40 controls. Pro-MMP-2 levels were determined by zymography and MMP-9, TIMP-1, and TIMP-2 levels were determined by ELISA. Results: While we found similar TIMP-2 levels, higher plasma pro-MMP-2 and pro-MMP-2/TIMP-2 ratios were found in MWA and MA patients compared with controls (P b 0.05). Higher TIMP-1 levels and lower MMP-9/TIMP-1 ratios were found in MA, but not in MWA, patients compared with controls (P b 0.05). We found no significant differences when patients without headache attack were compared with patients having a headache attack (all P b 0.05). Conclusions: We showed an increased net MMP-2 activity in MWA and MA. The increased MMP-9/TIMP-1 ratios in MWA patients contrast with the lower MMP-9/TIMP-1 ratios in MA patients and may reflect pathophysiological differences between these conditions.
Chronic migraine is a condition with significant prevalence all around the world and high socioec... more Chronic migraine is a condition with significant prevalence all around the world and high socioeconomic impact, and its handling has been challenging neurologists. Developments for understanding its mechanisms and associated conditions, as well as that of new therapies, have been quick and important, a fact which has motivated the Latin American and Brazilian Headache Societies to prepare the present consensus. The treatment of chronic migraine should always be preceded by a careful diagnosis review; the detection of possible worsening factors and associated conditions; the stratification of seriousness/impossibility to treat; and monitoring establishment, with a pain diary. The present consensus deals with pharmacological and nonpharmacological forms of treatment to be used in chronic migraine.
Due to its high prevalence, TTH accounts for a large part of the socioeconomic impact of headache... more Due to its high prevalence, TTH accounts for a large part of the socioeconomic impact of headaches. Although 60% of the patients with TTH report some disability related to headache, few studies have evaluated TTH individually. A Danish study reports that 43% of migraineurs and 12% of TTH patients (representing 2 and 9% of the population, respectively) took absence from work, the average number of days absent from work was 270 per 1000 migraineurs and 820 per 1000 TTH sufferers [14]. In a study conducted in Canada, 8.3% of the patients with ETTH reported missed days of work due to headache. When missed days of work are added to the reduced ability to work of persons who do not stay home during headache crises, the total is 4.2 days/year lost due to TTH [15]. In a population survey, it was found that half of TTH sufferers discontinued normal activities during their attacks and most required bed rest, preventing them from going to work or working efficiently [16].
Several studies have presented evidence that blocking peripheral nerves is effective for the trea... more Several studies have presented evidence that blocking peripheral nerves is effective for the treatment of some headaches and cranial neuralgias, resulting in reduction of the frequency, intensity, and duration of pain. In this article we describe the role of nerve block in the treatment of headaches and cranial neuralgias, and the experience of a tertiary headache center regarding this issue. We also report the anatomical landmarks, techniques, materials used, contraindications, and side effects of peripheral nerve block, as well as the mechanisms of action of lidocaine and dexamethasone. The nerve block can be used in primary (migraine, cluster headache, and nummular headache) and secondary headaches (cervicogenic headache and headache attributed to craniotomy), as well in cranial neuralgias (trigeminal neuropathies, glossopharyngeal and occipital neuralgias). In some of them this procedure is necessary for both diagnosis and treatment, while in others it is an adjuvant treatment. The block of the greater occipital nerve with an anesthetic and corticosteroid compound has proved to be effective in the treatment of cluster headache. Regarding the treatment of other headaches and cranial neuralgias, controlled studies are still necessary to clarify the real role of peripheral nerve block.
Objective.-To assess the prevalence of depressive symptoms and WCP in individuals with EM and CM,... more Objective.-To assess the prevalence of depressive symptoms and WCP in individuals with EM and CM, as well as to estimate the joint impact of these conditions on the HRQoL of these individuals.
Objective: To estimate the prevalence and evaluate the characteristics and severity of restless l... more Objective: To estimate the prevalence and evaluate the characteristics and severity of restless legs syndrome (RLS) in an urban Brazilian community. Methods: A transversal study was conducted over an 18-month period. A neurologist conducted 1155 interviews using the diagnostic criteria of the International Restless Legs Syndrome Study Group (IRLSSG). Results: The lifetime prevalence of RLS was found to be 6.40%. Prevalence during the last year, the last month, and the last week were found to be 5.71%, 5.36%, and 4.15%, respectively. A greater proportion of women met diagnostic criteria for RLS compared to men (OR: 2.63, CI 95%: 1.54-4.51). Furthermore, participants with low monthly family income (<$1575 USD) had a lower prevalence of disease compared to those with a high monthly family income (>$1575 USD) (OR: 2.91, CI 95%: 1.41-5.98). Conclusions: This is the first epidemiologic study of RLS conducted in a Brazilian population. The overall prevalence of disease and the greater proportion of RLS in women found in this study are similar to the findings of other studies conducted in western countries. The association of RLS with high family income is unpublished and should be confirmed in subsequent studies.
sUNct is one of the rarest and least known primary headache disorders. Although its pathogenesis ... more sUNct is one of the rarest and least known primary headache disorders. Although its pathogenesis has been partially understood by functional neuroimaging and reports of secondary cases, there is limited understanding of its cause. We report a case of sUNct in a 54-years-old man, that could not be strictly classified as secondary sUNct; however, the time lag of pain onset suggests a new theory in which neuroplasticity could be involved in the origin and duration of the pain in sUNct syndrome.
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Papers by Fabíola Dach