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.

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-For twelve years, the subject of this report, a 38-year-old man, presented a clinical condition compatible with the SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing) syndrome. He presented a stabbing and intense daily pain located in the left pre-auricular and temporal regions. Each of these intense pain attacks lasted around one minute and presented a f requency of two to eight times per day. The pain was associated with ipsilateral lacrimation, conjunctival injection and rhinorrhea. MRI revealed a pituitary tumor with little suprasellar extent. The subject's serial assays of prolactin, GH, TSH and ACTH were within normal levels. Following transsphenoidal hypophysect o m y, with complete removal of the tumor, the subject no more presented pain. The pathological diagnosis was non-secreting adenoma. Fourteen months after the surgery, he remains symptom-free.KEY WORDS: SUNCT, pituitary tumor, surgery, ultra-shorting headaches.Síndrome SUNCT associada a tumor de hipófise: relato de caso RESUMO -O paciente relatado neste artigo apresentou uma condição clínica compatível com síndro m e SUNCT (cefaléia de curta duração, unilateral, neuralgiforme com hiperemia conjuntival e lacrimejamento). Ele referia dor diária, intensa, em facada, localizada na região pré-auricular e temporal esquerd a s . Cada ataque de dor permanecia por cerca de um minuto, com freqüência de duas a oito vezes por dia. A dor se acompanhava de lacrimejamento ipsolateral, congestão conjuntival e rinorréia. A RM mostrou um tumor de hipófise com pouca extensão suprasselar. Dosagens de prolactina, GH, TSH e ACTH estavam em níveis normais. Foi então submetido a hipofisectomia transesfenoidal com remoção completa do tumor após o que a dor cessou completamente. O diagnóstico anátomo-patológico foi adenoma não secre t o r. Quatorze meses após a cirurgia, o paciente permanecia livre de dor. PALAVRAS-CHAVE: SUNCT, tumor de hipófise, cirurgia, cefaléia de curta duração. s y n d rome is the poor response to pharm a c o l o g i c a l t re a t m e n t s 3 , 4 . There have been re p o rts of impro v ement upon the use of amitriptyline, carbamazepine, gabapentin, prednisone, topiramate 5 , lamotrigine 6 , nifedipine and sumatriptan 4 . Anesthetic blockades do not work very well, although there have been re p o rts of improvement following the local opioid blockade of the superior cervical ganglion 7 . There have also been re p o rts of surgical pro c e d u res that worked eff e c t i v e l y 5 while others re p o rts have indicated a lack of response to such procedures 8 .This syndrome has been listed in the second edition of The International Classification of Headache D i s o rders together with trigeminal autonomic cephaThe SUNCT syndrome (short-lasting unilateral neur a l g i f o rm headache attacks with conjunctival injection and tearing) is an uncommon headache characterized by moderate to severe pain. Usualy, the locations with the most severe pain are the ocular/periocular regions and the fronta...

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RESUMO -A cefaléia tipo tensão em suas duas modalidades, episódica e crônica, é a forma mais comum de dor de cabeça na população. O tratamento é feito com medidas não farmacológicas e farmacológicas, tanto para o ataque como profilaxia das crises. Este estudo foi realizado com 5490 pacientes, que procuraram ambulatórios e consultórios médicos em várias regiões do Brasil. Cerca de 95% apresentavam cefaléia tipo tensão episódica e 5% cefaléia tipo tensão crônica. A maioria dos pacientes apresentou crises de intensidade moderada (62,19%). Em 5419 pacientes uma crise de cefaléia tipo tensão foi tratada com 1000 mg de paracetamol e 130 mg de cafeína. Em 93,98% início de melhora foi observado em até 2 horas após a ingestão da medicação. Em 77,61% houve reversão completa da crise em até 2 horas. Avaliação da eficácia boa/excelente foi observada em 51,93%/37,80% dos casos quando feita pelos médicos e em 48,51%/40,29 quando pelos pacientes. Efeitos adversos, em geral manifestações gastrointestinais, foram observados em 5,57%. Este estudo representa uma experiência brasileira no tratamento de ataque da cefaléia tipo tensão, demonstrando eficácia e segurança no uso da combinação paracetamol-cafeína. PALAVRAS-CHAVE: cefaléia, tratamento, paracetamol, cafeína. Clinical evaluation of the efficacy of the acetaminophen and caffeine combination in the treatment of tension headacheABSTRACT -Tension type headache in both its forms, episodic and chronic, is the most common type of headache experienced by the population. The headache attack or the prevention of new crises may be treated with pharmacological as well as non-pharmacological measures. This study included 5,490 patients from outpatient clinics and medical offices covering various regions of Brazil. Approximately 95% of the subjects had episodic tension type headache, while 5% had chronic tension type headache. The majority of the patients presented with crisis of moderate intensity (62.19%). In 5,419 patients a tension type headache crisis was treated with acetaminophen 1000 mg and caffeine 130 mg. In 93.98%, onset of relief occurred within 2 hours of taking the medication. In 77.61%, complete reversion of the crisis occurred within 2 hours. Good/excellent efficacy ratings were achieved in 61.93%/37.80% of the cases according to the physician's assessment and in 48.51%/40.29% according to the patients' assessment. Adverse events, commonly gastrointestinal manifestations, were reported by 5.57% of the patients. This is a Brazilian study of the efficacy and safety of the combined use of acetaminophen -caffeine for the treatment of tension type headache.KEY WORDS: headache, treatment, acetaminophen, caffeine.Cefaléia é qualquer dor referida no segmento cefálico. Trata-se de manifestação extremamente frequente na prática clínica, e alguns dados populacionais devem ser citados: -a prevalência de cefaléia durante a vida na população geral é maior que 90% 1 ; -em ambulatório geral de clínica