Sports activities associated with repetitive cranial trauma have become a fad and are popular in gyms and even among children. It is important to consistently characterize the consequences of such sports activities in order to better advise society on the real risks to the central nervous system. We present the case of a former boxer reporting cognitive and behavioral symptoms that began six years after his retirement as a boxer, evolving progressively with parkinsonian and cerebellar features suggestive of probable chronic traumatic encephalopathy (CTE). Using our case as a paradigm, we extended the range of differential diagnosis of CTE, including corticobasal degeneration, multiple system atrophy, vitamin B12 deficiency, neurosyphilis, frontotemporal dementia and Alzheimer’s disease.

Introduction: CGRP, a neuropeptide synthetized and released in the central nervous system and potent vasodilator, has been implicated in migraine physiopathology. Because of that, there are CGRP targeted therapies that decrease CGRP levels. Melatonin, a pineal gland secretion, has already proved its analgesic effect. We aimed to study CGRP expression in an animal model comparing capsaicin, CGRP and melatonin. Methods: We used in our study male animal rats and separated them into groups based in the kind of received solution (control group, capsaicin only and melatonin plus capsaicin). It was prepared brain stem slices and measured the CGRP levels in the trigemino nucleus caudalis (TNC). Results: Capsaicin group (N = 5) presented low intensity of GCRP expression and animals that received capsaicin plus melatonin (N = 5) showed high intensity of CGRP expression compared to capsaicin group. Conclusion: Melatonin decreases CGRP in an experimental model in rats induced by capsaicin, reducing its inflammatory action in cerebral vessels.

Anti-CGRP monoclonal antibodies have been developed for migraine preventive treatment. There is evidence of good efficacy and safety of these medications; however, cost is a factor that interferes with the choice of treatment. This paper proposes a framework in order to better assist the decision-making processes on the use of these drugs in developing countries without coverage of health care costs for migraine. The framework was built after reviewing phase II and III studies on episodic and chronic migraine treatment with erenumab, galcanezumab and fremanezumab.

No abstract

Background: Ketamine intravenous infusion has been used safely to several chronic pains and it is a good option to refractory chronic headaches. It is a noncompetitive NMDA receptor antagonist that blocks glutamate, responsible for the dissociation between thalamus-neocortical and limbic systems, leading to changes in patients’ pain perception. Due to this theorical mechanism and results in reducing cortical spreading depression, Ketamine has been proposed as a treatment for migraine. Methods: We conducted a retrospective medical chart review study at Hospital Israelita Albert Einstein including three patients. All of them were diagnosed previosly with refractory chronic headache. Results: Of participants included (n = 3), two were woman. The median duration of the disease was 21 years and 12 previous treatment’s failures. All the patients were currently in use of more than 4 preventive drugs. Treatment-emergent response was seen in all patients, requiring 1, 3 and 4 sessions to complete plain remission. They presented good tolerability to the treatment. One patient complained of tinnitus and mild dizziness at the end of the last session, which lasted less than 30 minutes. Conclusion: Ketamine is well tolerated and an effective treatment for patients with refractory chronic headache.