No abstract

HC should be considered among the diagnostic hypotheses of patients with continuous headache, with no change in neurological examination and additional tests, regardless the age of onset. The standard treatment with indomethacin (100-150mg.day(-1)) has significant risks associated with both short and long term use and may not be a good choice for continuous use. Recent studies point out possible alternatives: gabapentin, topiramate, cyclooxygenase-2 inhibitors, piroxicam, beta-cyclodextrin, amitriptyline, melatonin. Other drugs were described in different reports as efficient, but most of them were considered inefficient in other HC cases.

BACKGROUND AND OBJECTIVES: Headache is a very prevalent symptom, being considered the second more frequent type of pain by international epidemiological studies. It is also an expensive symptom for patients, relatives, society and general health systems, impairing quality of life of those suffering from this problem. Primary headaches, among them migraine and tension headache are classified as dysfunctional headaches. It is important to understand why these two disorders cannot be seen as somatic, neuropathic or visceral pain. This article shall use the terms migraine and megrim as synonyms. This study aimed at defining dysfunctional pain and at justifying why primary headaches are considered dysfunctional pain. CONTENTS: a) Migraine pathophysiology, most prevalent primary headache in medical offices, it is explained as a disease made up of crises which may have up to five phases and not simply as a headache. Migraine crisis phases are: premonitory symptoms, aura, headache, autonomic/hypothalamic symptoms and posdrome. b) Classify migraine as dysfunctional pain because it does not meet criteria to be classified as neuropathic or somatic pain. c) Discuss which type of pain secondary headaches are. CONCLUSION: It is possible to accept the idea that primary headaches are demodulatory pains, but that secondary headaches are nociceptive or visceral.

Artigo de revisão Resumo O objetivo desta revisão é juntar dados atualizados da literatura sobre a prevalente associação entre vertigem e migrânea. Vertigem e migrânea são muito prevalentes na população em geral. Então podemos imaginar que seria grande a chance de coexistirem em um mesmo paciente. Vertigem tem uma prevalência ao longo da vida de 7% e migrânea de 16%. A chance de coexistirem ao acaso seria de 1,1%, porém um estudo mostrou que, na verdade, essa coexistência é de 3,2%. Isso mostra que há uma íntima relação entre vertigem e migrânea, estando associadas em diversas patologias, como vertigem posicional paroxística benigna, cinetose, doença de Meniere, vertigem paroxística benigna da infância, migrânea vestibular, entre outras. Vamos abordar cada assunto discutindo tópicos como epidemiologia, clínica, critérios diagnósticos disponíveis e atualizados. Ainda há muito que se estudar em vertigem e migrânea, principalmente em ciência básica, como mecanismos fisiopatológicos para se descobrir etiologia, opções para tratamento e muitos outros mistérios.