Introduction Migraine is a chronic disease and affects about 15% of the World population. It is the second most disabling disease among young adults. Pathophysiology has not yet been fully clarified, but there is evidence for genetic alterations that cause a state of hyperexcitability and metabolic alterations that make the central nervous system more susceptible to external stimuli. Objective To present the evolution of a diagnosis of headache with aura treated with drugs and the results obtained. Methods Data collected through complete anamnesis.  Results/Case report Woman, 26 years old, student, white, with hypothyroidism, denies smoking and alcohol consumption. Reports practicing physical activity and maintaining a healthy diet. Complains of headache for 9 years, with increased intensity and frequency. At the age of 18, period of onset of pain, frequency was every 10-15 days, with a maximum duration of one day and visual changes. She was using oral contraceptive pill (OCP) and dipyrone, without neurological consultation. At the age of 20, the use of OCP ceased, with worsening of the frequency and intensity of pain, the patient sought specialized medical care. Neurologist diagnosed migraine with aura triggered by stress. As treatment, he prescribed 50 mg/day of topiramate divided into two doses and alprazolam 0.5 mg, with return in 60 days. Reports no improvement and there was an increase in topiramate dosage to 100 mg and alprazolam dosage to 1 mg/day. There was relative improvement for an approximate period of 4 months. Patient returned to daily pain, with episodes of throbbing pain, with exacerbated photo and phonophobia, need for hospital care twice a month and beginning of concentration problems. In hospital care, reports having received tramal, profenid and dramin.  (To see the complet abstract, please, check out the PDF.)

O diagnóstico da COVID-19 possui diferentes testes para sua confirmação. O teste padrão-ouro é o de reação da transcriptase reversa seguida pela reação da cadeia da polimerase (RT-PCR) para SARS-CoV-2, através da coleta de swab nasofaríngeo. Esse teste pode apresentar algumas complicações que merecem discussão na literatura, com destaque para a perfuração de ossos da base do crânio com evolução clínica de fístula liquórica iatrogênica. O objetivo deste estudo é relatar um caso de fístula liquórica iatrogênica diagnosticada com base na história, decorrente de swab nasofaríngeo para pesquisa de SARS-CoV-2 em paciente sem história pregressa de anomalias anatômicas de base de crânio. O desfecho do caso foi cirúrgico, sendo realizada septoplastia e sinusotomia etmoidal e esfenoidal à esquerda. Diante disso, nota-se a necessidade de instrução dos profissionais de saúde especialmente quanto a realização correta do teste, bem como da relevância da história pregressa do paciente no que tange a condições neurológicas e otorrinolaringológicas prévias, a fim de evitar a iatrogenia e possíveis complicações.

Introduction Migraine is a chronic disease that affects about 15% of world's population. It is the most disabling disease among men and women under 50 years. Studies indicate that the caffeine, which is the most consumed stimulating in the world and present on the daily diet, can be related to the migraine in an ambiguous way. ObjectiveConsidering the epidemiologic and economic point of view, the disease phisiopatology and the accessibility to caffeine, this study aims to understand if there would be a safe minimum dosage of caffeine for patients with migraine. MethodsThe words "migraine" and "caffeine" were searched in July 2022 at PUBMED and BVS with predetermined filters and selection of publication in qualis journals A1 and A2. 13 articles were found for this revision. ResultsCaffeine's effects on the nervous system and its relation with headaches have been target of several studies, mainly for producing symptoms similars to the prodromic phase of migraine e for the existence of the Caffeine Abstinence Syndrome, known as a diagnostic entity by the International Migraine Classification. The sensory hypersensitivity (migraine's characteristic) does not appear at the abstinence syndrome. The lack of information about pre-existing headache at studies shows a gap in the parameter ''caffeine withdrawal as a trigger per se''. It is possible that premonitory symptoms such as yawns, low energy and sleepiness can lead to caffeine intake, bringing forth the wrong idea that it has initiated the migraine.Caffeine, however, induces urinary magnesium loss, reducing its reabsorption. As magnesium affects neuromuscular conduction, nerve transmission and is beneficial in chronic pain conditions and migraines, caffeine, by decreasing magnesium level, can induce headache. Additionally, caffeine contains thiaminases, enzymes that degrade thiamine, which may have protective potential in migraine.  (To see the complete abstract, please, check out the PDF).