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Rethinking triage: enhancing the Manchester Triage System for headache emergencies 重新思考分诊:改进曼彻斯特头痛急诊分诊系统
Pub Date : 2024-07-02 DOI: 10.48208/headachemed.2024.11
Marcelo Moraes Valença, M. Peres
I n the busy and often overcrowded emergency services environment, the Manchester Triage System (MTS) plays a crucial role in saving lives and optimizing care. Initially developed at the Manchester Royal Infirmary in 1997, this innovative system enhances care in emergency departments by ensuring that patients needing immediate attention receive the required priority (1, 2). Since its implementation, the Manchester Triage System has improved workflows and patient safety and set a global standard, being adopted as a standard protocol in numerous hospitals across the UK and beyond (1). Despite its widespread adoption and initial success, recent evaluations and studies suggest that the system might be failing to manage certain critical cases (3, 4), particularly those involving severe headaches such as migraines and cluster headaches. These conditions, often debilitating and intensely painful, require prompt and effective treatment, yet under the current triage protocol, they may not be prioritized appropriately.
在繁忙且经常人满为患的急诊服务环境中,曼彻斯特分诊系统(MTS)在挽救生命和优化护理方面发挥着至关重要的作用。这一创新系统最初于 1997 年在曼彻斯特皇家医院开发,通过确保需要立即救治的病人获得必要的优先权,加强了急诊科的护理工作(1, 2)。自实施以来,曼彻斯特分诊系统改善了工作流程和患者安全,并树立了全球标准,被英国和其他国家的众多医院采纳为标准协议(1)。尽管该系统被广泛采用并取得了初步成功,但最近的评估和研究表明,该系统可能无法处理某些危重病例(3、4),尤其是涉及偏头痛和丛集性头痛等严重头痛的病例。这些病症通常会使人衰弱并伴有剧烈疼痛,需要及时有效的治疗,但在目前的分流方案下,这些病症可能没有得到适当的优先处理。
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引用次数: 0
Profile of hospital admissions for migraine and other headache syndromes in children and adolescents in Brazil between 2013 and 2023 2013 年至 2023 年巴西儿童和青少年因偏头痛和其他头痛综合征入院的概况
Pub Date : 2024-04-01 DOI: 10.48208/headachemed.2024.6
R. Silva-Néto, Bianca Piloni, Luan Almeida
Introduction: Migraine is a chronic neurological disease, with a prevalence of 15.2% in Brazil. It is defined as an abnormal neurovascular reaction that occurs in a genetically vulnerable individual. Clinically manifests itself in recurrent episodes of headache associated with other symptoms, dependent on triggering factors. Objective: To describe the epidemiological profile of hospital admissions of children and adolescents for migraine and other headache disorders. Methods: This was a retrospective and descriptive epidemiological study carried out with data extracted from the Brazilian Unified Health System's Hospital Information System (SIH/SUS), indexed to the Department of Informatics of the Unified Health System (DATASUS). Hospital admissions were selected based on age groups, with an emphasis on children under nine years old and adolescents between 10 and 19 years old, residing in Brazil, between July 2013 and June 2023. Results: Of 93,821 hospital admissions, there were 16,149 hospitalizations (17.2%) of children and adolescents (62.5% women and 37.5% men) due to migraine and other headache disorders. There was a predominance of the age group between 15 and 19 years old (50.2%), with a higher number of cases in the Southeast region (35.9%) and of brown ethnicity (42.6%). Over 10 years, there was a progressive increase in the number of hospital admissions, reaching a peak in 2019 (1,925/16,149; 11.9%), followed by a decline in 2020 and increasing again in subsequent years. Twenty-four deaths were found (24/16,149; 0.1%), 13 men and 11 women, with a predominance in the age group of 15 to 19 years (45.8%), coming from the Northeast region (58.3 %) and of brown ethnicity (58.4%). Deaths occurred predominantly in the years 2022 and 2023 (46.6%). Conclusions: There is an increase in the number of hospital admissions of children and adolescents due to migraine and other headache disorders with a consequent increase in the number of deaths.
简介偏头痛是一种慢性神经系统疾病,在巴西的发病率为 15.2%。它被定义为一种发生在遗传易感人群中的神经血管异常反应。临床表现为反复发作的头痛,并伴有其他症状,取决于诱发因素。目的描述儿童和青少年因偏头痛和其他头痛疾病入院治疗的流行病学概况。方法:这是一项回顾性和描述性研究:这是一项回顾性和描述性流行病学研究,研究数据来自巴西统一卫生系统的医院信息系统(SIH/SUS),并以统一卫生系统信息部(DATASUS)为索引。2013年7月至2023年6月期间,根据年龄组别选择了居住在巴西的9岁以下儿童和10至19岁青少年入院。研究结果在93,821例住院病例中,有16,149例(17.2%)儿童和青少年(62.5%为女性,37.5%为男性)因偏头痛和其他头痛疾病住院。偏头痛患者主要集中在15至19岁年龄段(50.2%),东南部地区(35.9%)和棕色人种(42.6%)的发病率较高。10 年间,入院人数逐渐增加,2019 年达到高峰(1 925/16 149 人;11.9%),2020 年有所下降,随后几年再次上升。共发现 24 例死亡病例(24/16 149;0.1%),其中男性 13 例,女性 11 例,主要集中在 15 至 19 岁年龄段(45.8%),来自东北地区(58.3%)和棕色人种(58.4%)。死亡时间主要集中在 2022 年和 2023 年(46.6%)。结论儿童和青少年因偏头痛和其他头痛疾病入院的人数有所增加,死亡人数也随之增加。
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引用次数: 0
Unlocking Insights: Harnessing AI for Headache Awareness and Understanding 开启洞察力:利用人工智能认识和理解头痛
Pub Date : 2024-04-01 DOI: 10.48208/headachemed.2024.1
M. Peres, Marcelo Moraes Valença, Ricardo Betanho Martins, J. Andrade
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引用次数: 0
Esteja alerta para a possibilidade de cefaleia por uso excessivo de medicamentos 警惕药物过度使用导致头痛的可能性
Pub Date : 2023-07-21 DOI: 10.48208/headachemed.2023.15
Renata Gomes Londero
Afetando 1-2% da população mundial e representado até 40% dos pacientes em serviços especializados em cefaleia, a cefaleia por uso excessivo de medicamentos segue um desafio. Iniciando pela necessidade de conscientizar os profissionais desde a atenção básica, passando pela educação do paciente e finalizando pelo adequado (e de sucesso) manejo, ainda há muito o que fazer na área. Esta revisão da literatura, busca alertar não apenas para a importância do reconhecimento da condição mas principalmente trazer o que há de mais recente no melhor manejo dos pacientes que padecem com dores mais de 14 dias por mês e que ainda vêem os analgésicos como única forma de tratamento.
药物滥用性头痛影响着全球1%-2%的人口,占头痛专科患者的40%,仍然是一项挑战。从提高初级保健专业人员的认识开始,到患者教育,再到适当(成功)的管理,这一领域仍有许多工作要做。这篇文献综述不仅旨在提高人们对认识头痛的重要性的认识,更重要的是为每月疼痛超过 14 天且仍将镇痛药视为唯一治疗方式的患者提供最佳治疗方法的最新进展。
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引用次数: 0
Propranolol: A migraine prophylactic since the 1960s 心得安:自20世纪60年代以来一直是偏头痛的预防药物
Pub Date : 2023-03-31 DOI: 10.48208/headachemed.2023.2
Wallyson Pablo de Oliveira Souza, Yasmine Maria Leódido Fortes, A. Soares, R. Silva-Néto
IntroductionPropranolol was the first non-selective beta-adrenergic blocker to be developed. Initially it was used in the treatment of cardiovascular diseases, but since the 60's it has been used in the prevention of migraine.ObjectiveThe objective of this study was to know the history of propranolol and its use as a migraine prophylactic.MethodsThis study was an integrative literature review using articles with historical data on propranolol, from its origin in cardiology to its indication in the preventive treatment of migraine.ResultsPropranolol was described in 1962 for the treatment of cardiovascular diseases. In the same decade, it was prescribed for the preventive treatment of migraine and, recently, included in the consensus of the Brazilian Headache Society.ConclusionAlthough propranolol was initially synthesized for the treatment of heart disease, it has proved to be an effective drug in preventing migraine attacks.
心得安是第一个被开发的非选择性β -肾上腺素能阻滞剂。最初,它被用于治疗心血管疾病,但自60年代以来,它已被用于预防偏头痛。目的了解普萘洛尔的历史及其作为偏头痛预防药物的应用。方法:本研究是一项综合文献综述,包括有关心得安的历史资料,从其心脏病学起源到其在偏头痛预防治疗中的适应症。结果心得安于1962年首次用于心血管疾病的治疗。在同一十年中,它被用于偏头痛的预防性治疗,最近被纳入巴西头痛学会的共识。结论心得安最初是为了治疗心脏病而合成的,但它已被证明是一种预防偏头痛发作的有效药物。
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引用次数: 1
Does running reduce the frequency and intensity of migraine attacks? A systematic review with meta-analysis 跑步能减少偏头痛发作的频率和强度吗?荟萃分析的系统综述
Pub Date : 2023-03-31 DOI: 10.48208/headachemed.2023.5
Claudia Baptista Tavares, D. A. D. Oliveira, Manuella Moraes Monteiro Barbosa Barros, J. Souza, P. M. Moreira Filho
IntroductionMigraine is a complex headache to treat, often with an unsatisfactory clinical response. Aerobic exercise, such as running, can be a non-pharmacological treatment to reduce migraine attacks.ObjectiveThis systematic review with meta-analysis investigated the effects of running on frequency and intensity of pain in subjects with migraine compared with other or no aerobic exercise.MethodsRandomized and quasi-randomized clinical trials were searched between September and November 2021 in BVS, PubMed, Cochrane, CINAHL, SCOPUS, Embase, and Web of Science databases. The Cochrane Risk of Bias tool assessed methodological quality, and the recommendation ranking assessed the certainty of evidence. The frequency of migraine attacks was pooled in a meta-analysis (random effects) that included interval and continuous running subgroups.ConclusionThe results were not sufficient to recommend running as a treatment to reduce the frequency and intensity of migraine attacks.
偏头痛是一种复杂的头痛治疗,往往有不满意的临床反应。有氧运动,如跑步,可以是一种减少偏头痛发作的非药物治疗方法。目的本系统综述结合荟萃分析探讨了与其他或无有氧运动相比,跑步对偏头痛患者疼痛频率和强度的影响。方法于2021年9月至11月在BVS、PubMed、Cochrane、CINAHL、SCOPUS、Embase和Web of Science数据库中检索随机和准随机临床试验。Cochrane偏倚风险工具评估方法学质量,推荐排序评估证据的确定性。偏头痛发作的频率汇总在一项荟萃分析中(随机效应),其中包括间歇和连续跑步亚组。结论本研究结果不足以推荐将跑步作为一种减少偏头痛发作频率和强度的治疗方法。
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引用次数: 0
Presence of mast cells in the rat pericranium – a tissue very sensitive to pain 大鼠的甲壳中存在肥大细胞,这是一种对疼痛非常敏感的组织
Pub Date : 2023-03-31 DOI: 10.48208/headachemed.2023.13
R. Reis, Regina Lúcia Gomes Botter, M. Ferreira, S. L. Souza, J. Andrade, S. L. T. Christensen, M. Valença
ObjectiveTo evaluate mast cell presence in the pericranium of Wistar rats.MethodsFive male rats of the Wistar strain were used. The animals were housed under a 12 h light cycle with ad libitum access to food and water and allowed 10 days of acclimatization before tissue sampling. The five rats were anesthetized by intraperitoneal injection of ketamine/xylazine, 10/20 mg/kg. Following aseptic preparation of the head skin, a midline longitudinal incision was made to expose the pericranium. Two samples of the pericranium were taken, one from the right and one from the left. These samples were fixed in 10% buffered formaldehyde for 24 h. After fixation, tissue samples were paraffin-embedded and sectioned at 4 μm. Then, slides were deparaffinized, stained with a concentration of 0.1% toluidine blue for 1 min, and washed with distilled water. Last, slides were photomicrographed under 400x magnification to identify mast cells.ResultsMast cells were identified in the dura mater and the five rats' pericranium. In the dura mater, mast cells were also found in these rats. We found both granulated (intact) and degranulated mast cells.ConclusionWe suggest that future preclinical studies investigating the involvement of dural mast cells and other meningeal cell populations should also include pericranium samples to explore this structure's relevance in migraine pain and other headache disorders.
目的评价Wistar大鼠颅骨中肥大细胞的存在。方法选用Wistar株雄性大鼠5只。动物在光照周期12 h下自由进食和饮水,并在组织取样前进行10天的环境适应。5只大鼠采用氯胺酮/噻嗪10/ 20mg /kg腹腔注射麻醉。头部皮肤无菌准备后,做一个中线纵向切口以暴露包皮。他们取了两个头骨样本,一个从右边取,一个从左边取。在10%的缓冲甲醛中固定24 h。固定后,组织样品石蜡包埋,在4 μm处切片。然后将载玻片脱蜡,用浓度为0.1%的甲苯胺蓝染色1分钟,用蒸馏水洗涤。最后,在400倍放大镜下对载玻片进行显微照相以鉴定肥大细胞。结果在硬脑膜和5只大鼠的脑壳中均检测到细胞。在这些大鼠的硬脑膜中也发现了肥大细胞。我们发现颗粒状(完整的)和脱颗粒状肥大细胞。结论:我们建议未来的临床前研究应该包括硬脑膜肥大细胞和其他脑膜细胞群的参与,以探索这种结构在偏头痛和其他头痛疾病中的相关性。
{"title":"Presence of mast cells in the rat pericranium – a tissue very sensitive to pain","authors":"R. Reis, Regina Lúcia Gomes Botter, M. Ferreira, S. L. Souza, J. Andrade, S. L. T. Christensen, M. Valença","doi":"10.48208/headachemed.2023.13","DOIUrl":"https://doi.org/10.48208/headachemed.2023.13","url":null,"abstract":"ObjectiveTo evaluate mast cell presence in the pericranium of Wistar rats.MethodsFive male rats of the Wistar strain were used. The animals were housed under a 12 h light cycle with ad libitum access to food and water and allowed 10 days of acclimatization before tissue sampling. The five rats were anesthetized by intraperitoneal injection of ketamine/xylazine, 10/20 mg/kg. Following aseptic preparation of the head skin, a midline longitudinal incision was made to expose the pericranium. Two samples of the pericranium were taken, one from the right and one from the left. These samples were fixed in 10% buffered formaldehyde for 24 h. After fixation, tissue samples were paraffin-embedded and sectioned at 4 μm. Then, slides were deparaffinized, stained with a concentration of 0.1% toluidine blue for 1 min, and washed with distilled water. Last, slides were photomicrographed under 400x magnification to identify mast cells.ResultsMast cells were identified in the dura mater and the five rats' pericranium. In the dura mater, mast cells were also found in these rats. We found both granulated (intact) and degranulated mast cells.ConclusionWe suggest that future preclinical studies investigating the involvement of dural mast cells and other meningeal cell populations should also include pericranium samples to explore this structure's relevance in migraine pain and other headache disorders.","PeriodicalId":12925,"journal":{"name":"Headache Medicine","volume":"180 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81809028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Headache changes in individuals with migraine post-Covid-19: general characteristics of the acute phase and worsening of the migraine pattern 新冠肺炎后偏头痛患者的头痛变化:急性期的一般特征和偏头痛模式的恶化
Pub Date : 2023-03-31 DOI: 10.48208/headachemed.2023.8
Aline Vitali da Silva, Marianne Klock Peçanha, Amanda Pasquini de Freitas, V. A. Bello, Regina Célia Poli
IntroductionThe aim of this study was to investigate how infection with SARS-CoV-2 affected headache in individuals with migraine, and to identify characteristics associated with a worsening of the migraine post COVID-19.MethodsObservational study composed of 157 individuals with migraine and who had been infected with the SARS-CoV-2 virus. They were recruited from the database of the headache research group at the Pontifical Catholic University of Paraná. The participants responded online to questions about their anthropometric data, history of infection with SARS-CoV-2, presence and characteristics of the headache in the acute phase, perception of a worsening of the migraine after infection, use of analgesics and prophylactic migraine medication. Validated digital questionnaires were used: Migraine Disability Assessment (MIDAS), Beck Depression Inventory (BDI) and Allodynia Symptom Checklist (ASC-12). The results of these questionnaires were compared to values previously recorded in the database, this information having been obtained prior to the infection with COVID-19.ConclusionIndividuals who notice a worsening in migraine post-COVID-19 have a more severe migraine condition prior to infection, have more prominent headache during the acute phase and, subsequently, present with greater disability.
本研究的目的是调查感染SARS-CoV-2如何影响偏头痛患者的头痛,并确定与COVID-19后偏头痛恶化相关的特征。方法对157例已感染SARS-CoV-2病毒的偏头痛患者进行观察性研究。他们是从帕拉parantifical Catholic大学头痛研究小组的数据库中招募的。参与者在网上回答了有关他们的人体测量数据、SARS-CoV-2感染史、急性期头痛的存在和特征、感染后偏头痛恶化的感觉、镇痛药和预防性偏头痛药物的使用等问题。使用经过验证的数字问卷:偏头痛残疾评估(MIDAS)、贝克抑郁量表(BDI)和异常性疼痛症状检查表(ASC-12)。将这些问卷的结果与数据库中先前记录的值进行比较,这些信息是在感染COVID-19之前获得的。发现新冠肺炎后偏头痛恶化的个体在感染前偏头痛病情更严重,在急性期头痛更突出,随后出现更大的残疾。
{"title":"Headache changes in individuals with migraine post-Covid-19: general characteristics of the acute phase and worsening of the migraine pattern","authors":"Aline Vitali da Silva, Marianne Klock Peçanha, Amanda Pasquini de Freitas, V. A. Bello, Regina Célia Poli","doi":"10.48208/headachemed.2023.8","DOIUrl":"https://doi.org/10.48208/headachemed.2023.8","url":null,"abstract":"IntroductionThe aim of this study was to investigate how infection with SARS-CoV-2 affected headache in individuals with migraine, and to identify characteristics associated with a worsening of the migraine post COVID-19.MethodsObservational study composed of 157 individuals with migraine and who had been infected with the SARS-CoV-2 virus. They were recruited from the database of the headache research group at the Pontifical Catholic University of Paraná. The participants responded online to questions about their anthropometric data, history of infection with SARS-CoV-2, presence and characteristics of the headache in the acute phase, perception of a worsening of the migraine after infection, use of analgesics and prophylactic migraine medication. Validated digital questionnaires were used: Migraine Disability Assessment (MIDAS), Beck Depression Inventory (BDI) and Allodynia Symptom Checklist (ASC-12). The results of these questionnaires were compared to values previously recorded in the database, this information having been obtained prior to the infection with COVID-19.ConclusionIndividuals who notice a worsening in migraine post-COVID-19 have a more severe migraine condition prior to infection, have more prominent headache during the acute phase and, subsequently, present with greater disability.","PeriodicalId":12925,"journal":{"name":"Headache Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89487294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Association between attention deficit hyperactivity disorder (ADHD) and migraine: a review of observational studies 注意缺陷多动障碍(ADHD)与偏头痛之间的关系:观察性研究综述
Pub Date : 2023-03-31 DOI: 10.48208/headachemed.2023.4
Henry Martins Soares Fortes, Clênia Leite Andrade
IntroductionAttention deficit hyperactivity disorder (ADHD) has been related to the presence of primary headaches. Among them, migraine presents a wide range of comorbidities shared with  ADHD, both from other psychiatric disorders and  somatic conditions.ObjectiveThis review proposes to describe the association between ADHD and migraine.MethodsBased on literature research in the major medical databases and using as descriptors “Migraine Disorders” and “Attention Deficit Disorder with Hyperactivity”. Observational studies that addressed the relationship between migraine and ADHD and written only in English were included. Of the 49 articles found, only 6 met the inclusion criteria and were analyzed.ConclusionThis review shows a possible sharing of symptoms between migraine and ADHD, requiring further studies to investigate this relationship.
注意缺陷多动障碍(ADHD)与原发性头痛有关。其中,偏头痛表现出与ADHD共有的广泛合并症,包括其他精神疾病和躯体疾病。目的探讨ADHD与偏头痛之间的关系。方法在主要医学数据库中查阅文献,以“偏头痛”和“注意缺陷多动障碍”作为描述词。研究偏头痛和注意力缺陷多动障碍之间关系的观察性研究仅以英文撰写。在发现的49篇文章中,只有6篇符合纳入标准并进行了分析。结论:本综述显示偏头痛和ADHD之间可能存在相同的症状,需要进一步研究这种关系。
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引用次数: 0
The effectiveness and safety of cranial nerve block in migraine: a critical review 颅神经阻滞治疗偏头痛的有效性和安全性:综述
Pub Date : 2023-03-31 DOI: 10.48208/headachemed.2023.3
Anne Lee, R. Domingues
Cranial nerve blocks (CNBs) have been used for the acute and preventive treatment of a variety of headaches, including migraine. The effectiveness of CNBs in migraine is usually observed beyond the duration of the nerve block, possibly due to central pain modulation. The most used target is the greater occipital nerve. Other commonly targeted nerves are the lesser occipital nerve and various branches of the trigeminal nerve, including the supratrochlear, supraorbital, and auriculotemporal nerves. CNBs are generally safe and well-tolerated procedures that can be performed in either emergency or outpatient settings. There is currently no guideline standardizing CNBs in migraine. In clinical practice, as well as the few published studies, the results are encouraging, justifying further studies in the area. In the present study we critically review the literature about the safety and efficacy of CNBs in the treatment of migraine attacks and in the preventive treatment of migraine.
颅神经阻滞(CNBs)已被用于各种头痛的急性和预防性治疗,包括偏头痛。CNBs治疗偏头痛的有效性通常超过神经阻滞的持续时间,可能是由于中枢性疼痛调节。最常用的目标是枕大神经。其他常见的目标神经是枕小神经和三叉神经的各种分支,包括滑车上神经、眶上神经和耳颞神经。CNBs通常是安全且耐受性良好的手术,可在急诊或门诊环境中进行。目前还没有标准的偏头痛CNBs指南。在临床实践和少数已发表的研究中,结果令人鼓舞,证明该领域的进一步研究是合理的。在本研究中,我们批判性地回顾了有关CNBs治疗偏头痛发作和偏头痛预防治疗的安全性和有效性的文献。
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引用次数: 0
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Headache Medicine
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