Fatores associados ao uso excessivo de medicação sintomática em enxaqueca crônica
Arquivos
Data
2007
Autores
Zukerman-Guendler, Vera 
Orientadores
Peres, Mario Fernando Prieto
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução. A enxaqueca cronica e frequente nas unidades de Saúde, embora permaneca sem diagnostico suficientemente preciso nas fases iniciais do problema. Varios sao os fatores que a causam, perpetuam ou exacerbam. O uso excessivo de medicacoes sintomaticas constitui um fator agravante, assim como a presenca de comorbidades psiquiatricas, que podem ser apontados como importantes causas da transformacao de enxaqueca episodica em enxaqueca cronica. Pouco se sabe, no entanto, sobre a relacao do uso excessivo de medicacao sintomatica e das comorbidades psiquiatricas com os portadores de enxaqueca cronica. Ha debate na literatura sobre a influencia do uso excessivo de medicacoes como fator isolado na cronificacao da enxaqueca. Nossa hipotese e de que o diagnostico psiquiatrico seja o fator subjacente ao uso excessivo de medicacao sintomatica. Objetivo. Estudar a relacao entre o diagnostico psiquiatrico em enxaqueca cronica e o uso excessivo de medicacao sintomatica. Metodos. No presente estudo, avaliamos a prevalencia de transtornos psiquiatricos em 72 pacientes com diagnostico de enxaqueca cronica com e sem uso excessivo de medicacao sintomatica, diagnosticados de acordo com os criterios da Sociedade Internacional das Cefaleias (IHS-2004/2006) e ,atraves do Manual de Diagnostico e Estatistica SCID I/P - de Disturbios Mentais, 4a ed. (DSM-V) e pela Mini-International Neuropsychiatric Interview (MINI-PLUS). A gravidade dos sintomas ansiosos foi avaliada pela Escala de ansiedade de Hamilton e Escala de ansiedade de Spielberg-Idate (estado-traco). Os sintomas depressivos foram avaliados pelo Inventario de depressao de Beck e pela Escala de depressao de Hamilton. Todos os pacientes foram submetidos ao questionario generico para avaliar qualidade de vida, Medical Outcome Study 36 Item Short-form Health Survey, SF-36, e pela Migraine Disability Assessment Scale(MIDAS), com a finalidade se verificar a incapacidade gerada pelas crises. Resultados. Dos 72 pacientes, 50 (69 por cento) eram portadores de enxaqueca cronica com uso excessivo de medicacoes sintomaticas e 22 (31 por cento) nao apresentavam uso excessivo. Idade, sexo, anos de escolaridade e indice de massa corporal, tipo de medicacao, caracteristicas da cefaleia e uso de cafeina nao foram fatores com diferencas estatisticamente significantes para distinguir os que usam medicacao analgesica excessivamente daqueles sem uso abusivo. Por outro lado, o diagnostico de transtorno de ansiedade e de transtorno do humor ao longo da vida foram estatisticamente significantes (p=O,OO3, p=0,045, respectivamente). Conclusoes. O diagnostico de transtorno de ansiedade e de humor e fator importante no tratamento de pacientes com enxaqueca cronica com uso excessivo de medicacao sintomatica, e a analise das comorbidades psiquiatricas deve influenciar na assistencia a esses pacientes. Medidas preventivas para tratamento de ansiedade e depressao podem ser preconizadas, para que se evite o uso excessivo de medicacao sintomatica
Introduction. Chronic Migraine is a common condition in many health care settings, but with significant under-diagnosis and under-treatment. Several factors are associated with the transformation of episodic migraine into chronic migraine. Acute medication overuse and psychiatric comorbidity are attributed to be the most important among these factors. There is still a debate regarding the role of acute medication overuse as an isolated factor in the establishing of chronic migraine. Our hypothesis is that migraine psychiatric comorbidity is the underlying condition that leads episodic migraine to chronic migraine through acute medication overuse. Objective. To study the relationship between psychiatric comorbidity and acute medication overuse in chronic migraine. Methods. In the present study, we have evaluated the lifetime prevalence of psychiatric disorders in 72 patients diagnosed with chronic migraine with and without acute medication overuse, according to the International Classification for Headache Disorders (2004-2006) and the structured interviews for the diagnosis of mental disorders DSM-IV (SCID I/P) and MINI-PLUS. Anxiety severity was assessed by the Hamilton Anxiety Scale and the Spielberg- Idate Scale. Depressive symptoms were assessed by the Beck Depression Inventory and the Hamilton Depression Scale. All patients had the Medical Outcome Study 36 Item Short-form Health Survey, SF-36, and “Migraine Disability Assessment Scale”, MIDAS scores filled out. Results. From 72 patients, 50 (69%) had chronic migraine with acute medication overuse and 22 (31%) had chronic migraine without acute medication overuse. Age, gender, education level, body mass index, acute medication type, headache type and caffeine consumption were not significantly different in the two groups studied. Lifetime anxiety and mood disorders were significantly more common in patients with acute medication overuse (p=0,003, p=0,045, respectively). Conclusions. The diagnosis of anxiety and mood disorders is an important factor for the treatment of patients with chronic migraine associated with analgesic overuse. The analysis of the psychiatric comorbidities should have an important role in this patients’ medical care. Preventive measures targeting mood and anxiety disorders should be used in the management of chronic migraine associated with acute medication overuse.
Introduction. Chronic Migraine is a common condition in many health care settings, but with significant under-diagnosis and under-treatment. Several factors are associated with the transformation of episodic migraine into chronic migraine. Acute medication overuse and psychiatric comorbidity are attributed to be the most important among these factors. There is still a debate regarding the role of acute medication overuse as an isolated factor in the establishing of chronic migraine. Our hypothesis is that migraine psychiatric comorbidity is the underlying condition that leads episodic migraine to chronic migraine through acute medication overuse. Objective. To study the relationship between psychiatric comorbidity and acute medication overuse in chronic migraine. Methods. In the present study, we have evaluated the lifetime prevalence of psychiatric disorders in 72 patients diagnosed with chronic migraine with and without acute medication overuse, according to the International Classification for Headache Disorders (2004-2006) and the structured interviews for the diagnosis of mental disorders DSM-IV (SCID I/P) and MINI-PLUS. Anxiety severity was assessed by the Hamilton Anxiety Scale and the Spielberg- Idate Scale. Depressive symptoms were assessed by the Beck Depression Inventory and the Hamilton Depression Scale. All patients had the Medical Outcome Study 36 Item Short-form Health Survey, SF-36, and “Migraine Disability Assessment Scale”, MIDAS scores filled out. Results. From 72 patients, 50 (69%) had chronic migraine with acute medication overuse and 22 (31%) had chronic migraine without acute medication overuse. Age, gender, education level, body mass index, acute medication type, headache type and caffeine consumption were not significantly different in the two groups studied. Lifetime anxiety and mood disorders were significantly more common in patients with acute medication overuse (p=0,003, p=0,045, respectively). Conclusions. The diagnosis of anxiety and mood disorders is an important factor for the treatment of patients with chronic migraine associated with analgesic overuse. The analysis of the psychiatric comorbidities should have an important role in this patients’ medical care. Preventive measures targeting mood and anxiety disorders should be used in the management of chronic migraine associated with acute medication overuse.
Descrição
Citação
ZUKERMAN-GUENDLER, Vera. Fatores associados ao uso excessivo de medicação sintomática em enxaqueca crônica. 2007. 96 f. Dissertação (Mestrado em Ciências) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2007.