Registro de cefaleia em salvas no Brasil
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Data
2015-12-08
Autores
Ribeiro, Reinaldo Teixeira [UNIFESP]
Orientadores
Peres, Mario Fernando Prieto [UNIFESP]
Tipo
Tese de doutorado
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ISSN da Revista
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Objetivo: Descrever as características demográficas, geográficas, clínicas, sazonais, habituais, históricas, comórbidas, assistenciais e terapêuticas da cefaleia em salvas no Brasil e nas suas macrorregiões. Métodos: Foi desenvolvido um questionário com 40 questões que poderiam ser abertas, dicotômicas e de múltipla escolha, não mutuamente exclusivas. Foram incluídas pessoas a partir de demanda espontânea de qualquer gênero ou idade, residente no Brasil, com critérios diagnósticos de cefaleia em salvas pela segunda edição da Classificação Internacional de Cefaleias, com consentimento esclarecido. 635 pacientes responderam ao questionário impresso sob supervisão e 363 pacientes ao questionário eletrônico autoaplicável via internet, que continha as mesmas questões acrescidas das informações adicionais geralmente solicitadas durante a supervisão. 26 pacientes preencheram os dois questionários e a concordância das respostas obrigatórias foi calculada pelos coeficientes Kappa e de correlação intraclasse. Variáveis com concordância satisfatória seguiram para análise descritiva. Resultados: As principais características da cefaleia em salvas no Brasil são semelhantes àquelas encontradas recentemente em populações ocidentais, como o declínio da preponderância masculina (relação Homem:Mulher de 2,55:1), a prevalência de padrão crônico entre 10 e 20% (13,4%), a lateralidade preferencial a direita (47,6%), localização orbital predominante da dor (87,5%), a alta prevalência de sintomas migranosos (87,5%) como a fotofobia, lacrimejamento como principal fenômeno autonômico (87,8%), a maioria dos pacientes com agitação ou inquietude (74,8%), a duração média da crise superior a 1h (71,6min), predomínio noturno das crise (00-02h com 53,6%), a baixa prevalência de história familiar de cefaleia em salvas (8,2%), o tabagismo (54,6%) e o alcoolismo (58,5%) acima da média do país, a comorbidade com sintomas psiquiátricos (62,7%) e distúrbios do sono (38,4%), e a maioria dos pacientes com relato de tratamento prévio ou atual (84,8%). A idade média de início foi um pouco menor (26,3 anos), como nas populações orientais e a sazonalidade nos solstícios se contrapõe aos equinócios dos demais estudos. A redução ainda maior da preponderância masculina nos pacientes crônicos em algum momento da vida (relação Homem:Mulher de 1,5:1), inclusive com inversão no Centro-Oeste (relação Homem:Mulher de 0,4:1) e no Norte (0,5:1), foi inesperada e aguarda novos estudos para ser confirmada e compreendida. O fato de que alguns pacientes crônicos ciclaram após quase 7 anos de doença, com remissão por cerca de 40 dias, também aguarda confirmação. A maior probabilidade de evolução crônica em pacientes com cores intermediárias dos olhos foi vista pela primeira vez e pode levar a estudos sobre disfunção simpática cervical preexistente. A maioria das características da doença nas macrorregiões brasileiras é semelhante ao encontrado para o Brasil, mas com algumas diferenças que precisam ser assinaladas, como a sazonalidade do Nordeste ter pico principal no inverno ao invés do verão, a lateralidade predominante no Sul ser a esquerda (49,3%), e a periodicidade da dor no Norte apresentar pico noturno mais cedo (21-23h) e outro pico idêntico nas primeiras horas da tarde (12-14h). Destaque para a média brasileira de 7,7 anos de demora para o diagnóstico correto da doença, que ocorre em todos os estudos sobre o tema, e a ocorrência de crises mais prolongadas, com maior área de irradiação, maior frequência de sintomas migranosos e psiquiátricos em mulheres com salvas, condição agravada pelo início mais cedo (24,9 anos) e maior demora para o diagnóstico da doença (11 meses a mais) neste verdadeiro grupo de risco. Conclusões: A maioria das características da cefaleia em salvas no Brasil e nas suas macrorregiões é semelhante ao encontrado na literatura ocidental, as diferenças apontadas podem ocorrer por influência de fatores populacionais e/ou geográficos que demandam novos estudos.
Purpose: To describe the demographical, geographical, clinical, seasonal, habitual, historical, comorbid, assistential and therapeutical characteristics of cluster headache in Brazil and its regions. Methods: A questionnaire was developed with 40 questions, which could be open, dichotomous and multiple choice, not mutually exclusive. People from spontaneous demand were included regardless of gender or age, resident in Brazil, with diagnostic criteria of cluster headache from the second edition of the International Classification of Headache Disorders, with informed consent. 635 patients responded to the paper questionnaire under supervision and 363 patients responded to the self-applied electronic questionnaire via internet, which consisted of the same questions with the summation of additional information usually asked during supervision. 26 patients responded to both questionnaires and the agreement between mandatory answers was calculated by Kappa and intraclass correlation coefficients. Variables with satisfactory agreement were submitted to descriptive analysis. Results: The main characteristics of cluster headache in Brazil are similar to those recently found in western populations, like the decline in male preponderance (Male:Female ratio of 2,55:1), the prevalence of chronic pattern between 10 and 20% (13,4%), the right side laterality preference (47,6%), predominant orbital pain localization (87,5%), the high prevalence of migrainous symptoms (87,5%) like photophobia, lacrimation as the main autonomic phenomenon (87,8%), the majority of patients with restlessness or inquietude (74,8%), the pain average duration superior to 1h (71,6min), nocturnal crisis predominance (00-02h with 53,6%), the low prevalence of familiar history of cluster headache (8,2%), the smoking (54,6%) and alcoholism (58,5%) above country?s average, the comorbidity with psychiatric symptoms (62,7%) and sleep disturbances (38,4%), and the majority of patients mentioning previous or current treatment (84,8%). The average age of onset was a bit lower (26,3 years), like in the eastern populations and the seasonality around solstices opposite to the equinoxes of other studies. The bigger reduction in male preponderance in patients that once were chronic (Male:Female ratio of 1,5:1), including inversion in the Midwest (Male:Female ratio of 0,4:1) and the North regions (0,5:1), was unexpected and demands new studies to be confirmed and understood. The fact that some chronic patients remitted for about 40 days after almost 7 years of disease onset, also demands confirmation. Higher likelihood of chronic evolution among patients with intermediate eye color was seen for the first time and may lead to further studies on preexistent cervical sympathetic dysfunction. The majority of the characteristics of cluster headache in Brazilian regions is similar to what is found in Brazil, but with some differences that must be noted, like the seasonality of the Northern region to have its peak during winter instead of summer, the left side laterality predominance of the South region (49,3%), and the pain periodicity in the North region to have earlier nocturnal peak (21-23h) and another similar peak in the first hours of the afternoon (12-14h). Highlight to the average 7,7 years of diagnostic delay, which occurs in all studies about the topic, and the occurrence of longer attacks, more widespread painful area, higher frequency of migrainous and psychiatric symptoms in women with cluster headache, a condition worsened by earlier onset (24,9 years) and bigger delay to correct diagnosis (additional 11 months) in this truly risk group. Conclusions: The majority of the cluster headache characteristics in Brazil and its regions is similar to what is found in the western literature, and the noted differences may occur influenced by populational and/or geographical factors that demand further studies.
Purpose: To describe the demographical, geographical, clinical, seasonal, habitual, historical, comorbid, assistential and therapeutical characteristics of cluster headache in Brazil and its regions. Methods: A questionnaire was developed with 40 questions, which could be open, dichotomous and multiple choice, not mutually exclusive. People from spontaneous demand were included regardless of gender or age, resident in Brazil, with diagnostic criteria of cluster headache from the second edition of the International Classification of Headache Disorders, with informed consent. 635 patients responded to the paper questionnaire under supervision and 363 patients responded to the self-applied electronic questionnaire via internet, which consisted of the same questions with the summation of additional information usually asked during supervision. 26 patients responded to both questionnaires and the agreement between mandatory answers was calculated by Kappa and intraclass correlation coefficients. Variables with satisfactory agreement were submitted to descriptive analysis. Results: The main characteristics of cluster headache in Brazil are similar to those recently found in western populations, like the decline in male preponderance (Male:Female ratio of 2,55:1), the prevalence of chronic pattern between 10 and 20% (13,4%), the right side laterality preference (47,6%), predominant orbital pain localization (87,5%), the high prevalence of migrainous symptoms (87,5%) like photophobia, lacrimation as the main autonomic phenomenon (87,8%), the majority of patients with restlessness or inquietude (74,8%), the pain average duration superior to 1h (71,6min), nocturnal crisis predominance (00-02h with 53,6%), the low prevalence of familiar history of cluster headache (8,2%), the smoking (54,6%) and alcoholism (58,5%) above country?s average, the comorbidity with psychiatric symptoms (62,7%) and sleep disturbances (38,4%), and the majority of patients mentioning previous or current treatment (84,8%). The average age of onset was a bit lower (26,3 years), like in the eastern populations and the seasonality around solstices opposite to the equinoxes of other studies. The bigger reduction in male preponderance in patients that once were chronic (Male:Female ratio of 1,5:1), including inversion in the Midwest (Male:Female ratio of 0,4:1) and the North regions (0,5:1), was unexpected and demands new studies to be confirmed and understood. The fact that some chronic patients remitted for about 40 days after almost 7 years of disease onset, also demands confirmation. Higher likelihood of chronic evolution among patients with intermediate eye color was seen for the first time and may lead to further studies on preexistent cervical sympathetic dysfunction. The majority of the characteristics of cluster headache in Brazilian regions is similar to what is found in Brazil, but with some differences that must be noted, like the seasonality of the Northern region to have its peak during winter instead of summer, the left side laterality predominance of the South region (49,3%), and the pain periodicity in the North region to have earlier nocturnal peak (21-23h) and another similar peak in the first hours of the afternoon (12-14h). Highlight to the average 7,7 years of diagnostic delay, which occurs in all studies about the topic, and the occurrence of longer attacks, more widespread painful area, higher frequency of migrainous and psychiatric symptoms in women with cluster headache, a condition worsened by earlier onset (24,9 years) and bigger delay to correct diagnosis (additional 11 months) in this truly risk group. Conclusions: The majority of the cluster headache characteristics in Brazil and its regions is similar to what is found in the western literature, and the noted differences may occur influenced by populational and/or geographical factors that demand further studies.
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Citação
RIBEIRO, Reinaldo Teixeira. Registro de cefaleia em salvas no Brasil. 2015. 141 f. Tese (Doutorado em Neurologia - Neurociências) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2015.