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Enxaqueca na criança : reavaliação 24 anos após o diagnóstico inicial
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Resumo(s)
Apesar da elevada prevalência e impacto socioeconómico da enxaqueca, o seu prognóstico a longo prazo ainda não foi claramente descrito. O presente estudo propõe-se a reavaliar um grupo de 66 crianças e adolescentes de uma coorte inicial de 84, diagnosticados com enxaqueca com e sem aura de acordo com os critérios ICHD- -II, no ano de 1994. Os dois principais objetivos são: compreender a história natural da enxaqueca e identificar fatores preditores de uma evolução clínica favorável ou desfavorável. Os dados foram colhidos através de uma entrevista telefónica padronizada. O diagnóstico foi feito com base na versão portuguesa de ID-MigraineTM. A análise descritiva e estatística foi realizada recorrendo à ferramenta IBM Statistics 24, ao “chi-test” e ao “Fisher-test”. O seguimento foi conseguido em 41 dos 66 doentes. No ano de 2018, 39% manteve o diagnóstico, 36,6% remitiu por completo e 24,4% sofreu uma alteração do diagnóstico. 73% dos doentes com enxaqueca referiu uma melhoria. Os métodos mais utilizados foram a analgesia não prescrita e a evitação de fatores precipitantes. A maioria das mulheres deste grupo refere uma associação entre as crises de enxaqueca e o período menstrual, gravidez e amamentação. De todos os parâmetros estudados, apenas a história familiar e o sexo feminino foram preditores de uma evolução clínica desfavorável, apesar de nenhum apresentar significância estatística: p=0.049 e p=0.067, respetivamente. Cerca de 24 anos após o diagnóstico inicial, apesar de uma tendência para a enxaqueca melhorar, a maioria dos doentes continua a sofrer de cefaleias na idade adulta. O tratamento de eleição observado sugere que a melhor abordagem a longo prazo é educar a criança desde cedo, encorajando-a a evitar os seus fatores precipitantes. A utilização regular de profilaxia não alterou a evolução das queixas. Parece existir um papel importante dos fatores genéticos e hormonais na fisiopatologia desta entidade.
Despite the high prevalence, as well as the socioeconomic impact of migraine in the paediatric populations, its long-term prognosis has not been clearly established. This study intents to evaluate the long-term prognosis of childhood migraines 24 years after initial diagnosis in a cohort of Portuguese children who had been diagnosed with migraine in 1994 by one of the authors. (i) to outline the natural history of migraine in childhood, and (ii) to identify early predictors of a favorable or unfavorable clinical evolution are our main objectives. 41 of the 66 children with migraine who attended the baseline examination, were, eligible for follow-up. Data were collected using a standardized telephone interview. Migraine diagnose were based on the Portuguese version of the ID-Migraine scale. Data analysis was performed by IBM Statistics 24, “chi-test” and “Fisher-test”. Follow-up was achieved for 41of 66 patients. In 2018, of the 41 subjects, 39 % had persistent migraine, 36.6 % had experienced remission, and 24.4% transformed to another headache subtype. 73% of the subjects with persistent migraine reported an improvement. The most commonly used intervention was nonprescription analgesia and precipitant avoidance. The majority of women of this group refers an association between the migraine crisis and the menstrual period, pregnancy and breastfeeding. Off all parameters investigated, only this the family history and the female sex were predictors of an unfavorable clinical evolution although none of them were statistically significant: p=0.049 and p=0.067, respectively. Twenty-four years after diagnosis of pediatric headache, most patients continue to have headache despite reporting an improvement. Encouraging children early to manage their headaches with simple analgesia and precipitant avoidance appears to have long-term benefits. The regular use of prophylactic medication did not alter the long-term prognosis. Both genetics and hormonal factors seems to play an important role in the pathology of the disease.
Despite the high prevalence, as well as the socioeconomic impact of migraine in the paediatric populations, its long-term prognosis has not been clearly established. This study intents to evaluate the long-term prognosis of childhood migraines 24 years after initial diagnosis in a cohort of Portuguese children who had been diagnosed with migraine in 1994 by one of the authors. (i) to outline the natural history of migraine in childhood, and (ii) to identify early predictors of a favorable or unfavorable clinical evolution are our main objectives. 41 of the 66 children with migraine who attended the baseline examination, were, eligible for follow-up. Data were collected using a standardized telephone interview. Migraine diagnose were based on the Portuguese version of the ID-Migraine scale. Data analysis was performed by IBM Statistics 24, “chi-test” and “Fisher-test”. Follow-up was achieved for 41of 66 patients. In 2018, of the 41 subjects, 39 % had persistent migraine, 36.6 % had experienced remission, and 24.4% transformed to another headache subtype. 73% of the subjects with persistent migraine reported an improvement. The most commonly used intervention was nonprescription analgesia and precipitant avoidance. The majority of women of this group refers an association between the migraine crisis and the menstrual period, pregnancy and breastfeeding. Off all parameters investigated, only this the family history and the female sex were predictors of an unfavorable clinical evolution although none of them were statistically significant: p=0.049 and p=0.067, respectively. Twenty-four years after diagnosis of pediatric headache, most patients continue to have headache despite reporting an improvement. Encouraging children early to manage their headaches with simple analgesia and precipitant avoidance appears to have long-term benefits. The regular use of prophylactic medication did not alter the long-term prognosis. Both genetics and hormonal factors seems to play an important role in the pathology of the disease.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2019
Palavras-chave
Enxaqueca Evolução clínica Fatores de prognóstico Pediatria