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Cefaleia em salvas: aspectos clinicos e terapeuticos em 26 casos

Cluster headache: clinical and therapeutic aspects in 26 cases

Resumos

Vinte e seis casos de cefaléia-em-salvas são estudados do ponto de vista clínico e terapêutico. Nos aspectos clínicos são ressaltados a dramaticidade deste tipo de cefaléia, o nítido predomínio no sexo masculino, a média de idade dos pacientes, a presença de manifestações associadas e os fatores desencadeantes das crises nos períodos suscetíveis. Do ponto de vista terapêutico três esquemas medicamentosos foram utilizados: maleato de metisergida, prednisona e associação de ambas as drogas. Em 88,3% dos casos um resultado significativo foi alcançado, traduzido por melhora ou abolição das crises.


The clinical and therapeutic aspects in 26 patients with cluster headache are reported. The patient's age ranged between 14 and 60 years old (average 31.5 years); 22 were male and 4 female. The patients constitued a consecutive series of typical cases (only one was a chronic cluster) with regular headache attacks; in 69.2 per cent of the cases there were associated symptoms and signs (ipsilateral lacrimation, stuffiness of the ipsilateral nostril and Horner's syndrome). In seven patients the cluster was induced by alcohol ingestion (during an active cluster period) and a cluster attack was reproduced by isosorbitol dinitrate (vasodilatador drug) in one patient. All patients received orally either methysergide maleate, prednisone or both. The first drug used, in 20 patients, was methysergide maleate in a dosage of 3-6 mg daily over a four weeks period. Eight patients received prednisone only, which presented side-effects or no improvement with methysergide, in a dosage of 40-60 mg daily and tapered off over a period of four weeks. Methysergide maleate and prednisone were given to 11 patients in association, because of moderate effect of the first drug. The clinical effect of the treatment was judged according to the following three categories: freedom from the attacks; slight improvement of the attacks; no improvement of the attacks. In 57.6 per cent of the cases (15 patients) there was freedom of the attacks, in 30.7 per cent of the cases (8 patients) there was a slight improvement and in 3 patients there was no improvement.


Cefaleia em salvas: aspectos clinicos e terapeuticos em 26 casos

Cluster headache: clinical and therapeutic aspects in 26 cases

Wilson Luiz SanvitoI; Charles Peter TilberyII

IProf. Pleno de Neurologia. Departamento de Medicina da Faculdade de Ciências Médicas da Santa Casa de São Paulo

IIProf. Assistente de Neurologia. Departamento de Medicina da Faculdade de Ciências Médicas da Santa Casa de São Paulo

RESUMO

Vinte e seis casos de cefaléia-em-salvas são estudados do ponto de vista clínico e terapêutico. Nos aspectos clínicos são ressaltados a dramaticidade deste tipo de cefaléia, o nítido predomínio no sexo masculino, a média de idade dos pacientes, a presença de manifestações associadas e os fatores desencadeantes das crises nos períodos suscetíveis. Do ponto de vista terapêutico três esquemas medicamentosos foram utilizados: maleato de metisergida, prednisona e associação de ambas as drogas. Em 88,3% dos casos um resultado significativo foi alcançado, traduzido por melhora ou abolição das crises.

SUMMARY

The clinical and therapeutic aspects in 26 patients with cluster headache are reported. The patient's age ranged between 14 and 60 years old (average 31.5 years); 22 were male and 4 female. The patients constitued a consecutive series of typical cases (only one was a chronic cluster) with regular headache attacks; in 69.2 per cent of the cases there were associated symptoms and signs (ipsilateral lacrimation, stuffiness of the ipsilateral nostril and Horner's syndrome). In seven patients the cluster was induced by alcohol ingestion (during an active cluster period) and a cluster attack was reproduced by isosorbitol dinitrate (vasodilatador drug) in one patient. All patients received orally either methysergide maleate, prednisone or both. The first drug used, in 20 patients, was methysergide maleate in a dosage of 3-6 mg daily over a four weeks period. Eight patients received prednisone only, which presented side-effects or no improvement with methysergide, in a dosage of 40-60 mg daily and tapered off over a period of four weeks. Methysergide maleate and prednisone were given to 11 patients in association, because of moderate effect of the first drug. The clinical effect of the treatment was judged according to the following three categories: freedom from the attacks; slight improvement of the attacks; no improvement of the attacks. In 57.6 per cent of the cases (15 patients) there was freedom of the attacks, in 30.7 per cent of the cases (8 patients) there was a slight improvement and in 3 patients there was no improvement.

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Trabalho da Disciplina de Neurologia do Departamento de Medicina da Faculdade de Ciências Médicas da Santa Casa de São Paulo.

Disciplina de Neurologia, Departamento de Medicina - Faculdade de Ciências Médicas da Santa Casa de São Paulo - Rua Cesário Motta Jr. 112 - 01221 São Paulo, SP - Brasil.

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Datas de Publicação

  • Publicação nesta coleção
    23 Ago 2012
  • Data do Fascículo
    Dez 1980
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