Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1016/j.bjane.2013.09.011
Brazilian Journal of Anesthesiology
Clinical Information

Treatment of status migrainosus by general anesthesia: a case report

Tratamento do estado de mal-enxaquecoso pela anestesia geral: relato de caso

Artur Udelsmann; Priscila Saccomani; Elisabeth Dreyer; Alberto Luiz Cunha da Costa

http://dx.doi.org/10.1016/j.bjane.2013.09.011 Braz J Anesthesiol, vol.65, n5, p.407-410, 2015
PDF English
PDF Português
Downloads: 0
Views: 976

Abstract

ABSTRACTBACKGROUND AND OBJECTIVES: The status migrainosus is a complication of migraine characterized by severe headache for more than 72 h that did not respond to treatment, with risk of stroke and suicide. Researches on treatment are directed to drugs that stimulate GABA receptors; propofol and isoflurane act on sub-GABAa receptors and theoretically could be interesting. The first has been the subject of research in severe migraine. Opioids are employed in pain, and its use in chronic headache is debatable, but these agents are employed in acute cases. The goal is to present a case of refractory status migrainosus in that we decided to break the pain cycle by general anesthesia.CASE REPORT: Female patient, aged 50 years, with status migrainosus, in the last five days with visits to the emergency department, medicated parenterally with various agents without result. Without comorbidities, dehydrated, described her pain as "well over 10" in Visual Numeric Scale (VNS). After consulting the literature, and given the apparent severity of the condition, we opted for a general anesthesia: induction with fentanyl, propofol, and vecuronium and maintenance with isoflurane and propofol for two hours. Following the treatment, in the postanesthetic recuperation (PAR), the patient related her pain as VNS 3, and was released after five hours with VNS 2. Subsequently, her preventive treatment was resumed.CONCLUSION: Status migrainosus is a rare disabling complication and anesthetics have been the subject of research in its treatment; the option for general anesthesia with agents that stimulate GABA receptors, propofol and isoflurane, in association with fentanyl, proved effective and should encourage new research.

Keywords

Migraine disorder, Combined therapy, General anesthesia

Resumo

RESUMOJUSTIFICATIVA E OBJETIVOS: O estado de mal-enxaquecoso é complicação da migrânea caracterizada por cefaleia severa por mais de 72 horas não responsiva à terapêutica com risco de AVC e suicídio. Pesquisas no tratamento se direcionam às drogas que estimulam receptores GABA; propofol e isoflurano atuam nos sub-receptores GABAa e teoricamente poderiam ser interessantes. O primeiro já foi objeto de pesquisas na migrânea severa. Opioides são empregados em dor, seu uso crônico nas cefaleias é discutível, mas são empregados nos casos agudos. O objetivo é apresentar caso de estado de mal-enxaquecoso refratário em que se optou para quebrar o ciclo álgico por uma anestesia geral.RELATO DE CASO: Paciente do sexo feminino com 50 anos em estado de mal-enxaquecoso havia cinco dias com passagens anteriores por serviço de urgências, medicada por via parenteral com vários agentes sem resultado. Sem comorbidades, desidratada, descrevia sua dor como "muito superior a 10" na ENV. Após consulta à literatura, face à gravidade aparente do quadro, optou-se pela feitura de uma anestesia geral; a indução foi com fentanil, propofol, vecurônio e manutenção com isoflurano e propofol por duas horas. No fim, na RPA, no primeiro contato classificou sua dor com ENV 3, teve alta após cinco horas com ENV 2. Ulteriormente retomou seu tratamento preventivo.CONCLUSÃO: O mal-enxaquecoso é uma complicação rara incapacitante e anestésicos têm sido objeto de pesquisas no tratamento; a opção por uma anestesia geral com agentes que estimulam os receptores GABA, propofol e isoflurano, aliados ao fentanil, mostrou-se eficaz e deve incentivar pesquisas.

Palavras-chave

Transtorno de enxaqueca, Terapia combinada, Anestesia geral

References

The international classification of headache disorders. Cephalalgia. 2004:1-150.

Alhazzani A, Goddeau RP. Migraine and stroke: a continuum association in adults. Headache. 2013;53:1023-7.

Lipton R, Peterson E, Welch KMA. Migraine headache and suicide attempt. Headache. 2012;52:723-31.

Mechtler LL, Kang M, Mogensen K,. Efficacy of intra- venous levetiracetam in the treatment of status migrainosus. Headache. 2008;48(^s1):S45-6.

Gentile S, Rainero I, Daniele D, Binello E, Valfrè W, Pinessi L. Reversible MRI abnormalities in a patient with recurrent status migrainosus. Cephalalgia. 2009;29:687-90.

Hand PJ, Stark RJ. Intravenous lignocaine for sever chronic daily headache. Med J Aust. 2000;172:157-9.

Rothrock JF. Treatment-refractory migraine: the case for opioid therapy. Headache. 2008;48:850-4.

Opioid therapy for migraine. Headache. 2007;47:1371-2.

Krusz JC, Scott V, Belanger J. Intravenous propofol: unique effectiveness in treating intractable migraine. Headache. 2000;40:224-30.

Mendes PM, Silberstein SD, Young WB, Rozen TD, Paolone MF. Intravenous propofol in the treatment of refractory headache. Headache. 2002;42:638-41.

Drumond-Levis J, Scher C. Propofol: a new strategy for refrac- tory headache. Pain Med. 2002;3:366-9.

Hall AC, Lieb WR, Franks NP. Stereoselective and non- stereoselective actions of isoflurane on the GABAA receptor. Br J Pharmacol. 1994;112:906-10.

Vahle-Hinz C, Detsch O, Siemers M,. Local GABA(A) receptor blockade reverses isoflurane's suppressive effects on thalamic neurons in vivo. Anesth Analg. 2001;92:1578-84.

Vos T, Flaxman AD, Naghavi M,. Years lived with dis- ability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Dis- ease Study 2010. Lancet. 2012;380:2163-96.

Natoli JL, Manack A, Dean B,. Global prevalence of chronic migraine: a systematic review. Cephalalgia. 2010;30:599-609.

Nappi RE, Sances G, Detaddei S,. Hormonal management of migraine at menopause. Menopause. 2009;15:82-6.

Pryse-Phillips W, Aubé M, Bailey P,. A clinical study of migraine evolution. Headache. 2006;46:1480-6.

Nishikawa T, Scatton B. Inhibitory influence of GABA on central serotonergic transmission. Involvement of the habernulo-raphe pathways in the GABAergic inhibition of ascending cerebral serotonergic neurons. Brain Res. 1985;331:91-103.

Mathew NT, Kailasam J, Meadors L,. Intravenous valproate sodium (depacon) aborts migraine rapidly: a preliminar report. Headache. 2000;40:720-3.

Cutrer FM, Moskowitz MA. Wolf Award 1996. The actions of valproate and neurosteroids in a model of trigeminal pain. Headache. 1996;36:579-85.

Ponnudurai RN, Nguyen KO, Liu PL. Protective effect of propofol-based general anestesia against postoperative headache in caffeine-consuming patients. Am J. Pain Med. 1999;9:4-7.

Saper JR, Lake3rd AE, Hamel RL,. Daily scheduled opioids for intractable head pain: long-term observations of a treat- ment program. Neurology. 2004;62:1687-94.

Krasowski MD, Koltchine VV,. Propofol and other intravenous anesthetics have sites of action on the gamma- aminobutyric acid type A receptor distinct from that for isoflurane. Mol Pharmacol. 1998;53:530-8.

Olsen RW, Li GD. GABA(A) receptors as molecular targets of gen- eral anesthetics: identification of binding sites provides clues to allosteric modulation. Can J Anaesth. 2011;58:206-15.

5dcdcbbc0e8825ea51bf58f1 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections