Prevalência e características clínicas das cefaleias em uma coorte de pacientes com doença inflamatória intestinal no Estado do Ceará

Abstract

Patients with Inflammatory Bowel Disease (IBD) may suffer from various extraintestinal manifestations (EIM). Headache and peripheral neuropathy (PN) are among the most frequent EIM, although in both cases, information on prevalence and characteristics is scarce and, possibly, conflicting in the literature. A prospective study was conducted in a cohort of patients with IBD in order to establish the prevalence and to analyze the characteristics of primary headaches and their subtypes in IBD. One hundred fifty-five consecutive patients with IBD - 75 with Crohn's disease (CD) and 80 with ulcerative colitis (UC), 84 patients with Gastritis / Dyspepsia (GD) and 101 healthy individuals, randomly invited among relatives of the patients, participated in the study. All were interviewed by using a standardized questionnaire. Headache was diagnosed according to the International Classification of Headache, 3rd edition. Patients with IBD and suspected of neurological disorders underwent standard neurological evaluation and neurophysiological tests. Headache and migraine were more prevalent in IBD patients than in control: 52.3% and 34.2% vs 40.6% and 20.8% (p<0.05). Migraine was 2.6 times more common in patients with CD than in control (95% CI = 1.343-5.129), 13.3 times more common in men with CD and 8.6 times more common in men with IBD (p <0 .05). Headache and migraine were also more common in GD patients than control (p <0.05). The percentages of PN in the IBD, CD and UC groups were, respectively, 29.7%, 37.3% and 22.5%. The prevalence of large-fiber PN was higher in the CD group than in the UC group (21.3% vs 5.0%, p = 0.010). In analyses using the chi-square test and the univariate and multivariate logistic regression model to verify the likelihood of patients with IBD, CD and UC concomitantly manifesting some type of PN with some type of headache, none of them showed a statistically significant association. Finally, the multivariate logistic regression analysis showed that, even with higher prevalence of headache in women and with discrete differences of gender, age and history of systemic arterial hipertension between groups, the differences in prevalence of headache and migraine between IBD patients and the control group after correction were maintained. Thus, it is concluded that patients with IBD have a higher prevalence of headache and migraine than in the control group; and similar to that of the GD group. In the CD group there is a higher prevalence of migraine than in control and a lower prevalence of tension headache than in the GD group. Headache and PN affect different groups of patients with IBD, both in CD and in UC. Further studies are necessary to understand the mechanisms underlying those diferences. Key-words: Headache. Migraine. Inflammatory Bowel Disease. Crohn's disease. Ulcerative colitis. Peripheral neuropathy.