Philosophiae Doctor - PhD / Headache disorders constitute a public-health problem which impacts on individuals and society. The functional limitation and psychosocial restriction, caused by chronic headache, may be a more reliable indication of the severity of the disorder than the pain intensity and temporal headache pattern itself. Evaluation of all these parameters may improve health care for individuals suffering from chronic headache. The ultimate purpose of this study was to develop and validate a multidimensional questionnaire to assess the severity and impact of headache in individuals suffering from chronic headache. The study was carried out in six phases, each stage building on the previous ones. A quantitative retrospective review of 450 patients' clinical files was executed to identify the elements of complaint of these patients. This was followed by a literature review of existing headache-related health measures and construction of a theoretical framework for the study. A questionnaire was developed based on these findings. This questionnaire was then tested for face and content validity in a chronic headache population sample (n=60) and physiotherapists working with these patients (n=18). The questionnaire was further refined by a small qualitative study, making use of small group discussions (n=10). After the suggested modifications were made, the Multidimensional Chronic Headache Questionnaire (MCHQ) was tested for stability in a group of chronic headache patients (n=21), who completed the questionnaire twice with a one-week intervening period with no intervention. It was then tested for responsiveness, where patients completed the questionnaire prior to, and after, an episode of treatment. The Wilcoxon Signed Rank Sum Test was used to detect significant differences (and hence responsiveness). Lastly, all the MCHQ's (n=148) that were completed during the course of the study were analised to establish the homogeneity of item content (Chronbach alpha values), and the construct validity of the instrument in terms of item structure (exploratory factor analysis). The retrospective review of patients' perceptions of the severity and impact of their chronic headache indicated that many of the patients experienced moderate to severe limitation of function and psychosocial restriction. Although many domains of headache-related health were represented in published questionnaires reviewed for this study, no instrument that assesses both the perceived severity and a wide range of impact was found. The MCHQ was developed from this study to measure these parameters. The items in the questionnaire were based on the retrospective study and existing questionnaires utilised in the chronic headache population. The face and content validity of the first draft of the instrument was found to be good. The stability of the questionnaire was very good, with Pearson's correlation coefficients of greater than 0.9334 for all repeated items. Responsiveness was very good, with all items found to be responsive to change (with probability values of p<O.OOOI for all but 3 items; these being effect of analgesics, triggering factors and impact on relationships). Homogeneity of item content was good (alpha values all >0.6647), and preliminary construct validity was suggested by demonstration of eight distinct factors that were clearly interpretable (one in the severity and seven in the impact domain). These suggested that severity is unidimensional, and that seven dimensions of impact are assessed in the MCHQ (functional limitations, two emotional dimensions, relationship restrictions, and three headache trigger dimensions). Positive linear correlations between severity and impact suggested that the higher the severity, the more severe the impact on the individual's quality of life (r=0.5183; p<.OOOI). These tests suggested preliminary construct validity for the questionnaire. The researcher concluded that severe and frequent headache has a considerable impact on the individual and that the multiple facets of headache-related health can be measured appropriately using this instrument. The Multidimensional Chronic Headache Questionnaire is a new instrument to assess headache-related health in terms of both severity and multidimensional impact on individuals, which can be utilised in a once-off health assessment as well as an outcome measure for therapy.

Pediatric headache is a global health concern, with up to 60% of youth experiencing persistent headache pain for at least three months (Abu-Arafeh et al., 2010). Often accompanying the headache are symptoms such as sensitivity to light and sound (Hayne & Martin, 2019; Neut et al., 2012). Headache pain and its associated sensitivities often result in a significant reduction in daily function and avoidance of school, leisure, and social activities (Langdon & DiSabella, 2017). Sensitivities to light and sound are important yet understudied symptoms of pediatric headache disorders. The lack of empirical evidence to guide occupational therapists in the treatment of headache-related sensitivities in children and adolescents presents a major gap in the practice area of pediatric chronic pain. Pediatric Auditory and Visual Exposure (PAVE) was developed to address this gap and to provide occupational therapists with an effective, standardized approach to treat headache-related sensitivities in youth. PAVE is a theoretically driven, exposure-based occupational therapy intervention for youth (ages 8–17) presenting with a diagnosed pediatric headache disorder and experiencing light and/or sound sensitivities that interfere with their daily functioning. The intervention consists of six treatment modules employed over the course of several weeks. The primary goal of PAVE is to improve participant daily functioning through reduction of avoidance behavior, sensory sensitivity, and pain intensity, all of which contribute to functional disability.

Nas últimas décadas, as doenças crônicas têm desempenhado um importante papel na morbimortalidade da população mundial atingindo não só a população idosa, mas também jovens em idade produtiva e principalmente mulheres. Dentre as doenças a cefaléia tem sido considerada uma das principais causas de doença do indivíduo adulto em todo o mundo industrializado e na maioria dos países em fase de desenvolvimento, principalmente, nos grandes centros urbanos, como uma doença crônica. A alta prevalência da doença tem se tornado um grande problema de saúde pública afetando milhares de pessoas e, conseqüentemente, a Qualidade de Vida dessa população. O presente estudo é do tipo transversal com objetivo geral de avaliar a prevalência da cefaléia nas mulheres de uma Instituição de Ensino Superior e a qualidade de vida relacionada à saúde das mesmas de um município do estado de Minas Gerais, no ano de 2006, segundo o Instrumento genérico de avaliação de QVRS, SF-36. A coleta de dados foi realizada junto a mulheres no período entre setembro e dezembro de 2006. Considerando os critérios de exclusão, 150 mulheres foram selecionados para participarem deste estudo, destas 72 faziam parte do grupo de Migrânea, 30 faziam parte do grupo Cefaléia Tensional e 48 não apresentaram cefaléia nos últimos 06 meses. Os resultados relacionados às variáveis aspectos clínicos da dor e impacto (freqüência das crises, intensidade da dor, sintomas associados às crises de dor) nos grupos que apresentavam migrânea e cefaléia tensional foram apresentados e discutidos. Os descritores de maior atribuição relatados pelas mulheres que apresentam migrânea foram alucinante fulminante, insuportável e os de menor atribuição foram aniquiliadora, colossal e brutal. Para as mulheres que apresentavam cefaléia tensional os descritores de maior atribuição foram dilacerante, desumana, terrível, e os de menor atribuição foram desgraçada, apavorante e pavorosa. Os escores padronizados do instrumento SF-36, segundo seus domínios foram apresentados e discutidos segundo os quartis, valores máximos e mínimos e representados por meio de tabelas. Adicionalmente, valores médios e respectivos desvios-padrão foram apresentados. A consistência interna do instrumento foi verificada por meio dos valores de alfa de Cronbach entre os domínios da escala. O programa estatístico SPSS, versão 12.1 para Windows foi utilizado. Entre as mulheres investigadas, idade média igual a 24,5 anos, com desvio-padrão de 8,21 anos,para o grupo Migrânea e idade média igual a 33,5 anos, com desvio-padrão de 9,2 anos,para o grupo Cefaléia Tensional. Em relação às propriedades de medida do SF-36, foi obtido um valor para alfa de Cronbach igual a 0,92, mostrando que houve consistência nas respostas dos indivíduos às questões. Tal resultado pôde ser verificado, também, para cada um dos domínios do SF-36, com valor mínimo para o alfa de Cronbach igual a 0,49 e máximo igual a 0,91. O grupo estudado apresentou um maior comprometimento nos domínios Vitalidade, Dor, Saúde Mental e Aspectos Físicos / In recent decades, chronic diseases have played an important role in global morbidity and mortality rates, affecting not only the aged population, but also young people in the productive age group. Amongst the illnesses the chronic headache has been considered one of the main causes of illness of the adult individual in industrialized the whole world and the majority of the countries in development phase, mainly, in the great urban centers, as a chronic illness. The high prevalence of the illness if has become a great problem of public health affecting thousand of people and, consequently, the Quality of Life of this population. The present study it is of the transversal type with general objective to evaluate the prevalence of the chronic headache in the women of an Institution of Superior Education and the quality of life related to the health of the same ones of a city of the state of Minas Gerais, in the year of 2006, according to generic Instrument of QVRS evaluation, SF-36. The collection of data was carried through next to women in the period between September and December of 2006. Considering the exclusion criteria, 150 women had been selected to participate of this study, of these 72 were part of the group of Migrânea, 30 were part of the group Tensional Chronic headache and 48 had not presented chronic headache in last the 06 months. The results related to the changeable clinical aspects of pain and impact (frequency of the crises, intensity of pain, symptoms associates to the pain crises) in the groups that presented migraine and tensional chronic headache had been presented and argued. The describers of bigger attribution told by the women who present migraine had been alucinante sudden, insuportável and of lesser attribution they had been aniquiliadora, colossal and brutal. For the women who presented tensional chronic headache the describers of bigger attribution had been dilacerante, desumana, terrible, and of lesser attribution they had been poor fellow, appalling and dreadful. You prop up them standardized of instrument SF-36, according to its dominious had been presented and argued according to quartiles, maximum and minimum and represented values by means of tables. Additionally, average and respective values shunting line-standard had been presented. The internal consistency of the instrument was verified by means of the values of alpha of Cronbach enters the dominious of the scale. The statistical program SPSS, version 12.1 for Windows was used. Between the investigated women, equal average age the 24,5 years, with shunting line-standard of 8,21 years, for the Migrânea group and equal average age the 33,5 years, with shunting line-standard of 9,2 years, for the group Tensional Chronic headache. We obtained a Cronbachs alpha of 0.92 for the measurement properties of SF- 36, which revealed consistency between the individuals answers to the questions. We obtained a Cronbachs alpha of 0.92 for the measurement properties of SF-36, which revealed consistency between the individuals answers to the questions. Vitality, Pain, Mental Health and Physical Aspects

Nas últimas décadas, as doenças crônicas têm desempenhado um importante papel na morbimortalidade da população mundial atingindo não só a população idosa, mas também jovens em idade produtiva e principalmente mulheres. Dentre as doenças a cefaléia tem sido considerada uma das principais causas de doença do indivíduo adulto em todo o mundo industrializado e na maioria dos países em fase de desenvolvimento, principalmente, nos grandes centros urbanos, como uma doença crônica. A alta prevalência da doença tem se tornado um grande problema de saúde pública afetando milhares de pessoas e, conseqüentemente, a Qualidade de Vida dessa população. O presente estudo é do tipo transversal com objetivo geral de avaliar a prevalência da cefaléia nas mulheres de uma Instituição de Ensino Superior e a qualidade de vida relacionada à saúde das mesmas de um município do estado de Minas Gerais, no ano de 2006, segundo o Instrumento genérico de avaliação de QVRS, SF-36. A coleta de dados foi realizada junto a mulheres no período entre setembro e dezembro de 2006. Considerando os critérios de exclusão, 150 mulheres foram selecionados para participarem deste estudo, destas 72 faziam parte do grupo de Migrânea, 30 faziam parte do grupo Cefaléia Tensional e 48 não apresentaram cefaléia nos últimos 06 meses. Os resultados relacionados às variáveis aspectos clínicos da dor e impacto (freqüência das crises, intensidade da dor, sintomas associados às crises de dor) nos grupos que apresentavam migrânea e cefaléia tensional foram apresentados e discutidos. Os descritores de maior atribuição relatados pelas mulheres que apresentam migrânea foram alucinante fulminante, insuportável e os de menor atribuição foram aniquiliadora, colossal e brutal. Para as mulheres que apresentavam cefaléia tensional os descritores de maior atribuição foram dilacerante, desumana, terrível, e os de menor atribuição foram desgraçada, apavorante e pavorosa. Os escores padronizados do instrumento SF-36, segundo seus domínios foram apresentados e discutidos segundo os quartis, valores máximos e mínimos e representados por meio de tabelas. Adicionalmente, valores médios e respectivos desvios-padrão foram apresentados. A consistência interna do instrumento foi verificada por meio dos valores de alfa de Cronbach entre os domínios da escala. O programa estatístico SPSS, versão 12.1 para Windows foi utilizado. Entre as mulheres investigadas, idade média igual a 24,5 anos, com desvio-padrão de 8,21 anos,para o grupo Migrânea e idade média igual a 33,5 anos, com desvio-padrão de 9,2 anos,para o grupo Cefaléia Tensional. Em relação às propriedades de medida do SF-36, foi obtido um valor para alfa de Cronbach igual a 0,92, mostrando que houve consistência nas respostas dos indivíduos às questões. Tal resultado pôde ser verificado, também, para cada um dos domínios do SF-36, com valor mínimo para o alfa de Cronbach igual a 0,49 e máximo igual a 0,91. O grupo estudado apresentou um maior comprometimento nos domínios Vitalidade, Dor, Saúde Mental e Aspectos Físicos / In recent decades, chronic diseases have played an important role in global morbidity and mortality rates, affecting not only the aged population, but also young people in the productive age group. Amongst the illnesses the chronic headache has been considered one of the main causes of illness of the adult individual in industrialized the whole world and the majority of the countries in development phase, mainly, in the great urban centers, as a chronic illness. The high prevalence of the illness if has become a great problem of public health affecting thousand of people and, consequently, the Quality of Life of this population. The present study it is of the transversal type with general objective to evaluate the prevalence of the chronic headache in the women of an Institution of Superior Education and the quality of life related to the health of the same ones of a city of the state of Minas Gerais, in the year of 2006, according to generic Instrument of QVRS evaluation, SF-36. The collection of data was carried through next to women in the period between September and December of 2006. Considering the exclusion criteria, 150 women had been selected to participate of this study, of these 72 were part of the group of Migrânea, 30 were part of the group Tensional Chronic headache and 48 had not presented chronic headache in last the 06 months. The results related to the changeable clinical aspects of pain and impact (frequency of the crises, intensity of pain, symptoms associates to the pain crises) in the groups that presented migraine and tensional chronic headache had been presented and argued. The describers of bigger attribution told by the women who present migraine had been alucinante sudden, insuportável and of lesser attribution they had been aniquiliadora, colossal and brutal. For the women who presented tensional chronic headache the describers of bigger attribution had been dilacerante, desumana, terrible, and of lesser attribution they had been poor fellow, appalling and dreadful. You prop up them standardized of instrument SF-36, according to its dominious had been presented and argued according to quartiles, maximum and minimum and represented values by means of tables. Additionally, average and respective values shunting line-standard had been presented. The internal consistency of the instrument was verified by means of the values of alpha of Cronbach enters the dominious of the scale. The statistical program SPSS, version 12.1 for Windows was used. Between the investigated women, equal average age the 24,5 years, with shunting line-standard of 8,21 years, for the Migrânea group and equal average age the 33,5 years, with shunting line-standard of 9,2 years, for the group Tensional Chronic headache. We obtained a Cronbachs alpha of 0.92 for the measurement properties of SF- 36, which revealed consistency between the individuals answers to the questions. We obtained a Cronbachs alpha of 0.92 for the measurement properties of SF-36, which revealed consistency between the individuals answers to the questions. Vitality, Pain, Mental Health and Physical Aspects

Made available in DSpace on 2018-06-04T19:14:38Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-08-31 / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Introdução: As intervenções baseadas em mindfulness podem ser efetivas para tratamento complementar das cefaleias primárias em populações socialmente vulneráveis. Este estudo com mulheres da maior favela do Ceará, no Nordeste do Brasil, verificou os efeitos de uma IBM em mulheres com cefaleia crônica sob risco social. Método: Estudo de eficácia preliminar, exploratório, quasi-experimental, de abordagem mista (quanti e qualitativa), que avaliou o impacto de uma IBM em mulheres usuárias do SUS com relação à incapacidade nas atividades da vida diária (Midas) decorrente da cefaleia crônica (desfecho primário), além de variáveis secundárias como nível de mindfulness, injustiça percebida e autocompaixão. Uma intervenção com acupuntura foi o grupo controle ativo. Resultados: O perfil das participantes foi: (44,5%) casadas; (51,3%) com até 2 filhos; (63,9%) nível fundamental; (53,8%) com renda de 1 a 2 salários-mínimos e (72,21%) com cefaleia crônica, sendo (63,3%) enxaqueca e (8,8%) cefaleia de tensão. A cefaleia está associada à baixa escolaridade, à baixa renda familiar (p<0,05) e a eventos emocionais negativos na vida. Nos autorrelatos, foram categorizados quatro determinantes sociais de saúde causadores de distress psicológico: papel social da mulher na comunidade; busca recorrente aos serviços de saúde; abuso de medicamentos e estratégias de enfrentamento disfuncionais. O distress psicológico estava na base das crises recorrentes de cefaleia. Na comparação dentro dos grupos IBM e acupuntura, IBM promoveu diminuição no nível da incapacidade da cefaleia indicado pelos autorrelatos, mas não por Midas; aumento da autocompaixão (p<0,05); aumento de do nível de mindfulness (p<0,05), enquanto que acupuntura promoveu diminuição apenas em Midas (p<0,05). Houve diminuição da injustiça percebida em ambos os grupos, mas não estatisticamente significante (p>0,05). Na comparação entre grupos, IBM apresentou níveis maiores de autocompaixão e de mindfulness que no grupo acupuntura, com diferença estatisticamente significante (p<0,05). Houve correlações estatisticamente significantes entre Midas e injustiça percebida (p<0,001) e Midas e mindfulness (p<0,05). No modelo de regressão, apenas injustiça percebida influenciou Midas (p<0,001), corroborando os autorrelatos que destacaram esse sentimento negativo na gênese da cefaleia. Considerações finais e Conclusão e: Esse é o primeiro estudo em nível internacional a avaliar os efeitos de uma IBM em população de mulheres com cefaleia crônica e vulneráveis socialmente, comparados com os da acupuntura. As duas intervenções foram efetivas para a redução da incapacidade da cefaleia, sendo que atuando através de mecanismos distintos. Os resultados sugerem que IBM influenciou positivamente a dor através de processos mentais e emocionais (controle atencional, consciência corporal e regulação emocional), o que não ocorreu em relação ao grupo acupuntura. Os efeitos da IBM e da acupuntura na cefaleia crônica das participantes demonstraram preliminar potencial eficácia de práticas mente-corpo em populações vulneráveis socioeconomicamente. / Introduction: Mindfulness-based interventions may be effective for complementary management of primary headaches in socially vulnerable populations. This study with women from the largest favela in Ceará, Northeast Brazil, verified the effects of an IBM in women with chronic headache at social risk. Method: Preliminary, exploratory, quasi-experimental, mixed-approach (quantitative and qualitative) efficacy study evaluating the impact of an IBM on women users of SUS in relation to the disability in daily life activities (Midas) due to chronic headache (Primary outcome), as well as secondary variables such as level of mindfulness, perceived injustice and self-pity. One intervention with acupuncture was the active control group. Results: The participants' profile was: (44.5%) married; (51.3%) with up to 2 children; (63.9%) fundamental level; (53.8%) with income of 1 to 2 minimum wages and (72.21%) with chronic headache, being (63.3%) migraine and (8.8%) tension headache. Headache is associated with low schooling, low family income (p <0.05) and negative emotional events in life. In the self-reports, four social determinants of health that caused psychological distress were categorized: the social role of women in the community; Recurrent search for health services; Drug abuse and dysfunctional coping strategies. Psychological distress was at the basis of recurrent headache crises In the comparison within the IBM groups and acupuncture, IBM promoted a decrease in the level of headache inability indicated by self-reported but not by Midas; Increased self-pity (p <0.05); Increased level of mindfulness (p <0.05), whereas acupuncture promoted a decrease only in Midas (p <0.05). There was a decrease in perceived injustice in both groups, but not statistically significant (p> 0.05). In the comparison between groups, IBM presented higher levels of self-pity and mindfulness than in the acupuncture group, with a statistically significant difference (p <0.05). There were statistically significant correlations between Midas and perceived injustice (p <0.001) and Midas and mindfulness (p <0.05). In the regression model, only perceived injustice influenced Midas (p <0.001), corroborating the self-reports that highlighted this negative feeling in the genesis of headache. Final considerations and conclusions: This is the first international study to evaluate the effects of an IBM on a population of women with chronic and socially vulnerable headache compared to acupuncture. The two interventions were effective in reducing the incapacity of headache, and acting through different mechanisms. The results suggest that IBM positively influenced pain through mental and emotional processes (attention control, body awareness and emotional regulation), which did not occur in relation to the acupuncture group. The effects of IBM and acupuncture on chronic headache of the participants demonstrated preliminary potential efficacy of mind-body practices in socioeconomically vulnerable populations. / BV UNIFESP: Teses e dissertações

Chronic headache may be the most frequently reported somatic symptom, yet it puzzles health experts and poses a considerable treatment challenge. It was suggested that this is because conventional views of headache, adhering to a Newtonian-Cartesian epistemology, focus almost exclusively on intrapsychic factors ignoring the wider social context in which the problem is embedded. An overview of the existing body of knowledge on the most widely researched headache conditions was presented, and it was argued that a conceptual shift is required to achieve a more comprehensive understanding of the problem. This study was conducted within an holistic, ecosystemic epistemology. A qualitative approach employing a case study method was adopted to provide rich descriptions of the contexts in which two chronic headache sufferers' symptoms were embedded. The case study presentations also illustrated the attempts that were made to intervene into the headache contexts from a second-order cybernetics stance. / Psychology / M.A. (Clinical Psychology)

Chronic headache may be the most frequently reported somatic symptom, yet it puzzles health experts and poses a considerable treatment challenge. It was suggested that this is because conventional views of headache, adhering to a Newtonian-Cartesian epistemology, focus almost exclusively on intrapsychic factors ignoring the wider social context in which the problem is embedded. An overview of the existing body of knowledge on the most widely researched headache conditions was presented, and it was argued that a conceptual shift is required to achieve a more comprehensive understanding of the problem. This study was conducted within an holistic, ecosystemic epistemology. A qualitative approach employing a case study method was adopted to provide rich descriptions of the contexts in which two chronic headache sufferers' symptoms were embedded. The case study presentations also illustrated the attempts that were made to intervene into the headache contexts from a second-order cybernetics stance. / Psychology / M.A. (Clinical Psychology)