Interview with Prof. Dr. Mário Peres
“To treat the eyes, one must treat the head; to treat the head, one must treat the body as a whole; to treat the body as a whole, one must treat the soul. Neglecting this truth is the cause of so many failures of Greek doctors today” (Plato, 427 – 347 B.C.).
This is the text that opens the first chapter of the book “Headache – what does it want with you?” by Prof. Dr. Mário Peres, neurologist, professor of the postgraduate course in Neurology/Neurosciences at UNIFESP, and senior researcher at the Albert Einstein Israelite Hospital (1).
This text can be considered quite current. Few are the Western doctors who evaluate the human being in its entirety and seek to treat it this way. Perhaps this is why probably few people have stopped to analyze the question posed by this title. And there are not few people who suffer from this ailment: an epidemiological study conducted by Dr. Mário himself estimates that 27.3 million Brazilians (15.2% of the population) suffer from migraine! (2).
In addition to the discomfort that this type of pain causes (and those who experience this ailment know well what we are talking about!), the person who has migraines is also at greater risk of developing other comorbidities, as depicted in the figure below, extracted from his aforementioned book (1):
But, after all, what is a migraine? How to get rid of this problem?
To answer these and other questions, there is nothing better than to count on the contribution of Dr. Mário himself, who kindly gifted us with a small interview! Grateful, let’s go to it!
Vânia: Dr. Mário, in your book there is a clear differentiation between migraine and tension-type headache. Could you briefly explain this to us?
Dr. Mário: Migraine is throbbing, is more on one side of the head, is stronger, has the presence of nausea, discomfort with light and noise, while tension-type headache has a heavy pain, presents on both sides of the head, is weaker, and generally does not have associated symptoms.
Vânia: What are the main practices and attitudes essential for eliminating headaches in general?
Dr. Mário: The fundamental concept is prevention; treatments to avoid the onset of headaches and to cut the pain once it appears are also important, but without prevention, one does not go very far.
Vânia: The study published this year on the relationship between anxiety and the prevalence of primary migraine, which involved 383 residents of Paraisópolis and included your participation, showed that people who suffer from headaches had a higher prevalence of anxiety symptoms and that the presence of two or more anxiety criteria was associated with the headache disorder (3). Comment on this relationship.
Dr. Mário: Anxiety is very common in patients with migraines; it causes pain, makes it stronger, more frequent, and longer-lasting. It is important to recognize it to direct treatment appropriately.
Vânia: Regarding the relationship between migraine and sleep terrors: another study that included your participation, conducted with 158 adolescents aged 10 to 19 years, showed that patients suffering from migraines had proportionally more reports of sleep terrors compared to the control group (4). In our last post, Prof. Dr. Valdemar Setzer from the Institute of Mathematics and Statistics at USP commented on the negative effects of media on children and adolescents, one of which is the excess stimulation that generates agitation. Do you believe that the increased time adolescents spend in front of the television, video games, and computer games may relate to the data observed in the study?
Dr. Mário: Any excess, any overload can provoke more headaches. Excessive hours dedicated to video games and TV in an inappropriate posture, without fluid intake and food, depriving hours of sleep, and also compromising physical activities are additional problems.
Vânia: A study published by Headache that evaluated the relationship between episodic migraine and sleep quality, daytime sleepiness, and sleep hygiene showed that poor sleep quality is significantly associated with a higher frequency of headaches (5). What are your tips, as a neurologist and scholar of the subject, for a good night's sleep?
Dr. Mário: A good night's sleep is essential for a healthy life. Sleep hygiene consists of:
· avoiding caffeinated drinks at night;
· avoiding excessive food intake before sleeping;
· not reserving the night to solve problems, discuss, or get worked up in conversations;
· avoiding alcoholic beverages (it may induce sleep but fragments all sleep);
· avoiding very strenuous physical activities (they can make a person more active and inhibit sleep).
Vânia: A topic of numerous recent research and publications, therapy with melatonin (a hormone produced naturally by the body) has shown benefits both for improving sleep quality and for relieving headache crises, as presented in a recent report by Isto é magazine, which also includes your contribution (http://www.istoe.com.br/reportagens/317231_O+SUPER+HORMONIO). In Brazil, unfortunately, there are still restrictions regarding its use, however, in the United States, it is sold as a dietary supplement, and it can be purchased through import websites. Is there any risk associated with its use without a doctor's prescription?
Dr. Mário: Melatonin is very safe, but if taken in the morning, for example, or taken at irregular times, it will not have the desired effect. Although it is safe, only a doctor will know how to best titrate the dose of melatonin, define the best treatment strategy, and evaluate interactions.
Vânia: In your book, there is a chapter dedicated to Spirituality, in which the importance of “self-knowledge of the disease as an opportunity for learning and personal growth” is made clear. Do you address this issue with your patients? Would you like to leave any message in this regard?
Dr. Mário: Spirituality, religiosity, faith are themes that permeate the human experience; neglecting them is to lose the integral dimension of the human being. Whenever pertinent, I address this issue with patients, as it greatly helps in adherence and good evolution of treatment.
Mário Peres holds a doctorate in neurology from the Paulista School of Medicine (Unifesp) and is currently part of the clinical staff at the Albert Einstein Israelite Hospital. He is responsible for the foundation and direction of the São Paulo Headache Center, and has completed a post-doctorate at the Jefferson Headache Center, a clinical center located in Philadelphia, considered a reference for headache treatment in the USA.
He also serves, among other roles, as a professor of the postgraduate course in Neurology/Neurosciences at the Paulista School of Medicine and as a researcher at the Teaching and Research Institute of the Albert Einstein Hospital.
Dr. Mario Peres had a project approved in the Natura Campus Projects Call 2012, titled “Influence of optimism and pessimism on primary headaches.”
Vânia Hercilia Talarico Bruno is a Pharmaceutical-Biochemist, with a focus on Food and Nutrition from UNESP and a postgraduate degree in Industrial Administration from Fundação Vanzolini - USP. She is a massage therapist trained by the Amor School (Association of Oriental Massage) and mother of Gabriel (3) and Guilherme (1.8). She currently dedicates herself to motherhood, studying philosophical topics, and providing services in Scientific Consulting.
Contact: vaniatal@yahoo.com.br
References:
1. Peres, M. Headache – what does it want with you? Ed. Integrare. 167 p. 2008;
2. Queiroz LP, Peres MF, Piovesan EJ, Kowacs F, Ciciarelli MC, Souza JA, Zukerman E. A nationwide population-based study of migraine in Brazil. Cephalalgia. 2009 Jun;29(6):642-9;
3. Lucchetti G, Peres MF, Lucchetti AL, Mercante JP, Guendler VZ, Zukerman E. Generalized anxiety disorder, subthreshold anxiety and anxiety symptoms in primary headache. Psychiatry and Clinical Neurosciences 2013; 67: 41–49;
4. Fialho LM, Pinho RS, Lin J, Minett TS, Vitalle MS, Fisberg M, Peres MF, Vilanova LC, Masruha MR. Sleep terrors antecedent is common in adolescents with migraine. Arq Neuropsiquiatr. 2013 Feb;71(2):83-6;
5. Walters AB, Hamer JD, Smitherman TA. Sleep Disturbance and Affective Comorbidity Among Episodic Migraineurs. Headache. 2013 Jun 28. doi: 10.1111/head.12168;
