https://repositorio.fleni.org.ar/xmlui/handle/123456789/15 Tue, 04 Aug 2026 16:42:30 GMT 2026-08-04T16:42:30Z https://repositorio.fleni.org.ar/xmlui/handle/123456789/1551 Trigeminal neuralgia Bohórquez-Valderrama, Stephania; Santillán, María Elena; Corzo, Matías Sebastián; Buonanotte, Carlos Federico; Bonamico, Lucas Héctor Background Trigeminal neuralgia (TN) is a chronic neuropathic pain disorder characterized by recurrent, severe, unilateral facial pain in the distribution of one or more branches of the trigeminal nerve. Discussion Although its prevalence is relatively low, TN remains one of the most debilitating pain syndromes due to its intensity and unpredictable nature. This review aims to summarize current knowledge on the pathophysiology, diagnostic criteria, and management of trigeminal neuralgia, including both pharmacological and surgical options. Conclusions Trigeminal neuralgia remains a challenging condition requiring an individualized, multidisciplinary approach. Wed, 31 Dec 2025 00:00:00 GMT https://repositorio.fleni.org.ar/xmlui/handle/123456789/1551 2025-12-31T00:00:00Z https://repositorio.fleni.org.ar/xmlui/handle/123456789/1550 Toxina botulínica tipo A en el tratamiento preventivo de la migraña crónica: experiencia en un servicio de cefaleas de Argentina Larripa, Natalia; Grandinetti, Mariela; Calvo, Daniela; Nagel, Vanesa; Goicochea, María Teresa Introducción: La migraña crónica (MC) es una de las enfermedades neurológicas más discapacitantes, con un marcado impacto en la calidad de vida y en la utilización de recursos sanitarios. En Argentina, no existen datos publicados de vida real sobre el uso de toxina botulíni ca tipo A; onabotulinumtoxinA (onabotA), en migraña crónica. El objetivo fue describir los resultados clínicos de pacientes con MC tratados con onabotA en un centro especializado en cefaleas de Argentina. Materiales y métodos: Se realizó un estudio observa cional retrospectivo mediante revisión de historias clíni cas digitales de pacientes con MC tratados con onabotA en el servicio de cefaleas de la institución, entre enero y diciembre de 2021. Se registraron datos epidemiológi cos, sobreuso de analgésicos, duración del tratamiento, respuesta clínica y eventos adversos. Resultados: Se analizaron 394 pacientes (91% muje res, edad media 46 años). El 66% presentaba sobreuso de analgésicos y el 40% refirió deterioro de fin de dosis. Entre quienes completaron el diario de cefaleas (n=162), el 65% alcanzó una reducción ≥50% en los días de cefalea mensuales y el 34% revirtió el sobreuso de analgésicos. Los eventos adversos fueron poco frecuentes (4%) y no motivaron la discontinuación del tratamiento. Conclusión: Nuestros resultados respaldan la efica cia y seguridad de onabotA en la prevención de la MC en la práctica clínica, en concordancia con los ensayos pivotales y estudios internacionales de vida real. Este trabajo constituye el primer reporte de experiencia local en Argentina. Tue, 23 Sep 2025 00:00:00 GMT https://repositorio.fleni.org.ar/xmlui/handle/123456789/1550 2025-09-23T00:00:00Z https://repositorio.fleni.org.ar/xmlui/handle/123456789/1542 Persistent post‑craniotomy headache: a narrative review Alarcon-Ruiz, Christoper A.; Goicochea, María Teresa Persistent post-craniotomy headache (PPCH) is a frequent yet underrecognized complication of cranial surgery, often leading to long-term disability and impaired quality of life. Defined as a headache developing within seven days of craniotomy and lasting more than three months, the true PPCH prevalence and incidence remains unclear and varied widely across studies and time windows. Despite its prevalence, the condition remains poorly understood, and standardized diagnostic and therapeutic protocols are lacking. Review PPCH arises from multifactorial mechanisms, including direct nerve injury, muscle adhesion to the dura mater, aseptic inflammation, and central sensitization. Five main phenotypes can be identified: scar-related neuropathic pain, occipital neuralgia–like headache, diffuse tension-type pattern, migraine-like phenotype, and mixed presentations. Risk factors include posterior fossa and suboccipital surgeries, pre-existing migraine, female sex, inadequate perioperative analgesia, and psychological comorbidities such as anxiety or depression. Evaluation must rule out secondary causes through clinical examination and selective imaging. Treatment should follow a multimodal, phenotype-driven approach combining pharmacologic agents with interventional procedures such as peripheral nerve blocks or scar-targeted botulinum toxin A injections. Surgery is reserved for refractory, well-defined cases involving neuromas or hardware irritation. Conclusions PPCH represents a complex chronic secondary headache condition that demands systematic identification and personalized, stepwise management. However, evidence remains limited, and prospective multicenter studies with standardized definitions and outcomes are urgently needed to improve prognosis and quality of life for affected patients. Wed, 31 Dec 2025 00:00:00 GMT https://repositorio.fleni.org.ar/xmlui/handle/123456789/1542 2025-12-31T00:00:00Z https://repositorio.fleni.org.ar/xmlui/handle/123456789/1512 Peripheral nerve block in patients with medication-overuse headache : systematic review and meta-analysis Arias-Tello, Piero A.; Coronado-Caceres, Carlos F.; Serrano-Sablich, Mario E.; Mantilla, Guillemo; Goicochea, María Teresa; Alarcon-Ruiz, Christoper A. BACKGROUND: Medication-overuse headache (MOH) is a disabling condition, particularly in settings with limited access to advanced preventive therapies. Peripheral nerve blocks (PNB) may offer a pragmatic option to reduce headache burden during MOH management. We aimed to assess the efficacy and safety of PNB in adults with MOH. METHODS: We conducted a systematic review in January 2025 using Scopus, PubMed, Embase, Web of Science, and the Cochrane Library. Randomized clinical trials comparing PNB with standard of care or other active interventions in adults with MOH were eligible. Primary outcomes included headache frequency, headache intensity, successful detoxification, and adverse effects. Risk of bias was assessed using the Cochrane Risk of Bias Tool 2.0. Random-effects meta-analyses were conducted when appropriate, and certainty of evidence was evaluated using the GRADE approach. RESULTS: Three randomized clinical trials involving 249 adults with MOH were included. All trials evaluated bilateral greater occipital nerve blocks, with variability in anesthetic agents, number of sessions, and use of additional nerve block sites. Standard of care consisted of medication withdrawal, hydration, and preventive therapy. Follow-up ranged from 1 to 4 months. Compared with standard of care alone, a single PNB session significantly reduced headache frequency (–4.56 days/month; 95%CI: − 7.46 to − 1.66) and monthly rescue medication use (–2.30 doses of medication/month; 95%CI: − 2.71 to − 1.89), without significant effects on headache intensity or detoxification success. Multiple PNB sessions were associated with greater reductions in headache frequency (–9.00 days/month; 95%CI: − 9.45 to − 8.55), headache intensity (–2.65 units in visual analog scale; 95%CI: − 2.77 to − 2.53), and monthly rescue medication use (–6.70 doses of medication/month; 95%CI: − 7.10 to − 6.30), with low to moderate certainty of evidence. Compared with topiramate, a single PNB session did not reduce headache frequency (+ 1.50 days/month; 95%CI: +1.21 to + 1.79), with no differences in headache intensity (very low certainty). Adverse effects were only reported by one trial, with no significant differences compared with topiramate. CONCLUSION: PNB, particularly when administered in multiple sessions, may reduce headache frequency and intensity in adults with MOH when other therapies are unavailable. However, given the limited evidence and low certainty, further high-quality trials are needed to define optimal protocols and long-term effectiveness and safety. Sat, 07 Feb 2026 00:00:00 GMT https://repositorio.fleni.org.ar/xmlui/handle/123456789/1512 2026-02-07T00:00:00Z