Mulheres com enxaqueca e dor cervical crônica têm alterações funcionais nos músculos do pescoço. Em média, aguentam 50% menos tempo nos testes de força, resistência e pressão nessa região do que as pacientes que não apresentam essas condições.
Além disso, nos testes feitos na Universidade de São Paulo (USP), observou-se como a musculatura craniocervical dessas pacientes fica mais fatigada do que a de quem não tem enxaqueca. São acometidos principalmente o esplênio e o escaleno anterior – músculos superficiais do pescoço que ajudam na flexão lateral e na rotação.
Isso sugere que os tratamentos propostos para quem tem enxaqueca precisam levar em consideração a dessensibilização da região cervical, aliando medicação e fisioterapia para que as pacientes tenham mais chances de obter bons resultados no tratamento e manejo da dor.
Os dados foram publicados no European Journal of Pain.
A pesquisa foi apoiada pela Fapesp (projetos 18/21687-8 e 15/18031-5) e liderada pela professora Débora Bevilaqua Grossi, responsável pelo Ambulatório de Fisioterapia em Cefaleia e Disfunção Temporomandibular (DTM) do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (FMRP-USP).
“Os pacientes com enxaqueca têm 12 vezes mais dor no pescoço do que uma pessoa sem dores de cabeça. Mesmo que o indivíduo não se queixe, é importante que seja avaliado do ponto de vista do sistema craniocervical para a investigação dos sintomas. Importante questionar se tem dor no pescoço, na face, para mastigar, no ouvido ou no ombro. Essas dores musculoesqueléticas periféricas são importantes de serem questionadas”, explica Grossi à Agência Fapesp.
Segundo a pesquisadora, quem tem enxaqueca não só tem dor no pescoço, mas também tem fraqueza. “E para tentar reverter esse quadro e ganhar força, amplitude de movimento, nós mostramos na pesquisa que é preciso aliar o medicamento à fisioterapia para tirar essa sobrecarga da musculatura. Aí, é mais rápido o resultado do tratamento”, afirma a neurologista Fabíola Dach, coautora do artigo e responsável pelos ambulatórios de Cefaleia, Dor Neuropática e Neurologia Geral do HCFMRP-USP.
Dor crônica
Segundo a Organização Mundial de Saúde (OMS), a estimativa é que mais da metade da população apresente algum tipo de cefaleia pelo menos em alguma fase da vida. O paciente é considerado crônico quando tem mais de 15 dias de dor durante o mês.
Ao todo, são mais de 250 tipos de dor de cabeça, segundo a Sociedade Internacional de Cefaleia. Uma delas é a enxaqueca, uma das doenças mais incapacitantes do mundo, que compromete a qualidade de vida dos pacientes, inclusive no ambiente profissional.
“Mais de 70% dos pacientes com enxaqueca apresentam dor cervical. E essa dor está, geralmente, relacionada à redução da resposta ao tratamento com medicamentos. Quem tem dor no pescoço apresenta mais chance de se tornar um paciente crônico e com implicações na resposta à medicação”, destaca Grossi.
Caso não seja tratada corretamente, a musculatura da cervical e de toda essa região da face pode levar ao aumento dos níveis de sensibilização do paciente e, com isso, acabar cronificando a dor, isto é, deixando as crises mais frequentes e com maior intensidade. Além de repercussões musculoesqueléticas, quem tem enxaqueca também pode apresentar comprometimento do equilíbrio e maior risco de quedas com o passar dos anos.
“Nós temos a sorte de trabalharmos juntos. Normalmente, fisioterapeutas e médicos trabalham sozinhos, mas, na nossa linha de pesquisa, nós mostramos os resultados desse trabalho em conjunto há muitos anos”, comemora Dach.
No site do grupo de pesquisa sobre DTM e cefaleia estão disponíveis gratuitamente diversos vídeos e materiais informativos, tanto para os profissionais quanto para os próprios pacientes.
Como foram os testes
A pesquisa envolveu um grupo de 100 mulheres entre 18 e 55 anos recrutadas na região de Ribeirão Preto, interior de São Paulo. Diversos testes foram conduzidos – quando as pacientes estavam sem dor – visando detectar as disfunções musculoesqueléticas.
As voluntárias foram separadas em quatro grupos: o primeiro, para controle, incluía mulheres sem enxaqueca nem dor no pescoço; no segundo grupo estavam as pacientes que tinham apenas dor no pescoço; no terceiro, mulheres com enxaqueca e dor no pescoço; e, por fim, no quarto grupo, as pacientes que tinham enxaqueca e também a possibilidade de ter alodinia – uma maior sensibilidade no rosto e no couro cabeludo, por exemplo, ao pentear ou amarrar os cabelos.
“Nós medimos em segundos a resistência desses músculos e comparamos quem tinha enxaqueca com quem não tinha. Os dados revelam que, em pacientes com enxaqueca, esses músculos cervicais estão mais fatigados e com menor resistência à contração do que em um indivíduo sem enxaqueca. Percebemos que era preciso treinar essa musculatura do pescoço. Normalmente as pessoas alongam esses músculos, mas se esquecem de fortalecê-los”, ressalta Grossi.
Primeiro, para medir o limiar de dor à pressão, foi utilizado um dinamômetro (medidor de pressão) e um disco metálico. As pacientes ficavam sentadas e recebiam uma leve pressão em alguns locais na região do trapézio superior e da escápula, entre outros músculos. Quando percebiam a dor, apertavam o gatilho.
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Первый тип в Дизайне Человека – это Генератор. Он отличаются высокой энергетичностью и способностью легко и эффективно завершать начатые задачи. Этот тип создан для работы, и его главное стремление — заниматься тем, что приносит удовольствие. Генератор начинает действовать, когда ощущает внутренний отклик. Когда Генератор действует из отклика, он не только продуктивен, но и создает вокруг себя атмосферу гармонии и успеха.
Еще один важный тип в Дизайне Человека — Манифестор. Манифесторы могут начинать новые проекты и вдохновлять других. Они не нуждаются в отклике, как Генераторы, и могут сразу принимать решения и действовать. Индивидуальная особенность Манифестора — это стремление к свободе и независимости. Главная их практическая задача — инициировать изменения.
Третий тип — это Проектор. Проекторы лучше всего проявляют себя в роли наблюдателей и стратегов. Они нуждаются в приглашении, прежде чем начать действовать, и могут эффективно использовать энергию, когда работают с другими людьми. Их сила — в правильном руководстве и управлении чужими ресурсами. Практическая задача Проектора – это координирование и организация.
И наконец, заключительный тип — Рефлектор. Они лучше всего ощущают общие тенденции и могут объективно оценивать ситуацию. Индивидуальная особенность Рефлектора заключается в том, что они полностью зависят от окружающего мира и людей. Их рациональная роль заключается в объективной оценке происходящего вокруг.
Заключение Каждый из четырех типов в Дизайне Человека имеет свои индивидуальные особенности, которые помогают им максимально эффективно взаимодействовать с миром. Понимание своего типа и его практического предназначения позволяет лучше организовать жизнь, выбрать правильные направления для работы и улучшить качество личных отношений.
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Вместо того чтобы жить своей жизнью, мы продолжаем отчаянно экспериментировать с социально одобренными методами и техниками, пытаясь выйти за рамки, которые защищают нас от проблем. Консультация Дизайн Человека – human design
Каждый из нас стремится понять, кто он такой, каково его место в мире и каково его предназначение «Дизайн человека»
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