{"id":1806,"date":"2025-10-02T00:50:55","date_gmt":"2025-10-02T00:50:55","guid":{"rendered":"https:\/\/exemplo.com\/?p=1806"},"modified":"2025-10-06T13:50:37","modified_gmt":"2025-10-06T16:50:37","slug":"dor-de-cabeca-frequente","status":"publish","type":"post","link":"https:\/\/med-br.com\/medicosbr\/doencas-neurologicas\/dor-de-cabeca\/dor-de-cabeca-frequente\/","title":{"rendered":"Recomenda\u00e7\u00f5es M\u00e9dicas Atualizadas 2025 Para Dor de Cabe\u00e7a Frequente"},"content":{"rendered":"<p data-start=\"996\" data-end=\"1432\">A dor de cabe\u00e7a frequente exige mais do que analg\u00e9sicos ocasionais. Em 2025, diretrizes internacionais e nacionais refor\u00e7am uma abordagem estruturada: avalia\u00e7\u00e3o cl\u00ednica cuidadosa, identifica\u00e7\u00e3o do tipo de cefaleia, manejo de gatilhos, terapias agudas seguras, preven\u00e7\u00e3o medicamentosa quando indicada e monitoramento para evitar abuso de rem\u00e9dios. Este guia resume o que os m\u00e9dicos recomendam hoje com base em evid\u00eancias e boas pr\u00e1ticas.<\/p>\n<h2 data-start=\"1439\" data-end=\"1464\"><span class=\"ez-toc-section\" id=\"Resumo_rapido\"><\/span><strong data-start=\"1445\" data-end=\"1462\">Resumo r\u00e1pido<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2><div id=\"ez-toc-container\" class=\"ez-toc-v2_0_86 counter-hierarchy ez-toc-counter ez-toc-white ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">\u00cdndice<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Alternar tabela de conte\u00fado\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 eztoc-toggle-hide-by-default' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/med-br.com\/medicosbr\/doencas-neurologicas\/dor-de-cabeca\/dor-de-cabeca-frequente\/#Resumo_rapido\" >Resumo r\u00e1pido<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/med-br.com\/medicosbr\/doencas-neurologicas\/dor-de-cabeca\/dor-de-cabeca-frequente\/#1_Classificacao_clinica_por_que_identificar_o_tipo_de_cefaleia_muda_tudo\" >1) Classifica\u00e7\u00e3o cl\u00ednica: por que identificar o tipo de cefaleia muda tudo<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/med-br.com\/medicosbr\/doencas-neurologicas\/dor-de-cabeca\/dor-de-cabeca-frequente\/#11_Sinais_de_alerta_%E2%80%9Cred_flags%E2%80%9D\" >1.1 Sinais de alerta (\u201cred flags\u201d)<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/med-br.com\/medicosbr\/doencas-neurologicas\/dor-de-cabeca\/dor-de-cabeca-frequente\/#2_Avaliacao_e_diario_de_cefaleia_a_base_do_plano_terapeutico\" >2) Avalia\u00e7\u00e3o e di\u00e1rio de cefaleia: a base do plano terap\u00eautico<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/med-br.com\/medicosbr\/doencas-neurologicas\/dor-de-cabeca\/dor-de-cabeca-frequente\/#3_Tratamento_agudo_de_crise_o_que_priorizar_em_2025\" >3) Tratamento agudo (de crise): o que priorizar em 2025<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/med-br.com\/medicosbr\/doencas-neurologicas\/dor-de-cabeca\/dor-de-cabeca-frequente\/#31_Analgesicos_e_AINEs_primeira_linha_para_muitos_casos\" >3.1 Analg\u00e9sicos e AINEs (primeira linha para muitos casos)<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/med-br.com\/medicosbr\/doencas-neurologicas\/dor-de-cabeca\/dor-de-cabeca-frequente\/#32_Triptanos_enxaqueca_moderadagrave\" >3.2 Triptanos (enxaqueca moderada\/grave)<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/med-br.com\/medicosbr\/doencas-neurologicas\/dor-de-cabeca\/dor-de-cabeca-frequente\/#33_Evitar_combinacoes_com_opioides_e_butalbital\" >3.3 Evitar combina\u00e7\u00f5es com opioides e butalbital<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/med-br.com\/medicosbr\/doencas-neurologicas\/dor-de-cabeca\/dor-de-cabeca-frequente\/#4_Profilaxia_prevencao_quando_iniciar_e_com_o_que\" >4) Profilaxia (preven\u00e7\u00e3o): quando iniciar e com o qu\u00ea<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/med-br.com\/medicosbr\/doencas-neurologicas\/dor-de-cabeca\/dor-de-cabeca-frequente\/#41_Quando_considerar_prevencao\" >4.1 Quando considerar preven\u00e7\u00e3o<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-11\" href=\"https:\/\/med-br.com\/medicosbr\/doencas-neurologicas\/dor-de-cabeca\/dor-de-cabeca-frequente\/#42_Opcoes_tradicionais_com_boa_evidencia\" >4.2 Op\u00e7\u00f5es tradicionais com boa evid\u00eancia<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-12\" href=\"https:\/\/med-br.com\/medicosbr\/doencas-neurologicas\/dor-de-cabeca\/dor-de-cabeca-frequente\/#43_Terapias_alvo-CGRP_contexto_2024%E2%80%932025\" >4.3 Terapias alvo-CGRP (contexto 2024\u20132025)<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-13\" href=\"https:\/\/med-br.com\/medicosbr\/doencas-neurologicas\/dor-de-cabeca\/dor-de-cabeca-frequente\/#5_Prevencao_nao_farmacologica_com_evidencia\" >5) Preven\u00e7\u00e3o n\u00e3o farmacol\u00f3gica com evid\u00eancia<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-14\" href=\"https:\/\/med-br.com\/medicosbr\/doencas-neurologicas\/dor-de-cabeca\/dor-de-cabeca-frequente\/#6_Cefaleia_por_uso_excessivo_de_medicacao_MOH_reconhecer_e_tratar\" >6) Cefaleia por uso excessivo de medica\u00e7\u00e3o (MOH): reconhecer e tratar<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-15\" href=\"https:\/\/med-br.com\/medicosbr\/doencas-neurologicas\/dor-de-cabeca\/dor-de-cabeca-frequente\/#7_Quando_pedir_exames_de_imagem_e_encaminhar\" >7) Quando pedir exames de imagem e encaminhar<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-16\" href=\"https:\/\/med-br.com\/medicosbr\/doencas-neurologicas\/dor-de-cabeca\/dor-de-cabeca-frequente\/#8_Recomendacoes_praticas_para_2025_passo_a_passo\" >8) Recomenda\u00e7\u00f5es pr\u00e1ticas para 2025 (passo a passo)<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-17\" href=\"https:\/\/med-br.com\/medicosbr\/doencas-neurologicas\/dor-de-cabeca\/dor-de-cabeca-frequente\/#9_Recomendacoes_no_contexto_brasileiro\" >9) Recomenda\u00e7\u00f5es no contexto brasileiro<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-18\" href=\"https:\/\/med-br.com\/medicosbr\/doencas-neurologicas\/dor-de-cabeca\/dor-de-cabeca-frequente\/#10_Perguntas_para_levar_a_consulta\" >10) Perguntas para levar \u00e0 consulta<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-19\" href=\"https:\/\/med-br.com\/medicosbr\/doencas-neurologicas\/dor-de-cabeca\/dor-de-cabeca-frequente\/#FAQ_%E2%80%93_Perguntas_Frequentes\" >FAQ \u2013 Perguntas Frequentes<\/a><\/li><\/ul><\/nav><\/div>\n\n<p data-start=\"1465\" data-end=\"1878\">Para dor de cabe\u00e7a frequente, m\u00e9dicos recomendam: classificar o tipo (tensional, enxaqueca etc.), otimizar medidas de estilo de vida, usar tratamentos de crise adequados (paracetamol\/AINEs; triptanos para enxaqueca), <strong data-start=\"1682\" data-end=\"1707\">evitar uso em excesso<\/strong> (risco de cefaleia por abuso), e considerar <strong data-start=\"1752\" data-end=\"1766\">profilaxia<\/strong> quando h\u00e1 \u22654 dias de dor\/m\u00eas. Sinais de alerta exigem avalia\u00e7\u00e3o imediata. <span class=\"\" data-state=\"closed\"><span class=\"ms-1 inline-flex max-w-full items-center relative top-[-0.094rem] animate-[show_150ms_ease-in]\" data-testid=\"webpage-citation-pill\"><a class=\"flex h-4.5 overflow-hidden rounded-xl px-2 text-[9px] font-medium transition-colors duration-150 ease-in-out text-token-text-secondary! bg-[#F4F4F4]! dark:bg-[#303030]!\" href=\"https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/headache-disorders?utm_source=chatgpt.com\" target=\"_blank\" rel=\"noopener\"><span class=\"relative start-0 bottom-0 flex h-full w-full items-center\"><span class=\"flex h-4 w-full items-center justify-between\"><span class=\"max-w-[15ch] grow truncate overflow-hidden text-center\">Organiza\u00e7\u00e3o Mundial da Sa\u00fade<\/span><span class=\"-me-1 flex h-full items-center rounded-full px-1 text-[#8F8F8F]\">+2<\/span><\/span><span class=\"flex h-4 w-full items-center justify-between absolute\"><span class=\"max-w-[15ch] grow truncate overflow-hidden text-center\">American Headache Society<\/span><span class=\"-me-1 flex h-full items-center rounded-full px-1 text-[#8F8F8F]\">+2<\/span><\/span><\/span><\/a><\/span><\/span><\/p>\n<h2 data-start=\"1885\" data-end=\"1966\"><span class=\"ez-toc-section\" id=\"1_Classificacao_clinica_por_que_identificar_o_tipo_de_cefaleia_muda_tudo\"><\/span><strong data-start=\"1888\" data-end=\"1966\">1) Classifica\u00e7\u00e3o cl\u00ednica: por que identificar o tipo de cefaleia muda tudo<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p data-start=\"1967\" data-end=\"2448\">A <strong data-start=\"1969\" data-end=\"1994\">classifica\u00e7\u00e3o correta<\/strong> guia a escolha do tratamento. Em consult\u00f3rio, utiliza-se a <strong data-start=\"2054\" data-end=\"2064\">ICHD-3<\/strong> (International Classification of Headache Disorders) para diferenciar <strong data-start=\"2135\" data-end=\"2157\">cefaleia tensional<\/strong>, <strong data-start=\"2159\" data-end=\"2172\">enxaqueca<\/strong> (com\/sem aura), <strong data-start=\"2189\" data-end=\"2211\">cefaleia em salvas<\/strong> e formas secund\u00e1rias (sinusite, hipertens\u00e3o, infec\u00e7\u00e3o, causas neurol\u00f3gicas). Em 2024, a IHS publicou um editorial de trabalho rumo ao ICHD-4, mantendo os crit\u00e9rios da ICHD-3 como refer\u00eancia cl\u00ednica. <span class=\"\" data-state=\"closed\"><span class=\"ms-1 inline-flex max-w-full items-center relative top-[-0.094rem] animate-[show_150ms_ease-in]\" data-testid=\"webpage-citation-pill\"><a class=\"flex h-4.5 overflow-hidden rounded-xl px-2 text-[9px] font-medium transition-colors duration-150 ease-in-out text-token-text-secondary! bg-[#F4F4F4]! dark:bg-[#303030]!\" href=\"https:\/\/ichd-3.org\/?utm_source=chatgpt.com\" target=\"_blank\" rel=\"noopener\"><span class=\"relative start-0 bottom-0 flex h-full w-full items-center\"><span class=\"flex h-4 w-full items-center justify-between\"><span class=\"max-w-[15ch] grow truncate overflow-hidden text-center\">ICHD-3<\/span><span class=\"-me-1 flex h-full items-center rounded-full px-1 text-[#8F8F8F]\">+2<\/span><\/span><span class=\"flex h-4 w-full items-center justify-between absolute\"><span class=\"max-w-[15ch] grow truncate overflow-hidden text-center\">International Headache Society<\/span><span class=\"-me-1 flex h-full items-center rounded-full px-1 text-[#8F8F8F]\">+2<\/span><\/span><\/span><\/a><\/span><\/span><\/p>\n<h3 data-start=\"2450\" data-end=\"2492\"><span class=\"ez-toc-section\" id=\"11_Sinais_de_alerta_%E2%80%9Cred_flags%E2%80%9D\"><\/span><strong data-start=\"2454\" data-end=\"2492\">1.1 Sinais de alerta (\u201cred flags\u201d)<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p data-start=\"2493\" data-end=\"2763\">Dor s\u00fabita \u201ca pior da vida\u201d, febre e rigidez de nuca, d\u00e9ficit neurol\u00f3gico (fraqueza, fala arrastada), nova dor em &gt;50 anos, ap\u00f3s trauma, c\u00e2ncer ou imunossupress\u00e3o s\u00e3o indica\u00e7\u00f5es de investiga\u00e7\u00e3o imediata e poss\u00edveis exames de imagem. <span class=\"\" data-state=\"closed\"><span class=\"ms-1 inline-flex max-w-full items-center relative top-[-0.094rem] animate-[show_150ms_ease-in]\" data-testid=\"webpage-citation-pill\"><a class=\"flex h-4.5 overflow-hidden rounded-xl px-2 text-[9px] font-medium transition-colors duration-150 ease-in-out text-token-text-secondary! bg-[#F4F4F4]! dark:bg-[#303030]!\" href=\"https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/headache-disorders?utm_source=chatgpt.com\" target=\"_blank\" rel=\"noopener\"><span class=\"relative start-0 bottom-0 flex h-full w-full items-center\"><span class=\"flex h-4 w-full items-center justify-between overflow-hidden\"><span class=\"max-w-[15ch] grow truncate overflow-hidden text-center\">Organiza\u00e7\u00e3o Mundial da Sa\u00fade<\/span><\/span><\/span><\/a><\/span><\/span><\/p>\n<h2 data-start=\"2770\" data-end=\"2839\"><span class=\"ez-toc-section\" id=\"2_Avaliacao_e_diario_de_cefaleia_a_base_do_plano_terapeutico\"><\/span><strong data-start=\"2773\" data-end=\"2839\">2) Avalia\u00e7\u00e3o e di\u00e1rio de cefaleia: a base do plano terap\u00eautico<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p data-start=\"2840\" data-end=\"3147\">M\u00e9dicos orientam <strong data-start=\"2857\" data-end=\"2874\">di\u00e1rio de dor<\/strong> com: frequ\u00eancia, intensidade, dura\u00e7\u00e3o, gatilhos (sono, jejum, stress, ciclo menstrual), uso de medicamentos e resposta. Esse registro reduz vi\u00e9s, orienta ajustes e ajuda a identificar <strong data-start=\"3059\" data-end=\"3108\">cefaleia por uso excessivo de medica\u00e7\u00e3o (MOH)<\/strong>. <span class=\"\" data-state=\"closed\"><span class=\"ms-1 inline-flex max-w-full items-center relative top-[-0.094rem] animate-[show_150ms_ease-in]\" data-testid=\"webpage-citation-pill\"><a class=\"flex h-4.5 overflow-hidden rounded-xl px-2 text-[9px] font-medium transition-colors duration-150 ease-in-out text-token-text-secondary! bg-[#F4F4F4]! dark:bg-[#303030]!\" href=\"https:\/\/www.mdpi.com\/2075-1729\/14\/9\/1146?utm_source=chatgpt.com\" target=\"_blank\" rel=\"noopener\"><span class=\"relative start-0 bottom-0 flex h-full w-full items-center\"><span class=\"flex h-4 w-full items-center justify-between overflow-hidden\"><span class=\"max-w-[15ch] grow truncate overflow-hidden text-center\">MDPI<\/span><\/span><\/span><\/a><\/span><\/span><\/p>\n<h2 data-start=\"3154\" data-end=\"3216\"><span class=\"ez-toc-section\" id=\"3_Tratamento_agudo_de_crise_o_que_priorizar_em_2025\"><\/span><strong data-start=\"3157\" data-end=\"3216\">3) Tratamento agudo (de crise): o que priorizar em 2025<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<h3 data-start=\"3217\" data-end=\"3283\"><span class=\"ez-toc-section\" id=\"31_Analgesicos_e_AINEs_primeira_linha_para_muitos_casos\"><\/span><strong data-start=\"3221\" data-end=\"3283\">3.1 Analg\u00e9sicos e AINEs (primeira linha para muitos casos)<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p data-start=\"3284\" data-end=\"3516\">Para crises leves a moderadas, o uso criterioso de <strong data-start=\"3335\" data-end=\"3350\">paracetamol<\/strong> ou <strong data-start=\"3354\" data-end=\"3363\">AINEs<\/strong> (ibuprofeno, naproxeno) continua recomendado. Tomar <strong data-start=\"3416\" data-end=\"3440\">o mais cedo poss\u00edvel<\/strong> na crise tende a aumentar a efic\u00e1cia. <span class=\"\" data-state=\"closed\"><span class=\"ms-1 inline-flex max-w-full items-center relative top-[-0.094rem] animate-[show_150ms_ease-in]\" data-testid=\"webpage-citation-pill\"><a class=\"flex h-4.5 overflow-hidden rounded-xl px-2 text-[9px] font-medium transition-colors duration-150 ease-in-out text-token-text-secondary! bg-[#F4F4F4]! dark:bg-[#303030]!\" href=\"https:\/\/americanheadachesociety.org\/resources\/primary-care\/acute-treatment-for-migraine?utm_source=chatgpt.com\" target=\"_blank\" rel=\"noopener\"><span class=\"relative start-0 bottom-0 flex h-full w-full items-center\"><span class=\"flex h-4 w-full items-center justify-between overflow-hidden\"><span class=\"max-w-[15ch] grow truncate overflow-hidden text-center\">American Headache Society<\/span><\/span><\/span><\/a><\/span><\/span><\/p>\n<h3 data-start=\"3518\" data-end=\"3566\"><span class=\"ez-toc-section\" id=\"32_Triptanos_enxaqueca_moderadagrave\"><\/span><strong data-start=\"3522\" data-end=\"3566\">3.2 Triptanos (enxaqueca moderada\/grave)<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p data-start=\"3567\" data-end=\"3784\"><strong data-start=\"3567\" data-end=\"3612\">Sumatriptano, rizatriptano, zolmitriptano<\/strong> e cong\u00eaneres s\u00e3o espec\u00edficos para enxaqueca, eficazes quando usados no in\u00edcio da dor. Contraindica\u00e7\u00f5es incluem doen\u00e7a cardiovascular. <span class=\"\" data-state=\"closed\"><span class=\"ms-1 inline-flex max-w-full items-center relative top-[-0.094rem] animate-[show_150ms_ease-in]\" data-testid=\"webpage-citation-pill\"><a class=\"flex h-4.5 overflow-hidden rounded-xl px-2 text-[9px] font-medium transition-colors duration-150 ease-in-out text-token-text-secondary! bg-[#F4F4F4]! dark:bg-[#303030]!\" href=\"https:\/\/americanheadachesociety.org\/resources\/primary-care\/acute-treatment-for-migraine?utm_source=chatgpt.com\" target=\"_blank\" rel=\"noopener\"><span class=\"relative start-0 bottom-0 flex h-full w-full items-center\"><span class=\"flex h-4 w-full items-center justify-between overflow-hidden\"><span class=\"max-w-[15ch] grow truncate overflow-hidden text-center\">American Headache Society<\/span><\/span><\/span><\/a><\/span><\/span><\/p>\n<h3 data-start=\"3786\" data-end=\"3842\"><span class=\"ez-toc-section\" id=\"33_Evitar_combinacoes_com_opioides_e_butalbital\"><\/span><strong data-start=\"3790\" data-end=\"3842\">3.3 Evitar combina\u00e7\u00f5es com opioides e butalbital<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p data-start=\"3843\" data-end=\"4003\">Diretrizes desencorajam opioides e barbit\u00faricos para cefaleia devido a pior perfil de risco e alto potencial para <strong data-start=\"3957\" data-end=\"3964\">MOH<\/strong>. <span class=\"\" data-state=\"closed\"><span class=\"ms-1 inline-flex max-w-full items-center relative top-[-0.094rem] animate-[show_150ms_ease-in]\" data-testid=\"webpage-citation-pill\"><a class=\"flex h-4.5 overflow-hidden rounded-xl px-2 text-[9px] font-medium transition-colors duration-150 ease-in-out text-token-text-secondary! bg-[#F4F4F4]! dark:bg-[#303030]!\" href=\"https:\/\/thejournalofheadacheandpain.biomedcentral.com\/articles\/10.1186\/s10194-024-01755-w?utm_source=chatgpt.com\" target=\"_blank\" rel=\"noopener\"><span class=\"relative start-0 bottom-0 flex h-full w-full items-center\"><span class=\"flex h-4 w-full items-center justify-between\"><span class=\"max-w-[15ch] grow truncate overflow-hidden text-center\">BioMed Central<\/span><span class=\"-me-1 flex h-full items-center rounded-full px-1 text-[#8F8F8F]\">+1<\/span><\/span><\/span><\/a><\/span><\/span><\/p>\n<blockquote data-start=\"4005\" data-end=\"4214\">\n<p data-start=\"4007\" data-end=\"4214\"><strong data-start=\"4007\" data-end=\"4024\">Dica cl\u00ednica:<\/strong> limite o uso de tratamentos agudos a <strong data-start=\"4062\" data-end=\"4078\">&lt;10 dias\/m\u00eas<\/strong> para triptanos\/combina\u00e7\u00f5es e <strong data-start=\"4108\" data-end=\"4124\">&lt;15 dias\/m\u00eas<\/strong> para analg\u00e9sicos simples, reduzindo o risco de MOH. <span class=\"\" data-state=\"closed\"><span class=\"ms-1 inline-flex max-w-full items-center relative top-[-0.094rem] animate-[show_150ms_ease-in]\" data-testid=\"webpage-citation-pill\"><a class=\"flex h-4.5 overflow-hidden rounded-xl px-2 text-[9px] font-medium transition-colors duration-150 ease-in-out text-token-text-secondary! bg-[#F4F4F4]! dark:bg-[#303030]!\" href=\"https:\/\/thejournalofheadacheandpain.biomedcentral.com\/articles\/10.1186\/s10194-024-01755-w?utm_source=chatgpt.com\" target=\"_blank\" rel=\"noopener\"><span class=\"relative start-0 bottom-0 flex h-full w-full items-center\"><span class=\"flex h-4 w-full items-center justify-between overflow-hidden\"><span class=\"max-w-[15ch] grow truncate overflow-hidden text-center\">BioMed Central<\/span><\/span><\/span><\/a><\/span><\/span><\/p>\n<\/blockquote>\n<h2 data-start=\"4221\" data-end=\"4281\"><span class=\"ez-toc-section\" id=\"4_Profilaxia_prevencao_quando_iniciar_e_com_o_que\"><\/span><strong data-start=\"4224\" data-end=\"4281\">4) Profilaxia (preven\u00e7\u00e3o): quando iniciar e com o qu\u00ea<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<h3 data-start=\"4282\" data-end=\"4321\"><span class=\"ez-toc-section\" id=\"41_Quando_considerar_prevencao\"><\/span><strong data-start=\"4286\" data-end=\"4321\">4.1 Quando considerar preven\u00e7\u00e3o<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p data-start=\"4322\" data-end=\"4501\">Diretriz cl\u00ednica: considerar profilaxia quando h\u00e1 <strong data-start=\"4372\" data-end=\"4399\">\u22654 dias de cefaleia\/m\u00eas<\/strong>, crises muito incapacitantes, contraindica\u00e7\u00f5es a agudos ou MOH. <span class=\"\" data-state=\"closed\"><span class=\"ms-1 inline-flex max-w-full items-center relative top-[-0.094rem] animate-[show_150ms_ease-in]\" data-testid=\"webpage-citation-pill\"><a class=\"flex h-4.5 overflow-hidden rounded-xl px-2 text-[9px] font-medium transition-colors duration-150 ease-in-out text-token-text-secondary! bg-[#F4F4F4]! dark:bg-[#303030]!\" href=\"https:\/\/americanheadachesociety.org\/resources\/primary-care\/preventative-migraine-treatment?utm_source=chatgpt.com\" target=\"_blank\" rel=\"noopener\"><span class=\"relative start-0 bottom-0 flex h-full w-full items-center\"><span class=\"flex h-4 w-full items-center justify-between overflow-hidden\"><span class=\"max-w-[15ch] grow truncate overflow-hidden text-center\">American Headache Society<\/span><\/span><\/span><\/a><\/span><\/span><\/p>\n<h3 data-start=\"4503\" data-end=\"4552\"><span class=\"ez-toc-section\" id=\"42_Opcoes_tradicionais_com_boa_evidencia\"><\/span><strong data-start=\"4507\" data-end=\"4552\">4.2 Op\u00e7\u00f5es tradicionais com boa evid\u00eancia<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n<ul data-start=\"4553\" data-end=\"4788\">\n<li data-start=\"4553\" data-end=\"4592\">\n<p data-start=\"4555\" data-end=\"4592\"><strong data-start=\"4555\" data-end=\"4575\">Betabloqueadores<\/strong> (propranolol),<\/p>\n<\/li>\n<li data-start=\"4593\" data-end=\"4645\">\n<p data-start=\"4595\" data-end=\"4645\"><strong data-start=\"4595\" data-end=\"4626\">Antidepressivos tric\u00edclicos<\/strong> (amitriptilina),<\/p>\n<\/li>\n<li data-start=\"4646\" data-end=\"4788\">\n<p data-start=\"4648\" data-end=\"4788\"><strong data-start=\"4648\" data-end=\"4670\">Anticonvulsivantes<\/strong> (topiramato),<br data-start=\"4684\" data-end=\"4687\" \/>ajustados ao perfil do paciente e com monitoriza\u00e7\u00e3o de efeitos. <span class=\"\" data-state=\"closed\"><span class=\"ms-1 inline-flex max-w-full items-center relative top-[-0.094rem] animate-[show_150ms_ease-in]\" data-testid=\"webpage-citation-pill\"><a class=\"flex h-4.5 overflow-hidden rounded-xl px-2 text-[9px] font-medium transition-colors duration-150 ease-in-out text-token-text-secondary! bg-[#F4F4F4]! dark:bg-[#303030]!\" href=\"https:\/\/americanheadachesociety.org\/resources\/clinicians\/guidelines?utm_source=chatgpt.com\" target=\"_blank\" rel=\"noopener\"><span class=\"relative start-0 bottom-0 flex h-full w-full items-center\"><span class=\"flex h-4 w-full items-center justify-between overflow-hidden\"><span class=\"max-w-[15ch] grow truncate overflow-hidden text-center\">American Headache Society<\/span><\/span><\/span><\/a><\/span><\/span><\/p>\n<\/li>\n<\/ul>\n<h3 data-start=\"4790\" data-end=\"4841\"><span class=\"ez-toc-section\" id=\"43_Terapias_alvo-CGRP_contexto_2024%E2%80%932025\"><\/span><strong data-start=\"4794\" data-end=\"4841\">4.3 Terapias alvo-CGRP (contexto 2024\u20132025)<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p data-start=\"4842\" data-end=\"5230\">Posi\u00e7\u00f5es recentes da comunidade de cefaleias indicam <strong data-start=\"4895\" data-end=\"4917\">terapias anti-CGRP<\/strong> (anticorpos monoclonais e \u201cgepantes\u201d) como op\u00e7\u00f5es efetivas e bem toleradas para preven\u00e7\u00e3o e, em alguns casos, tratamento agudo, com discuss\u00e3o crescente sobre seu uso <strong data-start=\"5084\" data-end=\"5107\">como primeira linha<\/strong> em certos cen\u00e1rios. A ado\u00e7\u00e3o depende de disponibilidade, custo e pol\u00edticas locais. <span class=\"\" data-state=\"closed\"><span class=\"ms-1 inline-flex max-w-full items-center relative top-[-0.094rem] animate-[show_150ms_ease-in]\" data-testid=\"webpage-citation-pill\"><a class=\"flex h-4.5 overflow-hidden rounded-xl px-2 text-[9px] font-medium transition-colors duration-150 ease-in-out text-token-text-secondary! bg-[#F4F4F4]! dark:bg-[#303030]!\" href=\"https:\/\/americanheadachesociety.org\/resources\/clinicians\/guidelines?utm_source=chatgpt.com\" target=\"_blank\" rel=\"noopener\"><span class=\"relative start-0 bottom-0 flex h-full w-full items-center\"><span class=\"flex h-4 w-full items-center justify-between\"><span class=\"max-w-[15ch] grow truncate overflow-hidden text-center\">American Headache Society<\/span><span class=\"-me-1 flex h-full items-center rounded-full px-1 text-[#8F8F8F]\">+2<\/span><\/span><span class=\"flex h-4 w-full items-center justify-between absolute\"><span class=\"max-w-[15ch] grow truncate overflow-hidden text-center\">Verywell Health<\/span><span class=\"-me-1 flex h-full items-center rounded-full px-1 text-[#8F8F8F]\">+2<\/span><\/span><\/span><\/a><\/span><\/span><\/p>\n<blockquote data-start=\"5232\" data-end=\"5374\">\n<p data-start=\"5234\" data-end=\"5374\"><strong data-start=\"5234\" data-end=\"5257\">Nota para o Brasil:<\/strong> a indica\u00e7\u00e3o e a disponibilidade variam no sistema p\u00fablico e privado; siga protocolos nacionais e cobertura do plano.<\/p>\n<\/blockquote>\n<h2 data-start=\"5381\" data-end=\"5432\"><span class=\"ez-toc-section\" id=\"5_Prevencao_nao_farmacologica_com_evidencia\"><\/span><strong data-start=\"5384\" data-end=\"5432\">5) Preven\u00e7\u00e3o n\u00e3o farmacol\u00f3gica com evid\u00eancia<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p data-start=\"5433\" data-end=\"5737\">Higiene do sono, regularidade alimentar (evitar jejum), hidrata\u00e7\u00e3o, redu\u00e7\u00e3o de \u00e1lcool e controle de cafe\u00edna, alongamentos\/atividade f\u00edsica leve e t\u00e9cnicas de relaxamento (respira\u00e7\u00e3o, biofeedback) <strong data-start=\"5629\" data-end=\"5665\">reduzem frequ\u00eancia e intensidade<\/strong> das crises em muitos pacientes. <span class=\"\" data-state=\"closed\"><span class=\"ms-1 inline-flex max-w-full items-center relative top-[-0.094rem] animate-[show_150ms_ease-in]\" data-testid=\"webpage-citation-pill\"><a class=\"flex h-4.5 overflow-hidden rounded-xl px-2 text-[9px] font-medium transition-colors duration-150 ease-in-out text-token-text-secondary! bg-[#F4F4F4]! dark:bg-[#303030]!\" href=\"https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/headache-disorders?utm_source=chatgpt.com\" target=\"_blank\" rel=\"noopener\"><span class=\"relative start-0 bottom-0 flex h-full w-full items-center\"><span class=\"flex h-4 w-full items-center justify-between overflow-hidden\"><span class=\"max-w-[15ch] grow truncate overflow-hidden text-center\">Organiza\u00e7\u00e3o Mundial da Sa\u00fade<\/span><\/span><\/span><\/a><\/span><\/span><\/p>\n<h2 data-start=\"5744\" data-end=\"5820\"><span class=\"ez-toc-section\" id=\"6_Cefaleia_por_uso_excessivo_de_medicacao_MOH_reconhecer_e_tratar\"><\/span><strong data-start=\"5747\" data-end=\"5820\">6) Cefaleia por uso excessivo de medica\u00e7\u00e3o (MOH): reconhecer e tratar<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p data-start=\"5821\" data-end=\"6200\">Crit\u00e9rios de 2024\/2025 apontam MOH quando h\u00e1 dor em <strong data-start=\"5873\" data-end=\"5889\">\u226515 dias\/m\u00eas<\/strong> por <strong data-start=\"5894\" data-end=\"5906\">\u22653 meses<\/strong> com uso excessivo de medica\u00e7\u00e3o aguda (\u226510 dias\/m\u00eas para triptanos\/opioides\/combina\u00e7\u00f5es; \u226515 dias\/m\u00eas para analg\u00e9sicos simples). O manejo envolve <strong data-start=\"6052\" data-end=\"6081\">redu\u00e7\u00e3o\/suspens\u00e3o gradual<\/strong>, <strong data-start=\"6083\" data-end=\"6111\">introdu\u00e7\u00e3o de profilaxia<\/strong> e acompanhamento pr\u00f3ximo para prevenir reca\u00eddas. <span class=\"\" data-state=\"closed\"><span class=\"ms-1 inline-flex max-w-full items-center relative top-[-0.094rem] animate-[show_150ms_ease-in]\" data-testid=\"webpage-citation-pill\"><a class=\"flex h-4.5 overflow-hidden rounded-xl px-2 text-[9px] font-medium transition-colors duration-150 ease-in-out text-token-text-secondary! bg-[#F4F4F4]! dark:bg-[#303030]!\" href=\"https:\/\/www.mdpi.com\/2075-1729\/14\/9\/1146?utm_source=chatgpt.com\" target=\"_blank\" rel=\"noopener\"><span class=\"relative start-0 bottom-0 flex h-full w-full items-center\"><span class=\"flex h-4 w-full items-center justify-between\"><span class=\"max-w-[15ch] grow truncate overflow-hidden text-center\">MDPI<\/span><span class=\"-me-1 flex h-full items-center rounded-full px-1 text-[#8F8F8F]\">+1<\/span><\/span><\/span><\/a><\/span><\/span><\/p>\n<h2 data-start=\"6207\" data-end=\"6259\"><span class=\"ez-toc-section\" id=\"7_Quando_pedir_exames_de_imagem_e_encaminhar\"><\/span><strong data-start=\"6210\" data-end=\"6259\">7) Quando pedir exames de imagem e encaminhar<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p data-start=\"6260\" data-end=\"6647\">Exames (RM ou TC) s\u00e3o reservados a casos com red flags, mudan\u00e7a de padr\u00e3o, in\u00edcio ap\u00f3s 50 anos, d\u00e9ficit neurol\u00f3gico, trauma, imunossupress\u00e3o ou suspeita de cefaleia secund\u00e1ria (sinusite complicada, tumores, doen\u00e7a vascular). Encaminhar ao <strong data-start=\"6499\" data-end=\"6515\">neurologista<\/strong> em cefaleia frequente refrat\u00e1ria, suspeita de enxaqueca cr\u00f4nica, cefaleia em salvas ou MOH. <span class=\"\" data-state=\"closed\"><span class=\"ms-1 inline-flex max-w-full items-center relative top-[-0.094rem] animate-[show_150ms_ease-in]\" data-testid=\"webpage-citation-pill\"><a class=\"flex h-4.5 overflow-hidden rounded-xl px-2 text-[9px] font-medium transition-colors duration-150 ease-in-out text-token-text-secondary! bg-[#F4F4F4]! dark:bg-[#303030]!\" href=\"https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/headache-disorders?utm_source=chatgpt.com\" target=\"_blank\" rel=\"noopener\"><span class=\"relative start-0 bottom-0 flex h-full w-full items-center\"><span class=\"flex h-4 w-full items-center justify-between overflow-hidden\"><span class=\"max-w-[15ch] grow truncate overflow-hidden text-center\">Organiza\u00e7\u00e3o Mundial da Sa\u00fade<\/span><\/span><\/span><\/a><\/span><\/span><\/p>\n<h2 data-start=\"6654\" data-end=\"6712\"><span class=\"ez-toc-section\" id=\"8_Recomendacoes_praticas_para_2025_passo_a_passo\"><\/span><strong data-start=\"6657\" data-end=\"6712\">8) Recomenda\u00e7\u00f5es pr\u00e1ticas para 2025 (passo a passo)<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<ol data-start=\"6713\" data-end=\"7504\">\n<li data-start=\"6713\" data-end=\"6818\">\n<p data-start=\"6716\" data-end=\"6818\"><strong data-start=\"6716\" data-end=\"6742\">Classifique a cefaleia<\/strong> (ICHD-3) e identifique red flags. <span class=\"\" data-state=\"closed\"><span class=\"ms-1 inline-flex max-w-full items-center relative top-[-0.094rem] animate-[show_150ms_ease-in]\" data-testid=\"webpage-citation-pill\"><a class=\"flex h-4.5 overflow-hidden rounded-xl px-2 text-[9px] font-medium transition-colors duration-150 ease-in-out text-token-text-secondary! bg-[#F4F4F4]! dark:bg-[#303030]!\" href=\"https:\/\/ichd-3.org\/?utm_source=chatgpt.com\" target=\"_blank\" rel=\"noopener\"><span class=\"relative start-0 bottom-0 flex h-full w-full items-center\"><span class=\"flex h-4 w-full items-center justify-between overflow-hidden\"><span class=\"max-w-[15ch] grow truncate overflow-hidden text-center\">ICHD-3<\/span><\/span><\/span><\/a><\/span><\/span><\/p>\n<\/li>\n<li data-start=\"6819\" data-end=\"6939\">\n<p data-start=\"6822\" data-end=\"6939\"><strong data-start=\"6822\" data-end=\"6859\">Eduque e adote di\u00e1rio de cefaleia<\/strong> para mapear gatilhos\/uso de f\u00e1rmacos. <span class=\"\" data-state=\"closed\"><span class=\"ms-1 inline-flex max-w-full items-center relative top-[-0.094rem] animate-[show_150ms_ease-in]\" data-testid=\"webpage-citation-pill\"><a class=\"flex h-4.5 overflow-hidden rounded-xl px-2 text-[9px] font-medium transition-colors duration-150 ease-in-out text-token-text-secondary! bg-[#F4F4F4]! dark:bg-[#303030]!\" href=\"https:\/\/www.mdpi.com\/2075-1729\/14\/9\/1146?utm_source=chatgpt.com\" target=\"_blank\" rel=\"noopener\"><span class=\"relative start-0 bottom-0 flex h-full w-full items-center\"><span class=\"flex h-4 w-full items-center justify-between overflow-hidden\"><span class=\"max-w-[15ch] grow truncate overflow-hidden text-center\">MDPI<\/span><\/span><\/span><\/a><\/span><\/span><\/p>\n<\/li>\n<li data-start=\"6940\" data-end=\"7049\">\n<p data-start=\"6943\" data-end=\"7049\"><strong data-start=\"6943\" data-end=\"6967\">Crise leve\/moderada:<\/strong> paracetamol ou AINE; use cedo na crise. <span class=\"\" data-state=\"closed\"><span class=\"ms-1 inline-flex max-w-full items-center relative top-[-0.094rem] animate-[show_150ms_ease-in]\" data-testid=\"webpage-citation-pill\"><a class=\"flex h-4.5 overflow-hidden rounded-xl px-2 text-[9px] font-medium transition-colors duration-150 ease-in-out text-token-text-secondary! bg-[#F4F4F4]! dark:bg-[#303030]!\" href=\"https:\/\/americanheadachesociety.org\/resources\/primary-care\/acute-treatment-for-migraine?utm_source=chatgpt.com\" target=\"_blank\" rel=\"noopener\"><span class=\"relative start-0 bottom-0 flex h-full w-full items-center\"><span class=\"flex h-4 w-full items-center justify-between overflow-hidden\"><span class=\"max-w-[15ch] grow truncate overflow-hidden text-center\">American Headache Society<\/span><\/span><\/span><\/a><\/span><\/span><\/p>\n<\/li>\n<li data-start=\"7050\" data-end=\"7162\">\n<p data-start=\"7053\" data-end=\"7162\"><strong data-start=\"7053\" data-end=\"7082\">Enxaqueca moderada\/grave:<\/strong> triptanos; evite opioides\/butalbital. <span class=\"\" data-state=\"closed\"><span class=\"ms-1 inline-flex max-w-full items-center relative top-[-0.094rem] animate-[show_150ms_ease-in]\" data-testid=\"webpage-citation-pill\"><a class=\"flex h-4.5 overflow-hidden rounded-xl px-2 text-[9px] font-medium transition-colors duration-150 ease-in-out text-token-text-secondary! bg-[#F4F4F4]! dark:bg-[#303030]!\" href=\"https:\/\/americanheadachesociety.org\/resources\/primary-care\/acute-treatment-for-migraine?utm_source=chatgpt.com\" target=\"_blank\" rel=\"noopener\"><span class=\"relative start-0 bottom-0 flex h-full w-full items-center\"><span class=\"flex h-4 w-full items-center justify-between\"><span class=\"max-w-[15ch] grow truncate overflow-hidden text-center\">American Headache Society<\/span><span class=\"-me-1 flex h-full items-center rounded-full px-1 text-[#8F8F8F]\">+1<\/span><\/span><\/span><\/a><\/span><\/span><\/p>\n<\/li>\n<li data-start=\"7163\" data-end=\"7320\">\n<p data-start=\"7166\" data-end=\"7320\"><strong data-start=\"7166\" data-end=\"7193\">Frequ\u00eancia \u22654 dias\/m\u00eas:<\/strong> discutir <strong data-start=\"7203\" data-end=\"7217\">profilaxia<\/strong> (tradicionais ou anti-CGRP conforme elegibilidade e acesso). <span class=\"\" data-state=\"closed\"><span class=\"ms-1 inline-flex max-w-full items-center relative top-[-0.094rem] animate-[show_150ms_ease-in]\" data-testid=\"webpage-citation-pill\"><a class=\"flex h-4.5 overflow-hidden rounded-xl px-2 text-[9px] font-medium transition-colors duration-150 ease-in-out text-token-text-secondary! bg-[#F4F4F4]! dark:bg-[#303030]!\" href=\"https:\/\/americanheadachesociety.org\/resources\/primary-care\/preventative-migraine-treatment?utm_source=chatgpt.com\" target=\"_blank\" rel=\"noopener\"><span class=\"relative start-0 bottom-0 flex h-full w-full items-center\"><span class=\"flex h-4 w-full items-center justify-between\"><span class=\"max-w-[15ch] grow truncate overflow-hidden text-center\">American Headache Society<\/span><span class=\"-me-1 flex h-full items-center rounded-full px-1 text-[#8F8F8F]\">+1<\/span><\/span><\/span><\/a><\/span><\/span><\/p>\n<\/li>\n<li data-start=\"7321\" data-end=\"7422\">\n<p data-start=\"7324\" data-end=\"7422\"><strong data-start=\"7324\" data-end=\"7338\">Evite MOH:<\/strong> limite dias de uso de agudos (10\u201315\/m\u00eas). <span class=\"\" data-state=\"closed\"><span class=\"ms-1 inline-flex max-w-full items-center relative top-[-0.094rem] animate-[show_150ms_ease-in]\" data-testid=\"webpage-citation-pill\"><a class=\"flex h-4.5 overflow-hidden rounded-xl px-2 text-[9px] font-medium transition-colors duration-150 ease-in-out text-token-text-secondary! bg-[#F4F4F4]! dark:bg-[#303030]!\" href=\"https:\/\/thejournalofheadacheandpain.biomedcentral.com\/articles\/10.1186\/s10194-024-01755-w?utm_source=chatgpt.com\" target=\"_blank\" rel=\"noopener\"><span class=\"relative start-0 bottom-0 flex h-full w-full items-center\"><span class=\"flex h-4 w-full items-center justify-between overflow-hidden\"><span class=\"max-w-[15ch] grow truncate overflow-hidden text-center\">BioMed Central<\/span><\/span><\/span><\/a><\/span><\/span><\/p>\n<\/li>\n<li data-start=\"7423\" data-end=\"7504\">\n<p data-start=\"7426\" data-end=\"7504\"><strong data-start=\"7426\" data-end=\"7453\">Reavalie periodicamente<\/strong> efic\u00e1cia, ades\u00e3o e eventos adversos; ajuste plano.<\/p>\n<\/li>\n<\/ol>\n<h2 data-start=\"7511\" data-end=\"7557\"><span class=\"ez-toc-section\" id=\"9_Recomendacoes_no_contexto_brasileiro\"><\/span><strong data-start=\"7514\" data-end=\"7557\">9) Recomenda\u00e7\u00f5es no contexto brasileiro<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p data-start=\"7558\" data-end=\"7927\">Protocolos do <strong data-start=\"7572\" data-end=\"7595\">Minist\u00e9rio da Sa\u00fade<\/strong> e rede p\u00fablica orientam manejo estruturado, educa\u00e7\u00e3o do paciente e encaminhamento quando necess\u00e1rio; hospitais universit\u00e1rios e servi\u00e7os de neurologia\/cefaleia no SUS refor\u00e7am condutas baseadas em evid\u00eancias e uso racional de f\u00e1rmacos. Verifique PCDTs vigentes e fluxos de refer\u00eancia locais.<\/p>\n<h2 data-start=\"7934\" data-end=\"7976\"><span class=\"ez-toc-section\" id=\"10_Perguntas_para_levar_a_consulta\"><\/span><strong data-start=\"7937\" data-end=\"7976\">10) Perguntas para levar \u00e0 consulta<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<ul data-start=\"7977\" data-end=\"8295\">\n<li data-start=\"7977\" data-end=\"8045\">\n<p data-start=\"7979\" data-end=\"8045\">Meu quadro \u00e9 mais compat\u00edvel com <strong data-start=\"8012\" data-end=\"8025\">tensional<\/strong> ou <strong data-start=\"8029\" data-end=\"8042\">enxaqueca<\/strong>?<\/p>\n<\/li>\n<li data-start=\"8046\" data-end=\"8107\">\n<p data-start=\"8048\" data-end=\"8107\"><strong data-start=\"8048\" data-end=\"8072\">Quantos dias por m\u00eas<\/strong> estou usando medica\u00e7\u00e3o de crise?<\/p>\n<\/li>\n<li data-start=\"8108\" data-end=\"8183\">\n<p data-start=\"8110\" data-end=\"8183\">Tenho indica\u00e7\u00e3o de <strong data-start=\"8129\" data-end=\"8143\">profilaxia<\/strong>? Quais op\u00e7\u00f5es fazem sentido para mim?<\/p>\n<\/li>\n<li data-start=\"8184\" data-end=\"8259\">\n<p data-start=\"8186\" data-end=\"8259\">H\u00e1 <strong data-start=\"8189\" data-end=\"8201\">gatilhos<\/strong> claros (sono, jejum, ciclo, cafe\u00edna) que posso manejar?<\/p>\n<\/li>\n<li data-start=\"8260\" data-end=\"8295\">\n<p data-start=\"8262\" data-end=\"8295\">Preciso de algum <strong data-start=\"8279\" data-end=\"8288\">exame<\/strong> agora?<\/p>\n<\/li>\n<\/ul>\n<hr data-start=\"8297\" data-end=\"8300\" \/>\n<h2 data-start=\"8302\" data-end=\"8335\"><span class=\"ez-toc-section\" id=\"FAQ_%E2%80%93_Perguntas_Frequentes\"><\/span><strong data-start=\"8305\" data-end=\"8335\">FAQ \u2013 Perguntas Frequentes<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p data-start=\"8337\" data-end=\"8880\"><strong data-start=\"8337\" data-end=\"8396\">1) \u201cTenho dor de cabe\u00e7a quase todo dia. Isso \u00e9 normal?\u201d<\/strong><br data-start=\"8396\" data-end=\"8399\" \/>N\u00e3o. Dor de cabe\u00e7a frequente (\u226515 dias\/m\u00eas por 3 meses) merece avalia\u00e7\u00e3o. Pode haver <strong data-start=\"8484\" data-end=\"8505\">enxaqueca cr\u00f4nica<\/strong>, <strong data-start=\"8507\" data-end=\"8539\">cefaleia tensional frequente<\/strong> ou <strong data-start=\"8543\" data-end=\"8550\">MOH<\/strong> por uso excessivo de analg\u00e9sicos. O m\u00e9dico ir\u00e1 classificar seu tipo de cefaleia, revisar o padr\u00e3o de uso de rem\u00e9dios e, se necess\u00e1rio, iniciar <strong data-start=\"8694\" data-end=\"8708\">profilaxia<\/strong> e plano de retirada gradual dos f\u00e1rmacos de crise. Manter um <strong data-start=\"8770\" data-end=\"8792\">di\u00e1rio da cefaleia<\/strong> ajuda muito no diagn\u00f3stico e no acompanhamento.<\/p>\n<p data-start=\"8882\" data-end=\"9414\"><strong data-start=\"8882\" data-end=\"8930\">2) \u201cQuando devo come\u00e7ar rem\u00e9dio preventivo?\u201d<\/strong><br data-start=\"8930\" data-end=\"8933\" \/>As recomenda\u00e7\u00f5es sugerem discutir preven\u00e7\u00e3o quando voc\u00ea tem <strong data-start=\"8993\" data-end=\"9031\">quatro ou mais dias de dor por m\u00eas<\/strong>, crises incapacitantes, contraindica\u00e7\u00f5es a tratamentos agudos ou suspeita de MOH. Op\u00e7\u00f5es incluem <strong data-start=\"9129\" data-end=\"9171\">propranolol, amitriptilina, topiramato<\/strong> e, conforme elegibilidade\/acesso, terapias <strong data-start=\"9215\" data-end=\"9228\">anti-CGRP<\/strong>. A decis\u00e3o \u00e9 individual, considerando comorbidades, gravidez, poss\u00edveis efeitos e prefer\u00eancias. Reavalia\u00e7\u00e3o peri\u00f3dica (8\u201312 semanas) \u00e9 essencial.<\/p>\n<p data-start=\"9416\" data-end=\"9837\"><strong data-start=\"9416\" data-end=\"9468\">3) \u201cPosso usar triptano sempre que a crise vem?\u201d<\/strong><br data-start=\"9468\" data-end=\"9471\" \/>Triptanos s\u00e3o excelentes para <strong data-start=\"9501\" data-end=\"9531\">enxaqueca moderada a grave<\/strong>, sobretudo se tomados cedo na crise. Por\u00e9m, limite o uso a <strong data-start=\"9591\" data-end=\"9607\">&lt;10 dias\/m\u00eas<\/strong> para evitar <strong data-start=\"9620\" data-end=\"9627\">MOH<\/strong>. Pessoas com doen\u00e7a cardiovascular precisam de alternativas. Se as crises s\u00e3o muito frequentes, converse sobre <strong data-start=\"9739\" data-end=\"9753\">profilaxia<\/strong> para depender menos de rem\u00e9dios de resgate.<\/p>\n<p data-start=\"9839\" data-end=\"10291\"><strong data-start=\"9839\" data-end=\"9902\">4) \u201cQuais h\u00e1bitos realmente ajudam a reduzir a frequ\u00eancia?\u201d<\/strong><br data-start=\"9902\" data-end=\"9905\" \/>Sono regular, <strong data-start=\"9919\" data-end=\"9935\">evitar jejum<\/strong>, hidrata\u00e7\u00e3o, modera\u00e7\u00e3o de cafe\u00edna\/\u00e1lcool, atividade f\u00edsica leve e t\u00e9cnicas de relaxamento t\u00eam boa evid\u00eancia para reduzir chances de crise. Identificar e manejar <strong data-start=\"10097\" data-end=\"10118\">gatilhos pessoais<\/strong> (odores fortes, priva\u00e7\u00e3o de sono, ciclo menstrual) \u00e9 parte central do sucesso. Use <strong data-start=\"10202\" data-end=\"10212\">di\u00e1rio<\/strong> para mapear padr\u00f5es e leve \u00e0 consulta.<\/p>\n<p data-start=\"10293\" data-end=\"10760\"><strong data-start=\"10293\" data-end=\"10358\">5) \u201cComo saber se estou com cefaleia por abuso de medica\u00e7\u00e3o?\u201d<\/strong><br data-start=\"10358\" data-end=\"10361\" \/>Sinais t\u00edpicos: dor quase di\u00e1ria, al\u00edvio curto ap\u00f3s tomar o rem\u00e9dio e retorno r\u00e1pido da dor; hist\u00f3rico de uso <strong data-start=\"10471\" data-end=\"10490\">\u226510\u201315 dias\/m\u00eas<\/strong> por 3 meses (varia com a classe). O tratamento envolve <strong data-start=\"10546\" data-end=\"10567\">reduzir\/suspender<\/strong> o f\u00e1rmaco em excesso, <strong data-start=\"10590\" data-end=\"10612\">iniciar profilaxia<\/strong> e ter seguimento pr\u00f3ximo para evitar reca\u00eddas. N\u00e3o interrompa por conta pr\u00f3pria: fa\u00e7a plano com seu m\u00e9dico.<\/p>\n<p data-start=\"10762\" data-end=\"11195\"><strong data-start=\"10762\" data-end=\"10837\">6) \u201cPreciso fazer resson\u00e2ncia para investigar dor de cabe\u00e7a frequente?\u201d<\/strong><br data-start=\"10837\" data-end=\"10840\" \/>Nem sempre. Na maioria dos casos sem <strong data-start=\"10877\" data-end=\"10890\">red flags<\/strong>, o diagn\u00f3stico \u00e9 <strong data-start=\"10908\" data-end=\"10919\">cl\u00ednico<\/strong>. Exames s\u00e3o indicados quando h\u00e1 in\u00edcio brusco e muito intenso, sinais neurol\u00f3gicos, idade &gt;50 com novo padr\u00e3o, trauma, c\u00e2ncer, imunossupress\u00e3o ou suspeita de causas secund\u00e1rias (p.ex., sinusite complicada). O m\u00e9dico avalia caso a caso.<\/p>\n<p data-start=\"11197\" data-end=\"11645\"><strong data-start=\"11197\" data-end=\"11240\">7) \u201cTerapias anti-CGRP s\u00e3o para todos?\u201d<\/strong><br data-start=\"11240\" data-end=\"11243\" \/>N\u00e3o. S\u00e3o op\u00e7\u00f5es eficazes e geralmente bem toleradas, mas <strong data-start=\"11300\" data-end=\"11342\">custo, acesso e crit\u00e9rios de cobertura<\/strong> limitam seu uso universal. Em 2024\u20132025, entidades de cefaleia discutem seu papel como <strong data-start=\"11430\" data-end=\"11448\">primeira linha<\/strong> em determinados perfis, enquanto outras diretrizes preferem tentar f\u00e1rmacos tradicionais antes. Decis\u00e3o compartilhada com o especialista \u00e9 o melhor caminho.<\/p>\n<p data-start=\"11647\" data-end=\"12132\"><strong data-start=\"11647\" data-end=\"11714\">8) \u201cQual \u00e9 o papel do neurologista na dor de cabe\u00e7a frequente?\u201d<\/strong><br data-start=\"11714\" data-end=\"11717\" \/>O neurologista confirma a <strong data-start=\"11743\" data-end=\"11760\">classifica\u00e7\u00e3o<\/strong> da cefaleia, ajuda a ajustar o tratamento agudo, indica <strong data-start=\"11817\" data-end=\"11831\">profilaxia<\/strong> quando necess\u00e1rio, monitora efeitos colaterais e previne <strong data-start=\"11889\" data-end=\"11896\">MOH<\/strong>. Tamb\u00e9m define quando investigar com exames e quando considerar terapias avan\u00e7adas (como toxina botul\u00ednica para enxaqueca cr\u00f4nica). O seguimento peri\u00f3dico aumenta a chance de controle sustentado.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>A dor de cabe\u00e7a frequente exige mais do que analg\u00e9sicos  [&#8230;]<\/p>\n","protected":false},"author":2,"featured_media":4599,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[320],"tags":[321,322,293,294],"class_list":["post-1806","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-dor-de-cabeca","tag-dor-de-cabeca","tag-neurologia","tag-sintomas","tag-tratamentos"],"_links":{"self":[{"href":"https:\/\/med-br.com\/medicosbr\/wp-json\/wp\/v2\/posts\/1806","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/med-br.com\/medicosbr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/med-br.com\/medicosbr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/med-br.com\/medicosbr\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/med-br.com\/medicosbr\/wp-json\/wp\/v2\/comments?post=1806"}],"version-history":[{"count":3,"href":"https:\/\/med-br.com\/medicosbr\/wp-json\/wp\/v2\/posts\/1806\/revisions"}],"predecessor-version":[{"id":5407,"href":"https:\/\/med-br.com\/medicosbr\/wp-json\/wp\/v2\/posts\/1806\/revisions\/5407"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/med-br.com\/medicosbr\/wp-json\/wp\/v2\/media\/4599"}],"wp:attachment":[{"href":"https:\/\/med-br.com\/medicosbr\/wp-json\/wp\/v2\/media?parent=1806"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/med-br.com\/medicosbr\/wp-json\/wp\/v2\/categories?post=1806"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/med-br.com\/medicosbr\/wp-json\/wp\/v2\/tags?post=1806"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}