Chronic migraine is a severe neurological disorder characterized by the presence of headache for 15 or more days/ month, for more than three months. Pain, on at least eight days/month, has the features of migraine. Pain is often intense, disabling and resistant to the usual treatments. Other disorders such as phono photophobia, nausea-vomiting, diarrhea, sleep and mood disorders can be found in combination with chronic migraine pain. The long-lasting migraine pain may be favored by the presence of factors such as hormonal changes in the menstrual period, or states of anxiety, stress, mood deflection, or overuse of symptomatic drugs with rebound effect.

We report the case of a 14 year-old female patient, with positive familiarity for migraine, which was brought to our observation for the presence of chronic headache with daily frequency migraine-like attacks, highly disabling and resistant to pharmacotherapy. During the hospitalization, a wash-out of the pharmacotherapy was performed, associated with the autogenous training, muscular relaxation exercises, psychological support and introduction of Lamotrigine for prophylactic therapy. Our patient showed a considerable amelioration with this multidisciplinary approach.

Study Objective: To observe the effect of hydroxyzine used for premedication on fentanyl -induced cough during induction of anesthesia.

Design: Prospective, randomized, single -blinded, clinical trial.

Setting: Department of Pediatric Surgery and operating room of a Training and Research Hospital.

Patients: 90 ASA physical status I pediatric patients, aged 3 and 12 years, scheduled for elective surgery during general anesthesia.

Interventions: Patients were randomized into one of two groups: a control group (Group C) and a hydroxyzine group (Group H). Group H patients were given 1 mg kg -1 hydroxyzine with 10 ml water to drink 2 h before surgery. No premedication was performed on Group C patients. In both groups 2 µg kg -1 fentanyliv were given for 3 sec to patients before induction of anesthesia.

Measurements: Patients sedation states were evaluated using the Ramsay Sedation Scale (RSS) in the operating room. The presence, onset and severity of cough were recorded.

Main Results: The incidences of cough were 11.1% in Group H and 51.1% in Group C (p<0.0001). All coughs in Group H were mild. In Group C, however, 24.4% of coughs were mild, 15.6% were moderate and 11.1% were severe. Significant differences were observed between the two groups in terms of moderate and severe cough (p=0.026 and p=0.028, respectively). RSS was significantly in favor of Group H (p<0.0001). When patients were given hydroxyzine an absolute risk reduction of -0.4 and a relative risk reduction of -0.78 were observed compared to the control group, and the number needed to treat was -2.5.

Conclusion: Hydroxyzine administered orally during the preoperative period is effective in preventing both the incidence and severity of fentanyl -induced cough in child patients. Our results demonstrate that hydroxyzine is a suitable drug for reducing this cough.