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Background: Headache is a very common complaint and it is increasingly prevalent among university students. Tinnitus consists of subjectively perceived sounds that occur in the absence of an external auditory signal. Presence of headache and tinnitus in association has implications for therapy and prognosis, because this describes the temporality of the symptoms. Recognition of the epidemiological profile of symptomatic students might contribute to interventions. Objective: To investigate the prevalence of the association between headache and tinnitus, and to describe the epidemiological profile of the study population and the chronological order of appearance of these symptoms. Methods: Cross-sectional, observational and analytical study on a sample representative of an academic center. Data referring to the epidemiological and clinical profile of headache and tinnitus among medical students were collected through an online questionnaire built using the Google Forms tool. Results: Out of the 234 participants, 26.1% reported having tinnitus and headache (p < 0.001). The participants with headache were more likely to be women (p = 0.045), white (p = 0.009) and 21-25 years old (p = 0.356). Among right-sided, left-sided and non-unilateral headaches, tinnitus was present predominantly in the non-unilateral type, but without statistical significance. Regarding timing, 18.0% of the students said that tinnitus started before headache, 57.4% said that headache started before tinnitus and 24.6% said that they started simultaneously. Conclusions: An important association between headache and tinnitus regarding lateralization and temporality was demonstrated. Thus, these data match the presumption that headache and tinnitus have a physiopathological connection. RESUMO Antecedentes: A cefaleia é uma queixa muito frequente e a prevalência em estudantes universitários vem sendo cada vez mais comum. Os zumbidos constituem percepções subjetivas de sons que acontecem na ausência de um sinal auditivo externo ou não. A correlação desses sintomas é importante para fins terapêuticos e prognóstico, pois descrever a temporalidade dos sintomas e conhecer o perfil epidemiológico dos estudantes sintomáticos pode contribuir com intervenções. Objetivo: Investigar a prevalência da relação da cefaleia e zumbido, descrever o perfil epidemiológico da população estudada e a ordem temporal do aparecimento desses dois sintomas. Métodos: Estudo de corte transversal, observacional e analítico representativo de um centro acadêmico. Foram coletados dados referentes ao perfil epidemiológico e clínico da cefaleia e zumbido entre acadêmicos de Medicina, por meio de um questionário online construído na ferramenta Google Forms. Resultados: Dos 234 participantes, 26,1% relataram a presença de zumbido e cefaleia. Os participantes com cefaleia apresentaram maior probabilidade de serem mulheres, da raça branca e ter entre 21-25 anos. Dentre as cefaleias sem unilateralidade, as localizadas à direita e as localizadas à esquerda, o zumbido predominou no tipo sem unilateralidade, entretanto sem significância estatística. Observou-se que 18,0% dos acadêmicos relataram o início do zumbido antes da cefaleia, 57,4% relataram o início da cefaleia antes do zumbido, e 24,6% início simultâneo. Conclusões: Foi demonstrada uma importante relação entre cefaleia e zumbido acerca da lateralidade e temporalidade. Assim, esses dados se encaixam na presunção de que a cefaleia e o zumbido possuem uma ligação fisiopatológica.

Introduction: The frontal osteomyelitis is a complication of rhinosinusitis which can evolve to acute or chronicle. There is inflammatory reaction by the increasing of intraosseous pressure, ischemia and local necrosis, leading to bone abscess formation. There is no drainage, it will occur detachment of the periosteum, soft tissue invasion and worsening of ischemia with subsequent bone sequestration. Method: Case report of an inpatient in an emergency service of another institution by the complication of rhinosinusitis who was referred to the Otorhinolaryngology Service of University Hospital Professor Edgard Santos of Federal University of Bahia. Case Report: Male patient, 16 years-old, presented himself to the ER of another institution with cephalea, vomits and fever which evolved to periorbital edema and frontal to the left, moving to palpebral fluctuation and frontal. Subjected to frontal and palpebral abscess drainage, with broad-spectrum antibiotic therapy with no improvement. He was referred to our service keeping edema and fluctuation in region frontal and light edema in left periorbital region. The nasal endoscopy showed edema in meatus to the left and the computerized tomography showed fronto-ethmoid sinusitis to the left and signs of frontal osteomyelitis with bone sequestration and epidural empyema. Subjected to sinasal endoscopy surgery, external Access or removal of the frontal one affected and epidural empyema drainage. Evolved to the remission of the disease. Final Considerations: Failure in the diagnosis and rhinosinusitis complication treatment can lead to sequalae and fatal complications. The diagnosis of the frontal osteomyelitis is confirmed by the clinical suspicion and confirmed by radiological examination. The surgery is indicated when the evolution is insidious, there is bone sequestration and intracranial complications.

Summary Introduction: Among the rhinosinusitis complications, the orbital are the most frequent ones, occurring mostly in the youngsters and children. Simultaneous complications involving the intracranial orbit and space are extremely rare, but they must be severely treated for they have a high rate of morbidity and mortality. Case report: In this work, the authors report a case of a patient who appeared to have preseptal cellulites and epidural abscess, in the form of simultaneous complications of an acute rhinosinusitis. In the patient of this case, choice was made for a clinic treatment associated with a nasosinusal endoscopic surgery and neurosurgical drainage of the intracranial abscess. CT was enough to achieve the diagnosis of this case. Final commentaries: However, it is recommended that, in cases where patients have rhinosinusitis complications, an extensive intracranial investigation needs to be deepened even when this is not so evident in the beginning. Given the polymicrobial nature of these infections, an aggressive culture-guided antibiotic therapy and a multidisciplinary follow-up significantly increase the likelihood of success.

Studies on the prevalence of headache in systemic lupus erythematosus (SLE) have shown that it varies from 32 to 78%. The purpose of our study was to determine the prevalence and characteristics of headache in SLE compared with patients with different types of diffuse connective tissue diseases (DCTD) and its relationship with clinical and laboratory manifestations of SLE. We studied patients with SLE (SLE group) and patients with DCTD (control group). All patients were made to answer questionnaire to assess the presence of headache, characterized by at least five episodes of headache during the last year, which was classified according to the International Headache Society criteria. A total of 207 patients were studied, 115 in SLE group and 92 in the control group. The 1-year prevalence of headache was 75.7% in SLE group and 66% in the control group. When the groups were analyzed, 66.1% met the diagnostic criteria for migraine in the SLE group compared with 52.2% in the control group (p=0.04) and 13.9% for tension-type headache in SLE group compared with 16.3% in the control group. The former was the only variable that reached statistical significance comparing the two groups. Both headache and migraine were associated with Raynaud's phenomenon in SLE patients (odds ratio of 2.80, 95% confidence interval: 1.11-7.05, p=0.02 and odds ratio of 2.34, 95% confidence interval: 1.04-5.23, p=0.03, respectively). These results suggest that headache is a common manifestation in SLE and in other DCTD and we cannot exclude the possibility that it may be related to the emotional stress induced by such clinical situations.

Kikuchi-Fujimoto's disease (KFD) or histiocytic necrotising lymphadenitis is a benign and self-limited disease, of unknown aetiology, which affects mainly young women. It presents with localised lymphadenopathy, predominantly in the cervical region, accompanied by fever and leukopenia in up to 50% of the cases. KFD has been rarely described in association with systemic lupus erythematosus (SLE), and its diagnosis can precede, postdate or coincide with the diagnosis of SLE. We present a patient with the diagnosis of SLE characterised by arthritis, leukopenia, malar rash, photosensitivity and positive ANA, besides cervical lymphadenopathy whose biopsy was compatible with KFD, which improved after using prednisone. Although the presence of lymphadenopathy is not uncommon in SLE patients, particularly in the phases of disease activity, the concomitance with KFD has rarely been reported in the literature. Its recognition is necessary because one can avoid laborious investigation for infectious and lymphoproliferative diseases.