info@puravidaquiropractica.com

(+34) 93 265 05 93

C/ Bruc 71, Bajo - 08009 - Barcelona

SORSI

Galardonado con el premio anual CHIROPRACTIC 2016 SORSI AWARD
por su trabajo con el avance de la Quiropráctica en Europa


¿Realmente ayuda el cuidado quiropráctico a los adultos con dolores de cabeza o migrañas?

 

Esta es una pregunta muy válida que ha sido planteada por muchas personas, incluyendo médicos y científicos.  Según un estudio basado en la evidencia realizado sobre una búsqueda sistémica de documentación y estudios publicados en revistas científicas durante los últimos 50 años, se encontraron pruebas suficientes para apoyar la efectividad de la atención quiropráctica para el tratamiento de la migraña y las cefaleas cervicogénicas.  En el 2011 el Journal of Manipulative Physical Theraphy publicó su hallazgo compuesto por 21 artículos que cumplían con los criterios y fueron usados para mostrar la eficacia del cuidado quiropráctico para dolores de cabeza y migrañas.

Causa de migrañas:

Existen muchos posibles detonantes para la migraña, incluyendo factores hormonales, emocionales, físicos, alimenticios, ambientales y medicinales.

Cambios hormonales:

Algunas mujeres padecen migrañas en el momento de su período, posiblemente debido a cambios en los niveles de hormonas como el estrógeno en ese momento.

Factores desencadenantes emocionales:

  • estrés
  • ansiedad
  • tensión
  • shock
  • depresión
  • excitación

Factores desencadenantes físicos:

  • fatiga
  • mala calidad del sueño.
  • trabajos por turnos
  • mala postura
  • tensión en el cuello o en los hombros
  • jet lag
  • nivel bajo de azúcar en la sangre (hipoglucemia)
  • Ejercicio extenuante, si no está acostumbrado.

Factores desencadenantes de la dieta:

  • saltarse comidas, retrasarlas o hacerlas de forma irregular
  • deshidratación
  • alcohol
  • el aditivo alimentario: tiramina
  • productos con cafeína, como el té y el café
  • alimentos específicos como el chocolate, los cítricos y el queso

Desencadenantes ambientales:

  • luces brillantes
  • pantallas parpadeantes, como un televisor o una pantalla de ordenador.
  • fumar (o habitaciones con humo)
  • ruidos altos
  • cambios en el clima, como cambios de humedad o temperaturas muy frías
  • olores fuertes

Medicación:

  • algunos tipos de pastillas para dormir
  • la píldora anticonceptiva combinada
  • terapia de reemplazo hormonal (HRT, por sus siglas en inglés), la cual algunas veces se usa para aliviar los síntomas asociados con la menopausia.

¿Cuáles son los síntomas de las migrañas?

  • dolor en un lado o en ambos lados de la cabeza
  • dolor que se siente latiendo o palpitando
  • sensibilidad a la luz, los sonidos y, a veces, a los olores y al tacto
  • náuseas y vómitos
  • visión borrosa
  • mareo, algunas veces seguido de desmayos

migrañasCausa de dolores de cabeza cervicogénicos:

La causa de un dolor de cabeza cervicogénico está relacionada con la tensión excesiva en el cuello. El dolor de cabeza puede ser el consecuencia de una osteoartritis cervical, un disco dañado o un movimiento tipo latigazo que irrita o comprime un nervio cervical.  Ciertas estructuras nerviosas espinales están asociadas con muchos dolores de cabeza cervicogénicos. En cada nivel de la columna cervical hay un conjunto de nervios espinales, uno en el lado izquierdo y otro en el derecho de la columna. En concreto C1, C2 y/o C3 pueden estar involucradas en el desarrollo de dolores de cabeza cervicogénicos, debido a que estos nervios permiten la función (movimiento) y la sensibilidad de la cabeza y el cuello. La compresión nerviosa puede causar inflamación y dolor.

 

¿Cuáles son los síntomas de las cefaleas cervicogénicas?

  • rigidez en el cuello
  • náuseas/ vómitos
  • mareos
  • visión borrosa
  • sensibilidad a la luz o al sonido
  • dolor en uno o ambos brazos
  • dificultades de movilidad

 

¿Qué puede hacer su quiropráctico?

Su especialista quiropráctico puede hacer una o más de las siguientes cosas si usted sufre de dolores de cabeza o migrañas:

  1. Realizar ajustes en la columna vertebral para mejorar la función cervical y aliviar el estrés del sistema nervioso, que es el causante del 95% de todos los dolores de cabeza y migrañas.
  2. Proporcionar consejos nutricionales y cambios en la dieta para ayudar a reducir la necesidad de medicamentos para el dolor de cabeza y las migrañas.
  3. Ofrecer consejos posturales, ergonómicos (posturas de trabajo), ejercicios y técnicas de relajación. Este consejo debería ayudar a aliviar la irritación y tensión recurrente de las articulaciones en los músculos del cuello y la parte superior de la espalda.

 

Los especialistas en quiropráctica se someten a un entrenamiento extenso para ayudar a sus pacientes de muchas maneras, más allá del tratamiento del dolor cervical o  lumbar. Ellos saben cómo la tensión en la columna vertebral se relaciona con problemas en otras partes del cuerpo y pueden tomar medidas para aliviar esos problemas.

Para obtener más información sobre la prevención y el bienestar, visite: www.puravidaquiropractica.com.

¿Cuándo fue la última vez que se hizo un chequeo por un quiropráctico?  Pida  cita en Puravida Quiropractica y vea si pueden ayudarle con sus dolores de cabeza y migrañas.

 

Bibliografía

Referencias:

  1. Robbins, MS and Lipton, RB.
    The epidemiology of primary headache disorders.
    Semin Neurol. 2010; 30: 107–119
  2. Stovner, LJ and Andree, C.
    Prevalence of headache in Europe: a review for the Eurolight project.
    J Headache Pain. Aug 2010; 11: 289–299
  3. Coulter, ID, Hurwitz, EL, Adams, AH, Genovese, BJ, Hays, R, and Shekelle, PG.
    Patients Using Chiropractors in North America:
    Who Are They, and Why Are They in Chiropractic Care?

    Spine (Phila Pa 1976) 2002; 27 (3) Feb 1: 291–298
  4. International Headache Society.
    The International Classification of Headache Disorders.
    in: Cephalalgia. 24. 2nd ed. ; 2004: 9–160 (Suppl 1)
  5. Bogduk, N and Govind, J.
    Cervicogenic Headache: An Assessment of the Evidence
    on Clinical Diagnosis, Invasive Tests, and Treatment

    Lancet Neurol. 2009 (Oct); 8 (10): 959–968
  6. van Tulder, M, Furlan, A, Bombardier, C, and Bouter, L.
    Updated method guidelines for systematic reviews in the cochrane collaboration back review group.
    Spine (Phila Pa 1976). 2003; 28: 1290–1299
  7. Oxman, AD and Guyatt, GH.
    Validation of an index of the quality of review articles.
    J Clin Epidemiol. 1991; 44: 1271–1278
  8. Furlan, AD, Pennick, V, Bombardier, C, and van Tulder, M.
    2009 updated method guidelines for systematic reviews in the Cochrane Back Review Group.
    Spine (Phila Pa 1976). 2009; 34: 1929–1941
  9. Sjaastad, O, Fredriksen, TA, and Pfaffenrath, V.
    Cervicogenic headache: diagnostic criteria. The Cervicogenic Headache International Study Group.
    1998; 38: 442–445
  10. Hawk, C, Long, CR, Reiter, R, Davis, CS, Cambron, JA, and Evans, R.
    Issues in Planning a Placebo-controlled Trial of Manual Methods:
    Results of a Pilot Study

    J Altern Complement Med 2002; 8 (1) Feb: 21–32
  11. Boline, PD, Kassak, K, Bronfort, G, Nelson, C, and Anderson, AV.
    Spinal Manipulation vs. Amitriptyline for the Treatment of Chronic
    Tension-type Headaches: A Randomized Clinical Trial

    J Manipulative Physiol Ther 1995 (Mar); 18 (3): 148–154
  12. Bove, G and Nilsson, N.
    Spinal manipulation in the treatment of episodic tension-type headache: a randomized controlled trial.
    1998; 280: 1576–1579
  13. Dittrich, SM, Gunther, V, Franz, G, Burtscher, M, Holzner, B, and Kopp, M.
    Aerobic exercise with relaxation: influence on pain and psychological well-being in female migraine patients.
    Clin J Sport Med. 2008; 18: 363–365
  14. Donkin, RD, Parkin-Smith, GF, and Gomes, N.
    Possible effect of chiropractic manipulation and combined manual traction and manipulation on tension-type headache: a pilot study.
    J Neuromusculoskeletal Systen. 2002; 10: 89–97
  15. Jull, G, Trott, P, Potter, H et al.
    A Randomized Controlled Trial of Exercise and Manipulative Therapy
    for Cervicogenic Headache

    Spine (Phila Pa 1976) 2002 (Sep 1); 27 (17): 1835—1843
  16. Lawler, SP and Cameron, LD.
    A randomized, controlled trial of massage therapy as a treatment for migraine.
    Ann Behav Med. 2006; 32: 50–59
  17. Nelson, CF, Bronfort, G, Evans, R, Boline, P, Goldsmith, C, and Anderson, AV.
    The Efficacy of Spinal Manipulation, Amitriptyline and the Combination
    of Both Therapies for the Prophylaxis of Migraine Headache

    J Manipulative Physiol Ther 1998 (Oct); 21 (8): 511–519
  18. Nilsson, N, Christensen, HW, and Hartvigsen, J.
    The Effect of Spinal Manipulation in the Treatment of Cervicogenic Headache
    J Manipulative Physiol Ther 1997 (Jun); 20 (5): 326–330
  19. Soderberg, E, Carlsson, J, and Stener-Victorin, E.
    Chronic tension-type headache treated with acupuncture, physical training and relaxation training. Between-group differences.
    2006; 26: 1320–1329
  20. Tuchin, PJ, Pollard, H, and Bonello, R.
    A Randomized Controlled Trial of Chiropractic Spinal Manipulative Therapy for Migraine
    J Manipulative Physiol Ther 2000 (Feb); 23 (2): 91–95
  21. Chou, R and Huffman, LH.
    Nonpharmacologic Therapies for Acute and Chronic Low Back Pain:
    A Review of the Evidence for an American Pain Society/
    American College of Physicians Clinical Practice Guideline

    Annals of Internal Medicine 2007 (Oct 2); 147 (7): 492–504
  22. Astin, JA and Ernst, E.
    The effectiveness of spinal manipulation for the treatment of headache disorders: a systematic review of randomized clinical trials.
    2002; 22: 617–623
  23. Biondi, DM.
    Physical treatments for headache: a structured review.
    2005; 45: 738–746
  24. Bronfort, G, Nilsson, N, Haas, M et al.
    Non-invasive physical treatments for chronic/recurrent headache.
    Cochrane Database Syst Rev. 2004; : CD001878
  25. Fernandez-de-Las-Penas, C, Alonso-Blanco, C, Cuadrado, ML, Miangolarra, JC, Barriga, FJ, and Pareja, JA.
    Are manual therapies effective in reducing pain from tension-type headache?: a systematic review.
    Clin J Pain. 2006; 22: 278–285
  26. Hurwitz, EL, Aker, PD, Adams, AH, Meeker, WC, and Shekelle, PG.
    Manipulation and Mobilization of the Cervical Spine:
    A Systematic Review of the Literature

    Spine (Phila Pa 1976) 1996 (Aug 1); 21 (15): 1746–1760
  27. Lenssinck, ML, Damen, L, Verhagen, AP, Berger, MY, Passchier, J, and Koes, BW.
    The effectiveness of physiotherapy and manipulation in patients with tension-type headache: a systematic review.
    2004; 112: 381–388
  28. Vernon, H, McDermaid, CS, and Hagino, C.
    Systematic review of randomized clinical trials of complementary/alternative therapies in the treatment of tension-type and cervicogenic headache.
    Complement Ther Med. 1999; 7: 142–155
  29. Fernandez-de-Las-Penas, C, Alonso-Blanco, C, Cuadrado, ML, and Pareja, JA.
    Spinal manipulative therapy in the management of cervicogenic headache.
    2005; 45: 1260–1263
  30. Maltby, JK, Harrison, DD, Harrison, D, Betz, J, Ferrantelli, JR, and Clum, GW.
    Frequency and duration of chiropractic care for headaches, neck and upper back pain.
    J Vertebr Subluxat Res. 2008; 2008: 1–12
  31. Demirturk, F, Akarcali, I, Akbayrak, T, Cita, I, and Inan, L.
    Results of two different manual therapy techniques in chronic tension-type headache.
    Pain Clin. 2002; 14: 121–128
  32. Lemstra, M, Stewart, B, and Olszynski, WP.
    Effectiveness of multidisciplinary intervention in the treatment of migraine: a randomized clinical trial.
    2002; 42: 845–854
  33. Marcus, DA, Scharff, L, Mercer, S, and Turk, DC.
    Nonpharmacological treatment for migraine: incremental utility of physical therapy with relaxation and thermal biofeedback.
    1998; 18: 266–272
  34. Narin, SO, Pinar, L, Erbas, D, Ozturk, V, and Idiman, F.
    The effects of exercise and exercise-related changes in blood nitric oxide level on migraine headache.
    Clin Rehabil. 2003; 17: 624–630
  35. Torelli, P, Jensen, R, and Olesen, J.
    Physiotherapy for tension-type headache: a controlled study.
    2004; 24: 29–36
  36. van Ettekoven, H and Lucas, C.
    Efficacy of physiotherapy including a craniocervical training programme for tension-type headache; a randomized clinical trial.
    2006; 26: 983–991
  37. Vavrek, D, Haas, M, and Peterson, D.
    Physical Examination and Self-Reported Pain Outcomes
    From a Randomized Trial on Chronic Cervicogenic Headache

    J Manipulative Physiol Ther. 2010 (Jun); 33 (5): 338–348
  38. Haas, M, Aickin, M, and Vavrek, D.
    A Preliminary Path Analysis of Expectancy and Patient-Provider
    Encounter in an Open-Label Randomized Controlled Trial of
    Spinal Manipulation for Cervicogenic Headache

    J Manipulative Physiol Ther 2010 (Jan); 33 (1): 5—13
  39. Toro-Velasco C, Arroyo-Morales M, Fernandez-de-Las-Penas C, Cleland JA.
    Short-Term Effects of Manual Therapy on Heart Rate Variability, Mood State,
    and Pressure Pain Sensitivity in Patients With Chronic Tension-Type Headache:
    A Pilot Study

    J Manipulative Physiol Ther. 2009 (Sep); 32 (7): 527–535
  40. Allais, G, De Lorenzo, C, Quirico, PE et al.
    Non-pharmacological approaches to chronic headaches: transcutaneous electrical nerve stimulation, lasertherapy and acupuncture in transformed migraine treatment.
    Neurol Sci. 2003; 24: S138–42
  41. Nilsson, N.
    A randomized controlled trial of the effect of spinal manipulation in the treatment of cervicogenic headache.
    J Manipulative Physiol Ther. 1995; 18: 435–440
  42. Annal, N, Soundappan, SV, Palaniappan, KMC, and Chadrasekar, S.
    Introduction of transcutaneous, low-voltage, non-pulsatile direct current (DC) therapy for migraine and chronic headaches. A comparison with transcutaneous electrical nerve stimulation (TENS).
    Headache Q. 1992; 3: 434–437
  43. Nilsson, N, Christensen, HW, and Hartvigsen, J.
    Lasting changes in passive range motion after spinal manipulation: a randomized, blind, controlled trial.
    J Manipulative Physiol Ther. 1996; 19: 165–168
  44. Anderson, RE and Seniscal, C.
    A comparison of selected osteopathic treatment and relaxation for tension-type headaches.
    2006; 46: 1273–1280
  45. Ouseley, BR and Parkin-Smith, GF.
    Possible effects of chiropractic spinal manipulation and mobilization in the treatment of chronic tension-type headache: a pilot study.
    Eur J Chiropr. 2002; 50: 3–13
  46. Fernandez-de-las-Penas, C, Fernandez-Carnero, J, Plaza Fernandez, A, Lomas-Vega, R, and Miangolarra-Page, JC.
    Dorsal manipulation in whiplash injury treatment: a randomized controlled trial.
    J Whiplash Related Disorders. 2004; 3: 55–72
  47. Parker, GB, Pryor, DS, and Tupling, H.
    Why does migraine improve during a clinical trial? Further results from a trial of cervical manipulation for migraine.
    Aust N Z J Med. 1980; 10: 192–198
  48. Parker, GB, Tupling, H, and Pryor, DS.
    A controlled trial of cervical manipulation of migraine.
    Aust N Z J Med. 1978; 8: 589–593
  49. Foster, KA, Liskin, J, Cen, S et al.
    The Trager approach in the treatment of chronic headache: a pilot study.
    Altern Ther Health Med. 2004; 10: 40–46
  50. Haas, M, Groupp, E, Aickin, M et al.
    Dose Response for Chiropractic Care of Chronic Cervicogenic
    Headache and Associated Neck Pain: A Randomized Pilot Study

    J Manipulative Physiol Ther 2004 (Nov); 27 (9): 547—553
  51. Sjogren, T, Nissinen, KJ, Jarvenpaa, SK, Ojanen, MT, Vanharanta, H, and Malkia, EA.
    Effects of a workplace physical exercise intervention on the intensity of headache and neck and shoulder symptoms and upper extremity muscular strength of office workers: a cluster randomized controlled cross-over trial.
    2005; 116: 119–128
  52. Hanten, WP, Olson, SL, Hodson, JL, Imler, VL, Knab, VM, and Magee, JL.
    The effectiveness of CV-4 and resting position techniques on subjects with tension-type headaches.
    J Manual Manipulative Ther. 1999; 7: 64–70
  53. Solomon, S, Elkind, A, Freitag, F, Gallagher, RM, Moore, K, Swerdlow, B et al. Safety and effectiveness of cranial electrotherapy in the treatment of tension headache.
    1989; 29: 445–450
  54. Hall, T, Chan, HT, Christensen, L, Odenthal, B, Wells, C, and Robinson, K.
    Efficacy of a C1-C2 self-sustained natural apophyseal glide (SNAG) in the management of cervicogenic headache.
    J Orthop Sports Phys Ther. 2007; 37: 100–107
  55. Solomon, S and Guglielmo, KM.
    Treatment of headache by transcutaneous electrical stimulation.
    1985; 25: 12–15
  56. Hoyt, WH, Shaffer, F, Bard, DA, Benesler, ES, Blankenhorn, GD, Gray, JH et al.
    Osteopathic manipulation in the treatment of muscle-contraction headache.
    J Am Osteopath Assoc. 1979; 78: 322–325
  57. Vernon, H, Jansz, G, Goldsmith, CH, and McDermaid, C.
    A randomized, placebo-controlled clinical trial of chiropractic and medical prophylactic treatment of adults with tension-type headache: results from a stopped trial.
    J Manipulative Physiol Ther. 2009; 32: 344–351
  58. Mongini, F, Ciccone, G, Rota, E, Ferrero, L, Ugolini, A, Evangelista, A et al.
    Effectiveness of an educational and physical programme in reducing headache, neck and shoulder pain: a workplace controlled trial.
    2008; 28: 541–552
  59. Fernandez-de-las-Penas, C, Alonso-Blanco, C, San-Roman, J, and Miangolarra-Page, JC.
    Methodological quality of randomized controlled trials of spinal manipulation and mobilization in tension-type headache, migraine, and cervicogenic headache.
    J Orthop Sports Phys Ther. 2006; 36: 160–169
  60. Lew, HL, Lin, PH, Fuh, JL, Wang, SJ, Clark, DJ, and Walker, WC.
    Characteristics and treatment of headache after traumatic brain injury: a focused review.
    Am J Phys Med Rehabil. 2006; 85: 619–627

Treatment of Migraine

  1. Spinal manipulation is recommended for the management of patients with episodic or chronic migraine with or without aura. This recommendation is based on studies that used a treatment frequency 1 to 2 times per week for 8 weeks (evidence level, moderate). One high-quality RCT, [20] 1 low-quality RCT, [17] and 1 high-quality SR [24] support the use of spinal manipulation for patients with episodic or chronic migraine (Table 4, Table 7).
  2. Weekly massage therapy is recommended for reducing episodic migraine frequency and for improving affective symptoms potentially linked to headache pain (evidence level, moderate). One high-quality RCT16 supports this practice recommendation (Table 4). Researchers used a 45-minute massage with focus on neuromuscular and trigger point framework of the back, shoulder, neck, and head.
  3. Multimodal multidisciplinary care (exercise, relaxation, stress and nutritional counseling, massage therapy) is recommended for the management of patients with episodic or chronic migraine. Refer as appropriate (evidence level, moderate). One high-quality RCT32 supports the effectiveness of multimodal multidisciplinary intervention for migraine (Table 4). The intervention prioritizes a general management approach consisting of exercise, education, lifestyle change, and self-management.
  4. There are insufficient clinical data to recommend for or against the use of exercise alone or exercise combined with multimodal physical therapies for the management of patients with episodic or chronic migraine (aerobic exercise, cervical range of motion [cROM], or whole body stretching). Three low-quality CCTs [13, 33, 34] contribute to this conclusion (Table 4).

Tension-Type Headache

  1. Low-load craniocervical mobilization (eg, Thera-Band, Resistive Exercise Systems; Hygenic Corporation, Akron, OH) is recommended for longer term (eg, 6 months) management of patients with episodic or chronic tension-type headaches (evidence level, moderate). One high-quality RCT [36] showed that low-load mobilization significantly reduced symptoms of tension-type headaches for patients during the longer term (Table 5).
  2. Spinal manipulation cannot be recommended for the management of patients with episodic tension-type headache (evidence level, moderate). There is moderate-level evidence that spinal manipulation after premanipulative soft tissue therapy provides no additional benefit for patients with tension-type headaches. One high-quality RCT12 (Table 5) and observations reported in 4 SRs [24-27] (Table 7) suggest no benefit of spinal manipulation for patients with episodic tension-type headaches.
  3. A recommendation cannot be made for or against the use of spinal manipulation (2 times per week for 6 weeks) for patients with chronic tension-type headache. Authors of 1 RCT [11] rated as high quality by the quality assessment too [16] (Table 1), and summaries of this study in 2 SRs [24, 26] suggest that spinal manipulation may be effective for chronic tension-type headache. However, the GDC considers the RCT [11] difficult to interpret and inconclusive (Table 5). The trial is inadequately controlled with imbalances in the number of subject-clinician encounters between study groups (eg, 12 visits for subjects in the soft tissue therapy plus spinal manipulation group vs 2 visits for subjects in the amitriptyline group). There is no way of knowing whether a comparable level of personal attention for subjects in the amitriptyline group may have impacted the study outcomes. These considerations and interpretations from 2 other SRs [25, 27]contribute to this conclusion (Table 7).
  4. There is insufficient evidence to recommend for or against the use of manual traction, connective tissue manipulation, Cyriax's mobilization, or exercise/physical training for patients with episodic or chronic tension-type headache. Three low-quality inconclusive studies [19, 31, 35] (Table 5), 1 low-quality negative RCT, [14] and 1 SR [25] contribute to this conclusion (Table 7).

Cervicogenic Headache

  1. Spinal manipulation is recommended for the management of patients with cervicogenic headache. This recommendation is based on 1 study that used a treatment frequency of 2 times per week for 3 weeks (evidence level, moderate). In a high-quality RCT, Nilsson et al [18] (Table 6) showed a significantly positive effect of high-velocity, low-amplitude spinal manipulation for patients with cervicogenic headache. Evidence synthesis from 2 SRs [24, 29] (Table 7) supports this practice recommendation.
  2. Joint mobilization is recommended for the management of patients with cervicogenic headache (evidence level, moderate). Jull et al [15] examined the effects of Maitland joint mobilization 8 to 12 treatments for 6 weeks in a high-quality RCT (Table 6). Mobilization followed typical clinical practice, in which the choice of low-velocity and high-velocity techniques was based on initial and progressive assessments of patients' cervical joint dysfunction. Beneficial effects were reported for headache frequency, intensity, as well as neck pain and disability. Evidence synthesis from 2 SRs [24, 29] (Table 7) supports this practice recommendation.
  3. Deep neck flexor exercises are recommended for the management of patients with cervicogenic headache (evidence level, moderate). This recommendation is based on a study of 2 times daily for 6 weeks. There is no consistently additive benefit of combining deep neck flexor exercises and joint mobilization for cervicogenic headache. One high-quality RCT [15] (Table 6) and observations provided in 2 SRs [24, 29] (Table 7) support this practice recommendation.
Compartir en :

    Este sitio web utiliza cookies para que usted tenga la mejor experiencia de usuario. Si continúa navegando está dando su consentimiento para la aceptación de las mencionadas cookies y la aceptación de nuestra política de cookies, pinche el enlace para mayor información.plugin cookies

    ACEPTAR
    Aviso de cookies