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Villani V, Prosperini L, Palombini F, Orzi F, Sette G. Single-blind, randomized, pilot study combining shiatsu and amitriptyline in refractory primary headaches. Neurol Sci 2017; 38:999-1007. [PMID: 28283760 DOI: 10.1007/s10072-017-2888-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/03/2017] [Indexed: 01/03/2023]
Abstract
Complementary alternative medicine, such as shiatsu, can represent a suitable treatment for primary headaches. However, evidence-based data about the effect of combining shiatsu and pharmacological treatments are still not available. Therefore, we tested the efficacy and safety of combining shiatsu and amitriptyline to treat refractory primary headaches in a single-blind, randomized, pilot study. Subjects with a diagnosis of primary headache and who experienced lack of response to ≥2 different prophylactic drugs were randomized in a 1:1:1 ratio to receive shiatsu plus amitriptyline, shiatsu alone, or amitriptyline alone for 3 months. Primary endpoint was the proportion of patients experiencing ≥50%-reduction in headache days. Secondary endpoints were days with headache per month, visual analogue scale, and number of pain killers taken per month. After randomization, 37 subjects were allocated to shiatsu plus amitriptyline (n = 11), shiatsu alone (n = 13), and amitriptyline alone (n = 13). Randomization ensured well-balanced demographic and clinical characteristics at baseline. Although all the three groups improved in terms of headache frequency, visual analogue scale score, and number of pain killers (p < 0.05), there was no between-group difference in primary endpoint (p = ns). Shiatsu (alone or in combination) was superior to amitriptyline in reducing the number of pain killers taken per month (p < 0.05). Seven (19%) subjects reported adverse events, all attributable to amitriptyline, while no side effects were related with shiatsu treatment. Shiatsu is a safe and potentially useful alternative approach for refractory headache. However, there is no evidence of an additive or synergistic effect of combining shiatsu and amitriptyline. These findings are only preliminary and should be interpreted cautiously due to the small sample size of the population included in our study. Trial registration 81/2010 (Ethical Committee, S. Andrea Hospital, Sapienza University, Rome, Italy).
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Affiliation(s)
- Veronica Villani
- Neuro-Oncology Unit, Regina Elena National Cancer Institute, Via Elio Chianesi 30, 00144, Rome, Italy.
| | - Luca Prosperini
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | | | - Francesco Orzi
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University, Rome, Italy
| | - Giuliano Sette
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University, Rome, Italy
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Raggi A, Giovannetti AM, Leonardi M, Sansone E, Schiavolin S, Curone M, Grazzi L, Usai S, D'Amico D. Predictors of 12-Months Relapse After Withdrawal Treatment in Hospitalized Patients With Chronic Migraine Associated With Medication Overuse: A Longitudinal Observational Study. Headache 2016; 57:60-70. [DOI: 10.1111/head.12979] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/31/2016] [Accepted: 08/31/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Alberto Raggi
- Neurology, Public Health and Disability Unit; Neurological Institute “C. Besta” IRCCS Foundation; Milan Italy
| | - Ambra M. Giovannetti
- Neurology, Public Health and Disability Unit; Neurological Institute “C. Besta” IRCCS Foundation; Milan Italy
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit; Neurological Institute “C. Besta” IRCCS Foundation; Milan Italy
| | - Emanuela Sansone
- Neurology, Public Health and Disability Unit; Neurological Institute “C. Besta” IRCCS Foundation; Milan Italy
| | - Silvia Schiavolin
- Neurology, Public Health and Disability Unit; Neurological Institute “C. Besta” IRCCS Foundation; Milan Italy
| | - Marcella Curone
- Headache and Neuroalgology Unit; Neurological Institute “C. Besta” IRCCS Foundation; Milan Italy
| | - Licia Grazzi
- Headache and Neuroalgology Unit; Neurological Institute “C. Besta” IRCCS Foundation; Milan Italy
| | - Susanna Usai
- Headache and Neuroalgology Unit; Neurological Institute “C. Besta” IRCCS Foundation; Milan Italy
| | - Domenico D'Amico
- Headache and Neuroalgology Unit; Neurological Institute “C. Besta” IRCCS Foundation; Milan Italy
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Lovati C, Giani L, D'Amico D, Mariani C. Sleep, headaches and cerebral energy control: a synoptic view. Expert Rev Neurother 2016; 17:239-250. [PMID: 27547918 DOI: 10.1080/14737175.2016.1226133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The amount of cerebral functions is particularly elevated. This intense activity requires a great expenditure of energy: the restoration of energy is the fundamental function of sleep whilst the slowdown in energy consumption may be considered the physiological effect of primary headaches. The continuous interaction of sleep and primary headaches is possible as they share many anatomical and functional cerebral systems. Areas covered: This review describes how sleep and headaches are reciprocally involved in preservation and restoration of brain energy. Data were obtained from the most relevant and recent works available in PubMed about this topic. Expert commentary: The energetic view of sleep, primary headaches and their relationship may have relevant clinical consequences: the investigation and the modification of the multiple aspects, primarily environmental, that may influence sleep and headache, become mandatory to facilitate the cerebral energy preservation by reducing its consumption and by ensuring its recovery.
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Affiliation(s)
| | - Luca Giani
- b Neurology Unit , Luigi Sacco Hospital, Milan Study University , Milan , Italy
| | - Domenico D'Amico
- c Headache Center , C. Besta Neurological Institute and Foundation , Milan , Italy
| | - Claudio Mariani
- b Neurology Unit , Luigi Sacco Hospital, Milan Study University , Milan , Italy
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Torres-Ferrús M, Quintana M, Fernandez-Morales J, Alvarez-Sabin J, Pozo-Rosich P. When does chronic migraine strike? A clinical comparison of migraine according to the headache days suffered per month. Cephalalgia 2016; 37:104-113. [DOI: 10.1177/0333102416636055] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction According to the IHCD-3β classification, chronic migraine (CM) is headache occurring on 15 or more days/month. Episodic migraine (EM) can be divided into low frequency (LFEM) and high frequency (HFEM) depending on the headache days suffered per month. Methods We performed a clinical comparison of migraine characteristics according to monthly headache days suffered. Patients were divided into three groups: LFEM (1–9 headache days/month), HFEM (10–14 headache days/month) and CM (≥15 headache days/month). Results The analysis included 1109 patients. Previously reported differences between EM and CM were replicated. However, there were three times more clinical differences between LFEM and HFEM than between HFEM and CM (15 vs. 6). A new model that takes 10 headache days as a cut-off value for CM would have a minimally higher predictive capacity (72.8%) and no statistical differences (71.8%) when comparing it to the current classification. Conclusions HFEM patients have few clinical differences compared with CM patients. This includes the poor outcomes regarding headache-related disability and impact on daily life. According to these findings, neurologists and headache specialists should consider that the emotional and functional impact in HFEM patients could be as disabling as in those with CM.
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Affiliation(s)
- M Torres-Ferrús
- Headache and Pain Research Group, Vall d’Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Spain
- Neurology Department, Hospital Universitari Vall d’Hebron (HUVH), Spain
| | - M Quintana
- Neurology Department, Hospital Universitari Vall d’Hebron (HUVH), Spain
| | - J Fernandez-Morales
- Headache and Pain Research Group, Vall d’Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Spain
| | - J Alvarez-Sabin
- Neurology Department, Hospital Universitari Vall d’Hebron (HUVH), Spain
| | - P Pozo-Rosich
- Headache and Pain Research Group, Vall d’Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Spain
- Neurology Department, Hospital Universitari Vall d’Hebron (HUVH), Spain
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Abstract
Migraine is a debilitating headache disorder that is underdiagnosed and undertreated worldwide, partially attributable to misdiagnosis and expectations of poor treatment outcomes. This article provides a review of chronic migraine, including pathophysiology, burden, diagnosis, and management, with special emphasis on the role of NPs. Migraine is a debilitating headache disorder that is underdiagnosed and undertreated worldwide, partially attributable to misdiagnosis and expectations of poor treatment outcomes. This article provides a review of chronic migraine, with special emphasis on the role of NPs.
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56
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Managing Chronic Pain in Children and Adolescents: A Clinical Review. PM R 2015; 7:S295-S315. [DOI: 10.1016/j.pmrj.2015.09.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 09/01/2015] [Accepted: 09/02/2015] [Indexed: 12/19/2022]
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Hickman C, Lewis KS, Little R, Rastogi RG, Yonker M. Prevention for Pediatric and Adolescent Migraine. Headache 2015; 55:1371-81. [DOI: 10.1111/head.12699] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2015] [Indexed: 01/23/2023]
Affiliation(s)
- Carolyn Hickman
- Barrow Neurological Institute at Phoenix Children's Hospital; Phoenix AZ USA
| | - Kara Stuart Lewis
- Barrow Neurological Institute at Phoenix Children's Hospital; Phoenix AZ USA
- College of Medicine, University of Arizona Phoenix; AZ USA
| | - Robert Little
- Barrow Neurological Institute at Phoenix Children's Hospital; Phoenix AZ USA
- College of Medicine, University of Arizona Phoenix; AZ USA
- Creighton University; Omaha NE USA
| | - Reena Gogia Rastogi
- Barrow Neurological Institute at Phoenix Children's Hospital; Phoenix AZ USA
| | - Marcy Yonker
- Barrow Neurological Institute at Phoenix Children's Hospital; Phoenix AZ USA
- College of Medicine, University of Arizona Phoenix; AZ USA
- Mayo Clinic; Scottsdale AZ USA
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Diener HC, Solbach K, Holle D, Gaul C. Integrated care for chronic migraine patients: epidemiology, burden, diagnosis and treatment options. Clin Med (Lond) 2015; 15:344-50. [PMID: 26407383 PMCID: PMC4952796 DOI: 10.7861/clinmedicine.15-4-344] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Migraine is a common neurological disorder, characterised by severe headaches. Epidemiological studies in the USA and Europe have identified a subgroup of migraine patients with chronic migraine. Chronic migraine is defined as ≥15 headache days per month for ≥3 months, in which ≥8 days of the month meet criteria for migraine with or without aura, or respond to treatment specifically for migraine. Chronic migraine is associated with a higher burden of disease, more severe psychiatric comorbidity, greater use of healthcare resources, and higher overall costs than episodic migraine (<15 headache days per month). There is a strong need to improve diagnosis and therapeutic treatment of chronic migraine. Primary care physicians, as well as hospital-based physicians, are integral to the identification and treatment of these patients. The latest epidemiological data, as well as treatment options for chronic migraine patients, are reviewed here.
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Affiliation(s)
| | - Kasja Solbach
- Headache Center, University Hospital Essen, Essen, Germany
| | - Dagny Holle
- Headache Center, University Hospital Essen, Essen, Germany
| | - Charly Gaul
- Migraine and Headache Clinic, Königstein, Germany, and consulting physician, Department of Neurology and Headache Center, University Hospital Essen, Essen, Germany
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59
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Raggi A, Schiavolin S, Leonardi M, Grazzi L, Usai S, Curone M, D’Amico D. Approaches to treatments of chronic migraine associated with medication overuse: a comparison between different intensity regimens. Neurol Sci 2015; 36 Suppl 1:5-8. [DOI: 10.1007/s10072-015-2134-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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60
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Are Depressive Symptomatology, Self-Efficacy, and Perceived Social Support Related to Disability and Quality of Life in Patients With Chronic Migraine Associated to Medication Overuse? Data From a Cross-Sectional Study. Headache 2015; 55:636-45. [DOI: 10.1111/head.12534] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2015] [Indexed: 11/26/2022]
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61
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Starling AJ, Dodick DW. Best practices for patients with chronic migraine: burden, diagnosis, and management in primary care. Mayo Clin Proc 2015; 90:408-14. [PMID: 25744118 DOI: 10.1016/j.mayocp.2015.01.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 01/12/2015] [Accepted: 01/15/2015] [Indexed: 01/03/2023]
Abstract
Headache and migraine are common medical complaints among patients visiting primary care physicians (PCPs). A number of these patients may have chronic migraine, which is more difficult to diagnose and manage than many other headache disorders. Identification of those at risk, correct diagnosis, and establishment of a comprehensive management plan for patients with chronic migraine will require a joint effort between the PCP and the headache specialist. Together, the PCP and headache specialist will need to assess the patient for modifiable exacerbating factors and comorbidities while managing prophylactic and as-needed therapies. Herein, we provide a review of chronic migraine for the PCP and describe tools for improving patient care.
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62
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Pusic AD, Mitchell HM, Kunkler PE, Klauer N, Kraig RP. Spreading depression transiently disrupts myelin via interferon-gamma signaling. Exp Neurol 2015; 264:43-54. [PMID: 25500111 PMCID: PMC4324018 DOI: 10.1016/j.expneurol.2014.12.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 11/24/2014] [Accepted: 12/02/2014] [Indexed: 01/31/2023]
Abstract
Multiple sclerosis and migraine with aura are clinically correlated and both show imaging changes suggestive of myelin disruption. Furthermore, cortical myelin loss in the cuprizone animal model of multiple sclerosis enhances susceptibility to spreading depression, the likely underlying cause of migraine with aura. Since multiple sclerosis pathology involves inflammatory T cell lymphocyte production of interferon-gamma and a resulting increase in oxidative stress, we tested the hypothesis that spreading depression disrupts myelin through similar signaling pathways. Rat hippocampal slice cultures were initially used to explore myelin loss in spreading depression, since they contain T cells, and allow for controlled tissue microenvironment. These experiments were then translated to the in vivo condition in neocortex. Spreading depression in slice cultures induced significant loss of myelin integrity and myelin basic protein one day later, with gradual recovery by seven days. Myelin basic protein loss was abrogated by T cell depletion, neutralization of interferon-gamma, and pharmacological inhibition of neutral sphingomyelinase-2. Conversely, one day after exposure to interferon-gamma, significant reductions in spreading depression threshold, increases in oxidative stress, and reduced levels of glutathione, an endogenous neutral sphingomyelinase-2 inhibitor, emerged. Similarly, spreading depression triggered significant T cell accumulation, sphingomyelinase activation, increased oxidative stress, and reduction of gray and white matter myelin in vivo. Myelin disruption is involved in spreading depression, thereby providing pathophysiological links between multiple sclerosis and migraine with aura. Myelin disruption may promote spreading depression by enhancing aberrant excitability. Thus, preservation of myelin integrity may provide novel therapeutic targets for migraine with aura.
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Affiliation(s)
- Aya D Pusic
- Department of Neurology, The University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL 60637-1470, USA; The Committee on Neurobiology, The University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL 60637-1470, USA.
| | - Heidi M Mitchell
- Department of Neurology, The University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL 60637-1470, USA.
| | - Phillip E Kunkler
- Department of Neurology, The University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL 60637-1470, USA.
| | - Neal Klauer
- Department of Neurology, The University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL 60637-1470, USA.
| | - Richard P Kraig
- Department of Neurology, The University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL 60637-1470, USA; The Committee on Neurobiology, The University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL 60637-1470, USA.
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63
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Gentile G, Negro A, D'Alonzo L, Aimati L, Simmaco M, Martelletti P, Borro M. Lack of association between oxidative stress-related gene polymorphisms and chronic migraine in an Italian population. Expert Rev Neurother 2015; 15:215-25. [PMID: 25585507 DOI: 10.1586/14737175.2015.1001748] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Migraine patients present increased risks of vascular diseases such as high blood pressure, insulin resistance, metabolic syndrome, stroke and coronary heart disease. Oxidative stress (OS) is increasingly being studied in relation to the pathophysiology of migraine, stimulated by the described association with the most frequent migraine comorbidities. Because many of the gene-encoded players of the OS balance are characterized by functional polymorphisms, it is supposed that the individual genomic profile could affect susceptibility to OS and to related pathophysiological conditions. This study aimed to characterize a panel of 10 polymorphisms in 8 OS-related genes in a chronic migraine (CM) population and healthy controls, to recognize a genetic risk in the process of migraine chronification. The sample consisted of 45 healthy women and 96 women diagnosed with CM. No deviations from the Hardy-Weinberg equilibrium were detected, or in the overall population, or in the CM group or in the control group.
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Affiliation(s)
- Giovanna Gentile
- Advanced Molecular Diagnostics Unit, Sant'Andrea Hospital, Rome, Italy
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Chronic migraine with medication overuse: Association between disability and quality of life measures, and impact of disease on patients' lives. J Neurol Sci 2015; 348:60-6. [DOI: 10.1016/j.jns.2014.11.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 10/31/2014] [Accepted: 11/03/2014] [Indexed: 01/20/2023]
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65
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66
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Raggi A, Giovannetti AM, Schiavolin S, Leonardi M, Bussone G, Grazzi L, Usai S, Curone M, Di Fiore P, D’Amico D. Validating the Migraine-Specific Quality of Life Questionnaire v2.1 (MSQ) in Italian inpatients with chronic migraine with a history of medication overuse. Qual Life Res 2013; 23:1273-7. [DOI: 10.1007/s11136-013-0556-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2013] [Indexed: 11/27/2022]
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67
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Abstract
The field of chronic pain medicine is currently facing enormous challenges. The incidence of chronic pain is increasing worldwide, particularly in the developed world. As a result, chronic pain is imposing a growing burden on Western societies in terms of cost of medical care and lost productivity. This burden is exacerbated by the fact that despite research efforts and a huge expenditure on treatment for chronic pain, clinicians have no highly effective treatments or definitive diagnostic measures for patients. The lack of an objective measure for pain impedes basic research into the biological and psychological mechanisms of chronic pain and clinical research into treatment efficacy. The development of objective measurements of pain and ability to predict treatment responses in the individual patient is critical to improving pain management. Finally, pain medicine must embrace the development of a new evidence-based therapeutic model that recognizes the highly individual nature of responsiveness to pain treatments, integrates bio-psycho-behavioural approaches, and requires proof of clinical effectiveness for the various treatments we offer our patients. In the long-term these approaches will contribute to providing better diagnoses and more effective treatments to lessen the current challenges in pain medicine.
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Affiliation(s)
- D Borsook
- P.A.I.N. Group, Department of Anesthesia and Radiology, Boston Children's Hospital, Harvard Medical School, Boston, USA.
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68
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Raggi A, Leonardi M, Giovannetti AM, Schiavolin S, Bussone G, Grazzi L, Usai S, Curone M, Di Fiore P, D’Amico D. A 14-month study of change in disability and mood state in patients with chronic migraine associated to medication overuse. Neurol Sci 2013; 34 Suppl 1:S139-40. [DOI: 10.1007/s10072-013-1371-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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69
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Chronic migraine and chronic tension-type headache are associated with concomitant low back pain: Results of the German Headache Consortium study. Pain 2013; 154:484-492. [DOI: 10.1016/j.pain.2012.12.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 11/19/2012] [Accepted: 12/12/2012] [Indexed: 11/19/2022]
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70
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Abstract
Cutaneous allodynia may be observed in patients with migraine and this reflects the central sensitization of the trigeminal neurons. We aimed to investigate the frequency of cutaneous allodynia in patients with episodic migraine and to compare clinical characteristics of migraine patients with and without allodynia. One hundred and eighty-six consecutive patients with episodic migraine attacks were prospectively included in the study. The cutaneous allodynia symptoms that occurred during headache attacks were documented using a questionnaire for assessing cephalic and extracephalic cutaneous allodynia. One hundred and fourteen patients (61.3 %) were observed to develop allodynia during migraine attacks and the ratio of the female gender was found higher among the patients with allodynia (p < 0.001). Migraine disease duration was longer (p = 0.004) and accompanying nausea and phonophobia were more common (p = 0.003 and p = 0.005, respectively) in the patients with allodynia. Menstrually related migraine was found to be associated with both allodynia (p = 0.049) and its severity (p = 0.003). The results of present study revealed that cutaneous allodynia was rather frequent in episodic migraine, particularly in patients having longer disease duration. Higher frequency of allodynia in women and its association with menstrually related migraine may be related to the effects of hormonal factors on cutaneous pain thresholds and central sensitization. Association of nausea and phonophobia with allodynia may be interpreted as the common pathways are shared in the development of these symptoms.
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71
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Guo X, Xiang J, Wang Y, O’Brien H, Kabbouche M, Horn P, Powers SW, Hershey AD. Aberrant neuromagnetic activation in the motor cortex in children with acute migraine: a magnetoencephalography study. PLoS One 2012. [PMID: 23185541 PMCID: PMC3502360 DOI: 10.1371/journal.pone.0050095] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Migraine attacks have been shown to interfere with normal function in the brain such as motor or sensory function. However, to date, there has been no clinical neurophysiology study focusing on the motor function in children with migraine during headache attacks. To investigate the motor function in children with migraine, twenty-six children with acute migraine, meeting International Classification of Headache Disorders criteria and age- and gender-matched healthy children were studied using a 275-channel magnetoencephalography system. A finger-tapping paradigm was designed to elicit neuromagnetic activation in the motor cortex. Children with migraine showed significantly prolonged latency of movement-evoked magnetic fields (MEF) during finger movement compared with the controls. The correlation coefficient of MEF latency and age in children with migraine was significantly different from that in healthy controls. The spectral power of high gamma (65–150 Hz) oscillations during finger movement in the primary motor cortex is also significantly higher in children with migraine than in controls. The alteration of responding latency and aberrant high gamma oscillations suggest that the developmental trajectory of motor function in children with migraine is impaired during migraine attacks and/or developmentally delayed. This finding indicates that childhood migraine may affect the development of brain function and result in long-term problems.
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Affiliation(s)
- Xinyao Guo
- Department of Human Anatomy and Histology-Embryology, Xi'an Jiaotong University, School of Medicine, Xi'an, Shaanxi, People’s Republic of China
- Department of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Jing Xiang
- Department of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
- Department of Neurology, University of Cincinnati, College of Medicine, Cincinnati, Ohio, United States of America
- * E-mail:
| | - Yingying Wang
- Department of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Hope O’Brien
- Department of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
- Department of Neurology, University of Cincinnati, College of Medicine, Cincinnati, Ohio, United States of America
| | - Marielle Kabbouche
- Department of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
- Department of Neurology, University of Cincinnati, College of Medicine, Cincinnati, Ohio, United States of America
| | - Paul Horn
- Department of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
- Department of Mathematical Sciences, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Scott W. Powers
- Department of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Andrew D. Hershey
- Department of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
- Department of Neurology, University of Cincinnati, College of Medicine, Cincinnati, Ohio, United States of America
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Abstract
PURPOSE OF REVIEW Recent evidence supports the suggestion that migraine is a chronic disorder with episodic attacks that increase in frequency in a subgroup of patients, transforming migraine into a refractory chronic condition with poor outcome and severe impact. Among the risk factors for migraine chronification depression figures notably. Early diagnosis and management of risk factors in migraineurs prevent migraine chronification and its consequences. The scope of this article is to review depression as a potential cofactor for migraine chronification. RECENT FINDINGS Population-based studies revealed that migraineurs often have symptoms of depression, with strongest associations for migraine with aura. Patients with depression also have an increased risk for migraine, migraine with aura in particular. Twin studies showed similar findings. This bidirectional relationship suggests that migraine and depression may share common causative factors, possibly genetically determined, that might control migraine chronification. Migraine patients may develop depression as a result of the demoralizing experience of recurrent and disabling headaches and depressed patients may develop migraine because of increased pain sensitivity, in the basis of a common genetic background. SUMMARY We suggest that clinicians consider depression as part of migraine management in order to optimize treatment and avoid migraine progression.
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73
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Borsook D, Maleki N, Becerra L, McEwen B. Understanding migraine through the lens of maladaptive stress responses: a model disease of allostatic load. Neuron 2012; 73:219-34. [PMID: 22284178 DOI: 10.1016/j.neuron.2012.01.001] [Citation(s) in RCA: 250] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2012] [Indexed: 12/12/2022]
Abstract
The brain and body respond to potential and actual stressful events by activating hormonal and neural mediators and modifying behaviors to adapt. Such responses help maintain physiological stability ("allostasis"). When behavioral or physiological stressors are frequent and/or severe, allostatic responses can become dysregulated and maladaptive ("allostatic load"). Allostatic load may alter brain networks both functionally and structurally. As a result, the brain's responses to continued/subsequent stressors are abnormal, and behavior and systemic physiology are altered in ways that can, in a vicious cycle, lead to further allostatic load. Migraine patients are continually exposed to such stressors, resulting in changes to central and peripheral physiology and function. Here we review how changes in brain states that occur as a result of repeated migraines may be explained by a maladaptive feedforward allostatic cascade model and how understanding migraine within the context of allostatic load model suggests alternative treatments for this often-debilitating disease.
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Affiliation(s)
- David Borsook
- Center for Pain and the Brain, McLean, Massachusetts General, and Children's Hospitals, Harvard Medical School, Boston, MA 02115, USA.
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Disability and mood state in patients with episodic and chronic migraine associated to medication overuse. Neurol Sci 2012; 33 Suppl 1:S169-71. [DOI: 10.1007/s10072-012-1076-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Chronic pain is a frequent component of many neurological disorders, affecting 20-40% of patients for many primary neurological diseases. These diseases result from a wide range of pathophysiologies including traumatic injury to the central nervous system, neurodegeneration and neuroinflammation, and exploring the aetiology of pain in these disorders is an opportunity to achieve new insight into pain processing. Whether pain originates in the central or peripheral nervous system, it frequently becomes centralized through maladaptive responses within the central nervous system that can profoundly alter brain systems and thereby behaviour (e.g. depression). Chronic pain should thus be considered a brain disease in which alterations in neural networks affect multiple aspects of brain function, structure and chemistry. The study and treatment of this disease is greatly complicated by the lack of objective measures for either the symptoms or the underlying mechanisms of chronic pain. In pain associated with neurological disease, it is sometimes difficult to obtain even a subjective evaluation of pain, as is the case for patients in a vegetative state or end-stage Alzheimer's disease. It is critical that neurologists become more involved in chronic pain treatment and research (already significant in the fields of migraine and peripheral neuropathies). To achieve this goal, greater efforts are needed to enhance training for neurologists in pain treatment and promote greater interest in the field. This review describes examples of pain in different neurological diseases including primary neurological pain conditions, discusses the therapeutic potential of brain-targeted therapies and highlights the need for objective measures of pain.
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Affiliation(s)
- David Borsook
- MD Center for Pain and the Brain C/O Brain Imaging Center, McLean Hospital Belmont, MA 02478, USA.
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