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Corasaniti MT, Lawrence GW, Bagetta G, Iannacchero R, Tarsitano A, Monteleone A, Pagliaro M, Tonin P, Sandrini G, Nicotera P, Scuteri D. Combination of anti-CGRP/CGRP-R mAbs with onabotulinumtoxin A as a novel therapeutic approach for refractory chronic migraine: a retrospective study of real-world clinical evidence and a protocol for a double-blind, randomized clinical trial to establish the efficacy and safety. Front Pharmacol 2023; 14:1296577. [PMID: 38152694 PMCID: PMC10751376 DOI: 10.3389/fphar.2023.1296577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/22/2023] [Indexed: 12/29/2023] Open
Abstract
Chronic migraine is a disabling neurovascular disorder that ranks amongst the top causes of years lived with disability worldwide. The duration and the frequency of migraine affect cognitive and affective domains, inducing worsening of memory, executive functions, orientation and causing anxiety. Population-based studies report a worrying level of resistance to treatments. Therefore, this study aims: 1) to assess efficacy of monoclonal antibodies (mAbs) directed towards the calcitonin gene-related peptide (CGRP) or its receptor (CGRP-R) for chronic migraine resistant to current preventatives; 2) to design a clinical trial protocol to evaluate the efficacy and safety of combination therapy utilizing anti-CGRP/CGRP-R together with onabotulinumtoxin A in patients suffering from resistant chronic migraine; 3) to provide a molecular rationale for combination therapy. A controlled trial is warranted as pooled analysis of real-world data from our group highlighted that combined treatment provides ≥50% reduction vs. baseline (onabotulinumtoxin A) of monthly headache days (MHDs) in up to 58.8% of patients, but there has been only sparse application of this combined therapy to date. The mAbs chosen are: erenumab, because its combination effect with onabotulinumtoxin A improved symptoms in 65% of patients; eptinezumab, due to its faster action. The results highlight that early diagnosis of migraine improves therapeutic outcomes with mAbs alone, confirming their effectiveness and the need for an adequately powered clinical trial evaluating the safety and potential superior effectiveness of eptinezumab/erenumab and onabotulinumtoxin A together.
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Affiliation(s)
- M. T. Corasaniti
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - G. W. Lawrence
- Department of Biotechnology, Dublin City University, Dublin, Ireland
| | - G. Bagetta
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | - R. Iannacchero
- Department of Neurology, Headache Center, Regional Hospital “Pugliese-Ciaccio”, Catanzaro, Italy
| | - A. Tarsitano
- Pain Therapy Center, Provincial Health Authority (ASP), Cosenza, Italy
| | - A. Monteleone
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | - M. Pagliaro
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | - P. Tonin
- Regional Center for Serious Brain Injuries, S. Anna Institute, Crotone, Italy
| | - G. Sandrini
- Department of Brain and Behavioral Sciences, IRCCS C. Mondino Foundation Neurologic Institute, University of Pavia, Pavia, Italy
| | - P. Nicotera
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - D. Scuteri
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
- Regional Center for Serious Brain Injuries, S. Anna Institute, Crotone, Italy
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2
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Scuteri D, Contrada M, Loria T, Sturino D, Cerasa A, Tonin P, Sandrini G, Tamburin S, Bruni AC, Nicotera P, Corasaniti MT, Bagetta G. Pain and agitation treatment in severe dementia patients: The need for Italian Mobilization-Observation-Behavior-Intensity-Dementia (I-MOBID2) pain scale translation, adaptation and validation with psychometric testing. Biomed Pharmacother 2022; 150:113013. [PMID: 35658247 DOI: 10.1016/j.biopha.2022.113013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 11/02/2022] Open
Abstract
The 97% of dementia patients develops fluctuant neuropsychiatric symptoms often related to under-diagnosed and unrelieved pain. Up to 80% severe demented nursing home residents experiences chronic pain due to age-related comorbidities. Patients lacking self-report skills risk not to be appropriately treated for pain. Mobilization-Observation-Behavior-Intensity-Dementia (MOBID2) is the sole pain scale to consider the frequent co-occurrence of musculoskeletal and visceral pain and to unravel concealed pain through active guided movements. Accordingly, the Italian real-world setting can benefit from its translation and validation. This clinical study provides a translated, adapted and validated version of the MOBID2, the Italian I-MOBID2. The translation, adaptation and validation of the scale for non-verbal, severe demented patients was conducted according to current guidelines in a cohort of 11 patients over 65 with mini-mental state examination ≤ 12. The I-MOBID2 proves: good face and scale content validity index (0.89); reliable internal consistency (Cronbach's α = 0.751); good to excellent inter-rater (Intraclass correlation coefficient, and test-retest (ICC = 0.902) reliability. The construct validity is high (Rho = 0.748 p < 0.05 for 11 patients, Spearman rank order correlation of the overall pain intensity score with the maximum item score of I-MOBID2 Part 1; rho=0.895 p < 0.01 for 11 patients, for the overall pain intensity score with the maximum item score of I-MOBID2 Part 2) and a good rate of inter-rater and test-retest agreement was demonstrated by Cohen's K = 0.744. The average execution time is of 5.8 min, thus making I-MOBID2 a useful tool suitable also for future development in community setting with administration by caregivers.
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Affiliation(s)
- D Scuteri
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy; Regional Center for Serious Brain Injuries, S. Anna Institute, 88900 Crotone, Italy.
| | - M Contrada
- Regional Center for Serious Brain Injuries, S. Anna Institute, 88900 Crotone, Italy.
| | - T Loria
- Casa Giardino RSA, 88836 Cotronei, Italy.
| | - D Sturino
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy.
| | - A Cerasa
- Regional Center for Serious Brain Injuries, S. Anna Institute, 88900 Crotone, Italy.
| | - P Tonin
- Regional Center for Serious Brain Injuries, S. Anna Institute, 88900 Crotone, Italy.
| | - G Sandrini
- Department of Brain and Behavioral Sciences, University of Pavia, IRCCS C. Mondino Foundation Neurologic Institute, Pavia 27100, Italy.
| | - S Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona 37100, Italy.
| | - A C Bruni
- Regional Neurogenetic Centre, Department of Primary Care, ASP-CZ, Lamezia Terme 88046, Italy.
| | - P Nicotera
- German Center for Neurodegenerative Diseases (DZNE), Bonn 53111, Germany.
| | - M T Corasaniti
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy.
| | - G Bagetta
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy.
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3
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De Icco R, Putortì A, De Paoli I, Ferrara E, Cremascoli R, Terzaghi M, Toscano G, Allena M, Martinelli D, Cosentino G, Grillo V, Colagiorgio P, Versino M, Manni R, Sances G, Sandrini G, Tassorelli C. Anodal transcranial direct current stimulation in chronic migraine and medication overuse headache: A pilot double-blind randomized sham-controlled trial. Clin Neurophysiol 2020; 132:126-136. [PMID: 33271482 DOI: 10.1016/j.clinph.2020.10.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/14/2020] [Accepted: 10/01/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Little evidence is available on the role of transcranial direct current stimulation (tDCS) in patients affected by chronic migraine (CM) and medication overuse headache (MOH). We aim to investigate the effects of tDCS in patients with CM and MOH as well as its role on brain activity. METHODS Twenty patients with CM and MOH were hospitalized for a 7-day detoxification treatment. Upon admission, patients were randomly assigned to anodal tDCS or sham stimulation delivered over the primary motor cortex contralateral to the prevalent migraine pain side every day for 5 days. Clinical data were recorded at baseline (T0), after 1 month (T2) and 6 months (T3). EEG recording was performed at T0, at the end of the tDCS/Sham treatment, and at T2. RESULTS At T2 and T3, we found a significant reduction in monthly migraine days (p = 0.001), which were more pronounced in the tDCS group when compared to the sham group (p = 0.016). At T2, we found a significant increase of alpha rhythm in occipital leads, which was significantly higher in tDCS group when compared to sham group. CONCLUSIONS tDCS showed adjuvant effects to detoxification in the management of patients with CM and MOH. The EEG recording showed a significant potentiation of alpha rhythm, which may represent a correlate of the underlying changes in cortico-thalamic connections. SIGNIFICANCE This study suggests a possible role for tDCS in the treatment of CM and MOH. The observed clinical improvement is coupled with a potentiation of EEG alpha rhythm.
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Affiliation(s)
- R De Icco
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | - A Putortì
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - I De Paoli
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - E Ferrara
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - R Cremascoli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
| | - M Terzaghi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
| | - G Toscano
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Stroke Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - M Allena
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - D Martinelli
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - G Cosentino
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - V Grillo
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - P Colagiorgio
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - M Versino
- Neurology and Stroke Unit, Circolo Hospital and Macchi Foundation, Varese, Italy; DMC Department, Insubria University, Varese, Italy
| | - R Manni
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
| | - G Sances
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - G Sandrini
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - C Tassorelli
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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Viana M, Khaliq F, Zecca C, Figuerola MDL, Sances G, Di Piero V, Petolicchio B, Alessiani M, Geppetti P, Lupi C, Benemei S, Iannacchero R, Maggioni F, Jurno ME, Odobescu S, Chiriac E, Marfil A, Brighina F, Barrientos Uribe N, Pérez Lago C, Bordini C, Lucchese F, Maffey V, Nappi G, Sandrini G, Tassorelli C. Poor patient awareness and frequent misdiagnosis of migraine: findings from a large transcontinental cohort. Eur J Neurol 2019; 27:536-541. [PMID: 31574197 DOI: 10.1111/ene.14098] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 09/27/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Although migraine is the second most disabling condition worldwide, there is poor awareness of it. The objective was to assess the awareness of migraine and previous diagnostic and therapeutic consultations and treatments in a large international population of migraineurs. METHODS This was a multicentre study conducted in 12 headache centres in seven countries. Each centre recruited up to 100 patients referred for a first visit and diagnosed with migraine. Subjects were given a structured clinical questionnaire-based interview about the perceptions of the type of headache they suffered from, its cause, previous diagnoses, investigations and treatments. RESULTS In all, 1161 patients completed the study. Twenty-eight per cent of participants were aware that they suffered from migraine. Sixty-four per cent called their migraine 'headache'; less commonly they used terms such as 'cervical pain' (4%), tension headache (3%) and sinusitis (1%). Eight per cent of general practitioners and 35% of specialists (of whom 51% were neurologists and/or headache specialists) consulted for migraine formulated the correct diagnosis. Before participating in the study, 50% of patients had undergone X-ray, computed tomography and/or magnetic resonance imaging of the cervical spine and 76% underwent brain and/or cervical spine imaging for migraine. Twenty-eight per cent of patients had received symptomatic migraine-specific medications and 29% at least one migraine preventive medication. CONCLUSIONS Although migraine is a very common disease, poor awareness of it amongst patients and physicians is still an issue in several countries. This highlights the importance of the promotion of migraine awareness to reduce its burden and limit direct and indirect costs and the risk of exposure to useless investigations.
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Affiliation(s)
- M Viana
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy.,Headache Center, Neurocenter of Southern Switzerland, Regional Hospital Lugano, Lugano, Switzerland.,Headache Group, Department of Basic and Clinical Neurosciences, King's College London, London, UK
| | - F Khaliq
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy.,Scunthorpe General Hospital, North Lincolnshire, UK
| | - C Zecca
- Headache Center, Neurocenter of Southern Switzerland, Regional Hospital Lugano, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - M D L Figuerola
- Hospital de Clínicas José San Martín, Buenos Aires, Argentina.,Hospital Alemán, Buenos Aires, Argentina
| | - G Sances
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - V Di Piero
- Sapienza University of Rome, Rome, Italy
| | | | | | - P Geppetti
- Headache Center, Careggi University Hospital, University of Florence, Florence, Italy
| | - C Lupi
- Headache Center, Careggi University Hospital, University of Florence, Florence, Italy
| | - S Benemei
- Headache Center, Careggi University Hospital, University of Florence, Florence, Italy
| | | | | | - M E Jurno
- FAME/FUNJOB and FHEMIG, Barbacena, Brazil
| | - S Odobescu
- National Headache Center, Institute of Neurology and Neurosurgery of Chisinau City, Chisinau, Moldova
| | - E Chiriac
- National Headache Center, Institute of Neurology and Neurosurgery of Chisinau City, Chisinau, Moldova
| | - A Marfil
- Hospital Universitario, Monterrey, Mexico
| | - F Brighina
- Headache Center, Department BIONEC, University of Palermo, Palermo, Italy
| | | | | | - C Bordini
- Clínica Neurológica Batatais, Batatais, Brazil
| | - F Lucchese
- Sapienza University of Rome, Rome, Italy
| | - V Maffey
- Sapienza University of Rome, Rome, Italy
| | - G Nappi
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - G Sandrini
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - C Tassorelli
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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Colnaghi S, Mallucci G, Mazzoleni V, Sandrini G, Bergamaschi R. Neuromodulation Strategies to Enhance the Effects of Gait Rehabilitation in Multiple Sclerosis Patients with Cerebellar Ataxia Preliminary Data. Mult Scler Relat Disord 2018. [DOI: 10.1016/j.msard.2018.10.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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6
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Tassorelli C, Sances G, Sandrini G. Botulinum toxins for chronic migraine: Clinical trials and technical aspects. Toxicon 2016. [DOI: 10.1016/j.toxicon.2016.11.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sandrini G, Rossi P, Milanov I, Serrao M, Cecchini AP, Nappi G. Abnormal Modulatory Influence of Diffuse Noxious Inhibitory Controls in Migraine and Chronic Tension-Type Headache Patients. Cephalalgia 2016; 26:782-9. [PMID: 16776692 DOI: 10.1111/j.1468-2982.2006.01130.x] [Citation(s) in RCA: 209] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The aim of this study was to evaluate the function of pain modulating systems subserving diffuse noxious inhibitory controls (DNICs) in primary headaches. DNICs were examined in 24 migraineurs, 17 patients with chronic tension-type headache (CTTH) and 20 healthy subjects by means of nociceptive flexion RIII reflex and the cold pressor test (CPT) as heterotopic noxious conditioning stimulation (HNCS). The subjective pain thresholds (Tp) and the RIII reflex threshold (Tr) were significantly lower in CTTH vs. controls. In controls a significant inhibition of the RIII reflex was observed during the CPT (-30±, P < 0.05). Conversely, migraine and CTTH patients showed facilitation (+31±, P < 0.05 and +40±, P < 0.01, respectively) of the RIII reflex during the HNCS. This study demonstrates a dysfunction in systems subserving DNICs in both migraine and CTTH. Impairment of endogenous supraspinal pain modulation systems may contribute to the development and/or maintenance of central sensitization in primary headaches.
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Affiliation(s)
- G Sandrini
- University Centre for Adaptive Disorders and Headache, IRCCS 'C. Mondino' Foundation, University of Pavia, Pavia, Italy.
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9
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Affiliation(s)
- G. Sandrini
- University Center for Adaptative Disorders and Headache, Dep. of Neurology IRCCS C. Mondino, University of Pavia
| | - L. Ruiz
- University Center for Adaptative Disorders and Headache, Dep. of Neurology IRCCS C. Mondino, University of Pavia
| | | | | | - A.P. Verri
- University Center for Adaptative Disorders and Headache, Dep. of Neurology IRCCS C. Mondino, University of Pavia
| | - G. Nappi
- University Center for Adaptative Disorders and Headache, Dep. of Neurology IRCCS C. Mondino, University of Pavia
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10
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Perrotta A, Chiacchiaretta P, Anastasio MG, Pavone L, Grillea G, Bartolo M, Siravo E, Colonnese C, De Icco R, Serrao M, Sandrini G, Pierelli F, Ferretti A. Temporal summation of the nociceptive withdrawal reflex involves deactivation of posterior cingulate cortex. Eur J Pain 2016; 21:289-301. [PMID: 27452295 DOI: 10.1002/ejp.923] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Temporal summation of pain sensation is pivotal both in physiological and pathological nociception. In humans, it develops in parallel with temporal summation of the nociceptive withdrawal reflex (NWR) of the lower limb, an objective representation of the temporal processing of nociceptive signals into the spinal cord. METHODS To study the contribution of cortical and subcortical structures in temporal summation of pain reflex responses, we compared the fMRI signal changes related to the temporal summation threshold (TST) of the NWR with that related to the single NWR response. We studied 17 healthy subjects using a stimulation paradigm previously determined to evoke both the TST of the NWR (SUMM) and the NWR single response (SING). RESULTS We found a significant activation in left (contralateral) primary somatosensory cortex (SI), bilateral secondary somatosensory cortex (SII), bilateral insula, anterior cingulate cortex (ACC) and bilateral thalamus during both SUMM and SING conditions. The SUMM versus SING contrast revealed a significant deactivation in the posterior cingulate cortex (PCC) and bilateral middle occipital gyrus in SUMM when compared to SING condition. CONCLUSIONS Our data support the hypothesis that temporal summation of nociceptive reflex responses is driven through a switch between activation and deactivation of a specific set of brain areas linked to the default mode network. This behaviour could be explained in view of the relevance of the pain processing induced by temporal summation, recognized as a more significant potential damaging condition with respect to a single, isolated, painful stimulation of comparable pain intensity. SIGNIFICANCE The study demonstrated that TST of the NWR involves a selective deactivation of PCC.
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Affiliation(s)
- A Perrotta
- IRCCS Neuromed, Pozzilli (Isernia), Italy
| | - P Chiacchiaretta
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio" of Chieti, Italy.,Institute for Advanced Biomedical Technologies (ITAB), University "G. d'Annunzio" of Chieti, Italy
| | | | - L Pavone
- IRCCS Neuromed, Pozzilli (Isernia), Italy
| | - G Grillea
- IRCCS Neuromed, Pozzilli (Isernia), Italy.,Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy
| | - M Bartolo
- IRCCS Neuromed, Pozzilli (Isernia), Italy
| | - E Siravo
- IRCCS Neuromed, Pozzilli (Isernia), Italy
| | - C Colonnese
- IRCCS Neuromed, Pozzilli (Isernia), Italy.,Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy
| | - R De Icco
- C. Mondino National Neurological Institute, Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - M Serrao
- Unit of Neurorehabilitation, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, ICOT, Latina, Italy
| | - G Sandrini
- C. Mondino National Neurological Institute, Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - F Pierelli
- IRCCS Neuromed, Pozzilli (Isernia), Italy.,Unit of Neurorehabilitation, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, ICOT, Latina, Italy
| | - A Ferretti
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio" of Chieti, Italy.,Institute for Advanced Biomedical Technologies (ITAB), University "G. d'Annunzio" of Chieti, Italy
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Tassorelli C, Greco R, Morazzoni P, Riva A, Sandrini G, Nappi G. Parthenolide is the Component of Tanacetum Parthenium that Inhibits Nitroglycerin-Induced Fos Activation: Studies in an Animal Model of Migraine. Cephalalgia 2016; 25:612-21. [PMID: 16033387 DOI: 10.1111/j.1468-2982.2005.00915.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Tanacetum parthenium (TP) is a member of the Asteracee family long used empirically as a herbal remedy for migraine. So far, however, clinical trials have failed to prove consistently the effectiveness of TP extracts in preventing migraine attacks, probably as a consequence of the uncertainty as regards the active principle. In this study, the biological effects of different TP extracts and purified parthenolide were tested in an animal model of migraine based on the quantification of neuronal activation induced by nitroglycerin. The extract enriched in parthenolide significantly reduced nitroglycerin-induced Fos expression in the nucleus trigeminalis caudalis. Purified parthenolide inhibited nitroglycerin-induced neuronal activation in additional brain nuclei and, significantly, the activity of nuclear factor-κB. These findings strongly suggest that parthenolide is the component responsible for the biological activity of TP as regards its antimigraine effect and provide important information for future controlled clinical trials.
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Affiliation(s)
- C Tassorelli
- Laboratory of Pathophysiology of Integrative Autonomic Systems, IRCCS Neurological Institute C. Mondino Foundation and University Centre for the Study of Adaptive Disorder and Headache, Pavia, Italy.
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12
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Magis D, Bendtsen L, Goadsby PJ, May A, Rio MSD, Sandór PS, Kaube H, Sandrini G, Schoonman GG, Schoenen J. Evaluation and Proposal for Optimization of Neurophysiological Tests In Migraine: Part 2—Neuroimaging and The Nitroglycerin Test. Cephalalgia 2016; 27:1339-59. [DOI: 10.1111/j.1468-2982.2007.01435.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Neuroimaging methods have been widely used in headache and migraine research. They have provided invaluable information on brain perfusion, metabolism and structure during and outside of migraine attacks, contributing to an improved understanding of the pathophysiology of the disorder. Human models of migraine attacks are indispensable tools in pathophysiological and therapeutic research. This review of neuroimaging methods and the attack-provoking nitroglycerin test is part an initiative by a task force within the EUROHEAD project (EU Strep LSHM-CT-2004-5044837-Workpackage 9) with the objective of critically evaluating neurophysiological tests used in migraine. The first part, presented in a companion paper, is devoted to electrophysiological methods, this second part to neuroimaging methods such as functional magnetic resonance imaging, positron emission tomography and voxel-based morphometry, as well as the nitroglycerin test. For each of these methods, we summarize the results, analyse the methodological limitations and propose recommendations for improved methodology and standardization of research protocols.
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Affiliation(s)
- D Magis
- Headache Research Unit, Department of Neurology, University of Liège, Liège, Belgium
| | - L Bendtsen
- Danish Headache Centre, Department of Neurology, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark
| | - PJ Goadsby
- Headache Group, Institute of Neurology, London, UK
| | - A May
- Department of Neurology, University of Hamburg, Hamburg, Germany
| | - M Sánchez del Rio
- Department of Neurology, Hospital Ruber Internacional, Madrid, Spain
| | - PS Sandór
- Headache and Pain Unit, Department of Neurology, University Hospital, Zürich, Switzerland
| | - H Kaube
- Headache Group, Institute of Neurology, London, UK
| | - G Sandrini
- University Centre for Adaptive Disorders and Headache, IRCCS C. Mondino Institute of Neurology Foundation, University of Pavia, Pavia, Italy
| | - GG Schoonman
- Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands
| | - J Schoenen
- Headache Research Unit, Department of Neurology, University of Liège, Liège, Belgium
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13
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Sarchielli P, Corbelli I, Messina P, Cupini LM, Bernardi G, Bono G, Di Piero V, Petolicchio B, Livrea P, Prudenzano MP, Pini LA, Sandrini G, Allena M, Tedeschi G, Russo A, Caproni S, Beghi E, Calabresi P. Psychopathological comorbidities in medication-overuse headache: a multicentre clinical study. Eur J Neurol 2015; 23:85-91. [PMID: 26228376 DOI: 10.1111/ene.12794] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 06/15/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE In medication-overuse headache (MOH) patients, the presence of psychopathological disturbances may be a predictor of relapse and poor response to treatment. This multicentre study aimed to assess the occurrence of psychopathological disorders in MOH patients by comparing the incidence of psychopathological disturbances with episodic migraine (EM) patients and healthy controls (HC). METHODS The psychopathological assessment of patients and HC involved the administrations of the Beck Depression Inventory, the Beck Anxiety Inventory, the Modified Mini International Neuropsychiatric Interview (M-MINI), the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Leeds Dependence Questionnaire. RESULTS The MOH, EM and HC groups (88, 129 and 102 subjects, respectively) differed significantly from each other for the presence of moderate/severe anxiety, whereas mood disorder and depression were revealed in similar proportions for both MOH and EM patients. By stratifying the M-MINI questionnaire results according to the number of psychiatric disorders, it was found that MOH patients had a more complex profile of psychiatric comorbidity. Furthermore, clinically relevant obsessive-compulsive disturbances for abused drugs assessed by Y-BOCS appeared to be more represented in the MOH group, whilst the prevalence of this trait in the EM group was comparable to that of HC (12.5%, 0.8% and 0%, respectively). CONCLUSIONS Our study indicates the multiple presence of psychopathological comorbidities in patients with MOH. In light of this, it is recommended that the assessment of the psychopathological profile be included in an evaluation of MOH patients, allowing the clinician to more rapidly start an appropriate behavioural treatment, which would greatly improve MOH management.
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Affiliation(s)
- P Sarchielli
- Clinica Neurologica, Azienda Ospedaliero - Universitaria di Perugia, Perugia, Italy
| | - I Corbelli
- Clinica Neurologica, Azienda Ospedaliero - Universitaria di Perugia, Perugia, Italy
| | - P Messina
- IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - L M Cupini
- Centro Cefalee e Malattie Cerebrovascolari, Ospedale S. Eugenio, Rome, Italy
| | - G Bernardi
- Clinica Neurologica, Policlinico TorVergata, Rome, Italy
| | - G Bono
- UCADH-Varese, Department Biotechnology and Life Sciences University of Insubria-Varese, Varese, Italy
| | - V Di Piero
- Dipartimento di Neurologia e Psichiatria, 'Sapienza' Università di Roma, Rome, Italy
| | - B Petolicchio
- Dipartimento di Neurologia e Psichiatria, 'Sapienza' Università di Roma, Rome, Italy
| | - P Livrea
- Clinica Neurologica, Policlinico di Bari, Bari, Italy
| | | | - L A Pini
- Centro Cefalee, Università degli Studi di Modena e Reggio Emilia, Modena, Italy
| | - G Sandrini
- Department of Brain and Behavioural Sciences, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy
| | - M Allena
- Department of Brain and Behavioural Sciences, C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy
| | - G Tedeschi
- Clinica Neurologica, II Università degli Studi di Napoli, Napoli, Italy
| | - A Russo
- Clinica Neurologica, II Università degli Studi di Napoli, Napoli, Italy
| | - S Caproni
- Clinica Neurologica, Azienda Ospedaliero - Universitaria di Perugia, Perugia, Italy
| | - E Beghi
- IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - P Calabresi
- Clinica Neurologica, Azienda Ospedaliero - Universitaria di Perugia, Perugia, Italy.,IRCCS Fondazione 'S. Lucia', Rome, Italy
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14
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Berra E, Sances G, De Icco R, Avenali M, Berlangieri M, De Paoli I, Bolla M, Allena M, Ghiotto N, Guaschino E, Cristina S, Tassorelli C, Sandrini G, Nappi G. Cost of Chronic and Episodic Migraine. A pilot study from a tertiary headache centre in northern Italy. J Headache Pain 2015; 16:532. [PMID: 26018292 PMCID: PMC4460116 DOI: 10.1186/s10194-015-0532-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/12/2015] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Chronic migraine (CM) has a high impact on functional performance and quality of life (QoL). CM also has a relevant burden on the National Health Service (NHS), however precise figures are lacking. In this pilot study we compared the impact in terms of costs of CM and episodic migraine (EM) on the individual and on the National Health System (NHS). Furthermore, we comparatively evaluated the impact of CM and EM on functional capability and on QoL of sufferers. METHODS We enrolled 92 consecutive patients attending the Pavia headache centre: 51 subjects with CM and 41 with episodic migraine (EM). Patients were tested with disability scales (MIDAS, HIT-6, SF-36) and with an ad hoc semi-structured questionnaire. RESULTS The direct mean annual cost (in euro) per patient suffering from CM was €2250.0 ± 1796.1, against €523.6 ± 825.8 per patient with EM. The cost loaded on NHS was €2110.4 ± 1756.9 for CM, €468.3 ± 801.8 for EM. The total economic load and the different sub-items were significantly different between groups (CM vs. EM p = 0.001 for each value). CM subjects had higher scores than EM for MIDAS (98.4 ± 72,3 vs 15.5 ± 17.7, p = 0.001) and for HIT-6 (66.1 ± 8.4 vs 58.7 ± 10.1, p = 0.001). The SF-36 score was 39.9 ± 14,74 for CM and 66.2 ± 18.2 for EM (p = 0.001). CONCLUSIONS CM is a disabling condition with a huge impact on the QoL of sufferers and a significant economic impact on the NHS. The adequate management of CM, reverting it back to EM, will provide a dual benefit: on the individual and on the society.
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Affiliation(s)
- E Berra
- Headache Science Centre, "C. Mondino" National Neurological Institute, Pavia, Italy,
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15
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Greco R, Bandiera T, Mangione AS, Demartini C, Siani F, Nappi G, Sandrini G, Guijarro A, Armirotti A, Piomelli D, Tassorelli C. Effects of peripheral FAAH blockade on NTG-induced hyperalgesia--evaluation of URB937 in an animal model of migraine. Cephalalgia 2015; 35:1065-76. [PMID: 25608877 DOI: 10.1177/0333102414566862] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 12/06/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Systemic nitroglycerin (NTG) activates brain nuclei involved in nociceptive transmission as well as in neuroendocrine and autonomic functions in rats. These changes are considered relevant for migraine because NTG consistently provokes spontaneous-like migraine attacks in migraineurs. Several studies have suggested a relationship between the endocannabinoid levels and pain mediation in migraine. URB937, a peripheral inhibitor of fatty acid amide hydrolase (FAAH)-the enzyme that degrades anandamide, produces analgesia in animal models of pain, but there is no information on its effects in migraine. AIM We evaluated whether URB937 alters nociceptive responses in the animal model of migraine based on NTG administration in male rats, using the tail flick test and the plantar and orofacial formalin tests, under baseline conditions and after NTG administration. Furthermore, we investigated whether URB937 affects NTG-induced c-Fos expression in the brain. RESULTS During the tail flick test, URB937 showed an antinociceptive effect in baseline conditions and it blocked NTG-induced hyperalgesia. URB937 also proved effective in counteracting NTG-induced hyperalgesia during both the plantar and orofacial formalin tests. Mapping of brain nuclei activated by NTG indicates that URB937 significantly reduces c-Fos expression in the nucleus trigeminalis caudalis and the locus coeruleus. CONCLUSIONS The data suggest that URB937 is capable of changing, probably via indirect mechanisms, the functional status of central structures that are important for pain transmission in an animal model of migraine.
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Affiliation(s)
- R Greco
- Laboratory of Neurophysiology of Integrative Autonomic Systems, Headache Science Centre, C. Mondino National Neurological Institute, Italy
| | - T Bandiera
- Dept. of Drug Discovery and Development, Istituto Italiano di Tecnologia, Italy
| | - A S Mangione
- Laboratory of Neurophysiology of Integrative Autonomic Systems, Headache Science Centre, C. Mondino National Neurological Institute, Italy
| | - C Demartini
- Laboratory of Neurophysiology of Integrative Autonomic Systems, Headache Science Centre, C. Mondino National Neurological Institute, Italy
| | - F Siani
- Laboratory of Functional Neurochemistry, Center for Research in Neurodegenerative Diseases, National Neurological Institute "C. Mondino," Italy
| | - G Nappi
- Laboratory of Neurophysiology of Integrative Autonomic Systems, Headache Science Centre, C. Mondino National Neurological Institute, Italy
| | - G Sandrini
- Laboratory of Neurophysiology of Integrative Autonomic Systems, Headache Science Centre, C. Mondino National Neurological Institute, Italy Dept. of Brain and Behavioural Sciences, University of Pavia, Italy
| | - A Guijarro
- Dept. of Drug Discovery and Development, Istituto Italiano di Tecnologia, Italy
| | - A Armirotti
- Dept. of Drug Discovery and Development, Istituto Italiano di Tecnologia, Italy
| | - D Piomelli
- Dept. of Drug Discovery and Development, Istituto Italiano di Tecnologia, Italy Dept. of Anatomy and Neurobiology, University of California, USA
| | - C Tassorelli
- Laboratory of Neurophysiology of Integrative Autonomic Systems, Headache Science Centre, C. Mondino National Neurological Institute, Italy Dept. of Brain and Behavioural Sciences, University of Pavia, Italy
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16
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Greco R, Bandiera T, Mangione AS, Siani F, Nappi G, Sandrini G, Guijarro A, Armirotti A, Piomelli D, Tassorelli C. EHMTI-0141. URB937 as a potential therapeutic option for migraine: evaluation in animal model of migraine. J Headache Pain 2014. [PMCID: PMC4181995 DOI: 10.1186/1129-2377-15-s1-f27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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17
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Galli F, Tassorelli C, Ghiotto N, Guaschino E, Allena M, Antonaci F, Sandrini G, Nappi G, Sances G. EHMTI-0305. Psychological assessment of patients with chronic refractory headache: a consecutive case series. J Headache Pain 2014. [PMCID: PMC4182197 DOI: 10.1186/1129-2377-15-s1-d52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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18
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Viana M, Sances G, Nappi G, Sandrini G, Tassorelli C. EHMTI-0035. "Cervical pain" study in an Italian tertiary referral headache center. J Headache Pain 2014. [PMCID: PMC4181886 DOI: 10.1186/1129-2377-15-s1-d69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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19
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Tassorelli C, De Icco R, Alfonsi E, Bartolo M, Serrao M, Avenali M, De Paoli I, Conte C, Pozzi N, Bramanti P, Nappi G, Sandrini G. Botulinum toxin type A potentiates the effect of neuromotor rehabilitation of Pisa syndrome in Parkinson disease: A placebo controlled study. Parkinsonism Relat Disord 2014; 20:1140-4. [DOI: 10.1016/j.parkreldis.2014.07.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 07/18/2014] [Accepted: 07/31/2014] [Indexed: 01/21/2023]
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20
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Greco R, Mangione AS, Siani F, Blandini F, Vairetti M, Nappi G, Sandrini G, Buzzi MG, Tassorelli C. Effects of CGRP receptor antagonism in nitroglycerin-induced hyperalgesia. Cephalalgia 2013; 34:594-604. [DOI: 10.1177/0333102413517776] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 11/28/2013] [Indexed: 11/16/2022]
Abstract
Background The release of calcitonin gene-related peptide (CGRP) from trigeminal nerves plays a central role in the pathophysiology of migraine and clinical evidence shows an antimigraine effect for CGRP receptor antagonists. Systemic administration of nitroglycerin (NTG), a nitrovasodilator, consistently provokes spontaneous-like migraine attacks in migraine sufferers; in the rat, systemic NTG induces a condition of hyperalgesia, probably through the activation of cerebral/spinal structures involved in nociceptive transmission. Aim The aim of this article is to test the analgesic effect of the CGRP receptor antagonist MK-8825 in two animal models of pain that may be relevant for migraine: the tail flick test and the formalin test performed during NTG-induced hyperalgesia. Results MK-8825 showed analgesic activity when administered alone at both the tail flick test and the formalin test. Furthermore, the CGRP antagonist proved effective in counteracting NTG-induced hyperalgesia in both tests. MK-8825 indeed reduced the nociceptive behavior when administered either simultaneously or prior to (30–60 minutes before) NTG. Conclusion These data suggest that MK-8825 may represent a potential therapeutic tool for the treatment of migraine.
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Affiliation(s)
- R Greco
- Laboratory of Neurophysiology of Integrative Autonomic Systems, Headache Science Centre, “C. Mondino” National Neurological Institute, Italy
| | - AS Mangione
- Laboratory of Neurophysiology of Integrative Autonomic Systems, Headache Science Centre, “C. Mondino” National Neurological Institute, Italy
| | - F Siani
- Laboratory of Functional Neurochemistry, Center for Research in Neurodegenerative Diseases, “C. Mondino” National Neurological Institute, Italy
| | - F Blandini
- Laboratory of Functional Neurochemistry, Center for Research in Neurodegenerative Diseases, “C. Mondino” National Neurological Institute, Italy
| | - M Vairetti
- Department of Internal Medicine and Therapeutics, Pharmacology and Toxicology Unit, University of Pavia, Italy
| | - G Nappi
- Laboratory of Neurophysiology of Integrative Autonomic Systems, Headache Science Centre, “C. Mondino” National Neurological Institute, Italy
| | - G Sandrini
- Laboratory of Neurophysiology of Integrative Autonomic Systems, Headache Science Centre, “C. Mondino” National Neurological Institute, Italy
- IRCCS Santa Lucia Foundation, Italy
| | - MG Buzzi
- Department of Brain and Behaviour, University of Pavia, Italy
| | - C Tassorelli
- Laboratory of Neurophysiology of Integrative Autonomic Systems, Headache Science Centre, “C. Mondino” National Neurological Institute, Italy
- IRCCS Santa Lucia Foundation, Italy
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21
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Di Fabio R, Serrao M, Pierelli F, Fragiotta G, Sandrini G. Pure akinesia: a kinematic analysis in a case responsive to rotigotine. Funct Neurol 2013; 28:133-5. [PMID: 24125564 DOI: 10.11138/fneur/2013.28.2.133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A patient with pure akinesia is described. This rare gait disorder, poorly responsive to therapy, is characterized by gait impairment which may be associated with handwriting and speech difficulties, in the absence of further signs of extrapyramidal involvement. Here, we report the improvement in a patient suffering from pure akinesia after low doses of rotigotine, a non-ergolinic dopamine agonist, detailing the kinematic analysis before and after the treatment. After therapy, an improvement in all of the gait parameters, particularly gait speed, was observed with a trend toward normalization. Our case report suggests that rotigotine may be a therapeutic option in cases of pure akinesia.
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22
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Cosentino G, Valentino F, Pozzi N, Brighina F, Fierro B, Savettieri G, Sandrini G, Pacchetti C, D'Amelio M. Transcranial direct current stimulation for treatment of freezing of gait in Parkinson's disease. A cross-over study. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Greco R, Mangione AS, De Icco R, Bandiera T, Sandrini G, Nappi G, Piomelli D, Tassorelli C. Effects of URB937 on an animal model of migraine pain. J Headache Pain 2013. [PMCID: PMC3620510 DOI: 10.1186/1129-2377-14-s1-p68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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24
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Jensen R, Tassorelli C, Rossi P, Allena M, Osipova V, Steiner T, Sandrini G, Olesen J, Nappi G. A basic diagnostic headache diary (BDHD) is well accepted and useful in the diagnosis of headache. a multicentre European and Latin American study. Cephalalgia 2011; 31:1549-60. [PMID: 22019575 DOI: 10.1177/0333102411424212] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS We tested the usability and usefulness of the basic diagnostic headache diary (BDHD) for the diagnosis of migraine, tension-type headache and medication-overuse headache in European and Latin American countries. METHODS Patients were subdivided into two groups according to a 1:1 randomization list. Those in group 1 were sent the BDHD before their first visit to the headache centre and asked to complete it for at least 1 month. Those in group 2 made their first visit to the headache centre without receiving the BDHD. RESULTS A total of 626 patients from nine countries and 16 centres completed the study. The BDHD entries were complete in 97.5% of cases. BDHD information and clinical interview were, when taken together, considered complete for diagnosis in 97.7% of cases in group 1 whereas the information obtained by clinical interview alone in group 2 was considered complete in only 86.8% of cases (p < 0.001). The median number of diagnoses per patient in group 1 was significantly higher than in group 2 (p = 0.04). The BDHD was very well accepted by both patients and doctors. CONCLUSIONS It is concluded that the BDHD is a useful tool in the diagnostic assessment of the most frequent and disabling forms of primary headache and in headache management.
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Affiliation(s)
- R Jensen
- Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Denmark
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25
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Ranavolo A, Conte C, Iavicoli S, Silvetti A, Serrao M, Sandrini G, Pierelli F, Draicchio F. [Walking efficiency of blind people on trapezoidal and sinusoidal section tactile leading indicators]. G Ital Med Lav Ergon 2011; 33:214-216. [PMID: 23393839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Gait of visually impaired subjects (VIS) is worse than that of sighted ones. VIS can use tactile ground surface indicators to optimize their walking efficiency. Aim of the study was to compare VIS walking efficiency on either trapezoidal and sinusoidal shape leading indicators. VIS walking on the sinusoidal leading indicators showed a worsening of the time-distance parameters (a longer stance phase, a shorter swing phase and shorter step and stride lengths), reduced lower limb joint excursions and increased center of mass oscillations. In conclusion sinusoidal tactile indicators induce a stiffening of joints and a loss of balance with an increased risk of fall.
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Affiliation(s)
- A Ranavolo
- INAIL ex ISPESL, Dipartimenti di Medicina del Lavoro, Via Fontana Candida 1, 00040 Monte Porzio Catone (RM), 0694181267, Italy.
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26
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Cortese F, Serrao M, Andersen OK, Conte C, Perrotta A, Sandrini G, Pierelli F. P23.21 Trigemino-cervical reflex receptive fields organization in humans. Clin Neurophysiol 2011. [DOI: 10.1016/s1388-2457(11)60607-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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27
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Perrotta A, Serrao M, Coppola G, Ambrosini A, Bolla M, Sandrini G, Pierelli F. P23.16 Dysfunctional supraspinal control of pain in cluster headache. Clin Neurophysiol 2011. [DOI: 10.1016/s1388-2457(11)60602-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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28
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Perrotta A, Gasperi V, Leal NA, Bazzini E, Sances G, Blandini F, Tassorelli C, Pierelli F, Sandrini G, Nappi G. P23.18 An acute reduction of the endocannabinoid-hydrolase fatty acid amide hydrolase (FAAH) is coupled with an improvement of the facilitation of the nociceptive pathways in medication-overuse headache. Clin Neurophysiol 2011. [DOI: 10.1016/s1388-2457(11)60604-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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29
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Ranavolo A, Conte C, Iavicoli S, Serrao M, Silvetti A, Sandrini G, Pierelli F, Draicchio F. Walking strategies of visually impaired people on trapezoidal- and sinusoidal-section tactile groundsurface indicators. Ergonomics 2011; 54:246-256. [PMID: 21390954 DOI: 10.1080/00140139.2010.548533] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The visual system in walking serves to perceive feedback or feed-forward signals. Therefore, visually impaired persons (VIP) have biased motor control mechanisms. The use of leading indicators (LIs) and long canes helps to improve their walking efficiency. The aims of this study were to compare the walking efficiency of VIP on trapezoidal- and sinusoidal-section LIs using an optoelectronic motion analysis system. VIP displayed a significantly longer stance phase, a shorter swing phase and shorter step and stride lengths when they walked on the sinusoidal LI than when they walked on the trapezoidal LI. Compared with the trapezoidal LI, VIP walking on the sinusoidal LI displayed significantly lower joint ranges of motion. The centre of mass lateral displacement was wider for VIP walking on the sinusoidal LI than on the trapezoidal LI. Some significant differences were also found in sighted persons walking on both LIs. In conclusion, the trapezoidal shape enabled visually impaired subjects to walk more efficiently, whereas the sinusoidal shape caused dynamic balance problems. STATEMENT OF RELEVANCE: These findings suggest that VIP can walk more efficiently, with a lower risk of falls, on trapezoidal-section than on sinusoidal-section LIs. These results should be considered when choosing the most appropriate ground tactile surface indicators for widespread use.
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Affiliation(s)
- A Ranavolo
- Department of Occupational Medicine, INAIL, Rome, Italy.
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30
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Bartolo M, Zucchella C, Pichiecchio A, Pucci E, Sandrini G, Sinforiani E. Alien hand syndrome in left posterior stroke. Neurol Sci 2011; 32:483-6. [DOI: 10.1007/s10072-011-0490-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 01/31/2011] [Indexed: 11/25/2022]
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31
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Sandrini G, Friberg L, Coppola G, Jänig W, Jensen R, Kruit M, Rossi P, Russell D, Sanchez del Rìo M, Sand T, Schoenen J. Neurophysiological tests and neuroimaging procedures in non-acute headache (2nd edition). Eur J Neurol 2010; 18:373-81. [PMID: 20868464 DOI: 10.1111/j.1468-1331.2010.03212.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE A large number of instrumental investigations are used in patients with non-acute headache in both research and clinical fields. Although the literature has shown that most of these tools contributed greatly to increasing understanding of the pathogenesis of primary headache, they are of little or no value in the clinical setting. METHODS This paper provides an update of the 2004 EFNS guidelines and recommendations for the use of neurophysiological tools and neuroimaging procedures in non-acute headache (first edition). Even though the period since the publication of the first edition has seen an increase in the number of published papers dealing with this topic, the updated guidelines contain only minimal changes in the levels of evidence and grades of recommendation. RESULTS (i) Interictal EEG is not routinely indicated in the diagnostic evaluation of patients with headache. Interictal EEG is, however, indicated if the clinical history suggests a possible diagnosis of epilepsy (differential diagnosis). Ictal EEG could be useful in certain patients suffering from hemiplegic or basilar migraine. (ii) Recording evoked potentials is not recommended for the diagnosis of headache disorders. (iii) There is no evidence warranting recommendation of reflex responses or autonomic tests for the routine clinical examination of patients with headache. (iv) Manual palpation of pericranial muscles, with standardized palpation pressure, can be recommended for subdividing patient groups but not for diagnosis. Pain threshold measurements and EMG are not recommended as clinical diagnostic tests. (v) In adult and pediatric patients with migraine, with no recent change in attack pattern, no history of seizures, and no other focal neurological symptoms or signs, the routine use of neuroimaging is not warranted. In patients with trigeminal autonomic cephalalgia, neuroimaging should be carefully considered and may necessitate additional scanning of intracranial/cervical vasculature and/or the sellar/orbital/(para)nasal region. In patients with atypical headache patterns, a history of seizures and/or focal neurological symptoms or signs, MRI may be indicated. (vi) If attacks can be fully accounted for by the standard headache classification (IHS), a PET or SPECT scan will normally be of no further diagnostic value. Nuclear medical examinations of the cerebral circulation and metabolism can be carried out in subgroups of patients with headache for the diagnosis and evaluation of complications, when patients experience unusually severe attacks or when the quality or severity of attacks has changed. (vii) Transcranial Doppler examination is not helpful in headache diagnosis. CONCLUSION Although many of the examinations described in the present guidelines are of little or no value in the clinical setting, most of the tools, including thermal pain thresholds and transcranial magnetic stimulation, have considerable potential for differential diagnostic evaluation as well as for the further exploration of headache pathophysiology and the effects of pharmacological treatment.
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Affiliation(s)
- G Sandrini
- University Centre for Adaptive Disorders and Headache (UCADH), IRCCS C. Mondino Foundation, Pavia, Italy.
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Bendtsen L, Evers S, Linde M, Mitsikostas DD, Sandrini G, Schoenen J. EFNS guideline on the treatment of tension-type headache - Report of an EFNS task force. Eur J Neurol 2010; 17:1318-25. [PMID: 20482606 DOI: 10.1111/j.1468-1331.2010.03070.x] [Citation(s) in RCA: 207] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- L Bendtsen
- Department of Neurology, Danish Headache Centre, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark.
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Antonaci F, Sances G, Loi M, Sandrini G, Dumitrache C, Cuzzoni MG. SUNCT syndrome with paroxysmal mydriasis: Clinical and pupillometric findings. Cephalalgia 2010; 30:987-90. [DOI: 10.1177/0333102409357478] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
SUNCT syndrome (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing) is a primary headache characterised by a high frequency of attacks associated with marked autonomic periocular signs and symptoms. Activation of the hypothalamus via the superior salivary nucleus is probably responsible for some of the autonomic involvement observed during SUNCT attacks. We describe a case of SUNCT with unusual autonomic features (e.g., mydriasis) and early onset. Pupillometric studies were performed both in a basal condition (without anisocoria) and after instillation of phenylephrine (a drug with direct sympathomimetic activity) and pilocarpine (a parasympathetic agonist). The findings in this patient seem to indicate involvement of the ocular sympathetic supply in SUNCT, responsible for the mydriasis, and seem to strengthen the possibility that the autonomic phenomena in this syndrome vary with different levels of pain severity.
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Affiliation(s)
- F Antonaci
- University Centre for Adaptive Disorders and Headache, Italy
- Headache Medicine Centre, Polyclinic of Monza, Italy
| | - G Sances
- Mondino Institute of Neurology Foundation, Italy
| | - M Loi
- Headache Medicine Centre, Polyclinic of Monza, Italy
| | - G Sandrini
- University Centre for Adaptive Disorders and Headache, Italy
| | - C Dumitrache
- University Emergency Hospital of Bucharest, Romania
| | - MG Cuzzoni
- University Centre for Adaptive Disorders and Headache, Italy
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Greco R, Gasperi V, Sandrini G, Bagetta G, Nappi G, Maccarrone M, Tassorelli C. Alterations of the endocannabinoid system in an animal model of migraine: evaluation in cerebral areas of rat. Cephalalgia 2010; 30:296-302. [PMID: 19515121 DOI: 10.1111/j.1468-2982.2009.01924.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Endocannabinoids are involved in the modulation of pain and hyperalgesia. In this study we investigated the role of the endocannabinoid system in the migraine model based on nitroglycerin-induced hyperalgesia in the rat. Male rats were injected with nitroglycerin (10 mg/kg, i.p.) or vehicle and sacrificed 4 h later. The medulla, the mesencephalon and the hypothalamus were dissected out and utilized for the evaluation of activity of fatty acid amide hydrolase (that degrades the endocannabinoid anandamide), monoacylglycerol lipase (that degrades the endocannabinoid 2-arachidonoylglycerol), and binding sites specific for cannabinoid (CB) receptors. The findings obtained show that nitroglycerin-induced hyperalgesia is associated with increased activity of both hydrolases and increased density of CB binding sites in the mesencephalon. In the hypothalamus we observed an increase in the activity of fatty acid amide hydrolase associated with an increase in density of CB binding sites, while in the medulla only the activity of fatty acid amide hydrolase was increased. Anandamide also proved effective in preventing nitroglycerin-induced activation (c-Fos) of neurons in the nucleus trigeminalis caudalis. These data strongly support the involvement of the endocannabinoid system in the modulation of nitroglycerin-induced hyperalgesia, and, possibly, in the pathophysiological mechanisms of migraine.
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Affiliation(s)
- R Greco
- IRCCS Neurological Institute C Mondino Foundation, University of Pavia, Pavia, Italy
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Bartolo M, De Luca D, Serrao M, Sinforiani E, Zucchella C, Sandrini G. Caregivers burden and needs in community neurorehabilitation. J Rehabil Med 2010; 42:818-22. [DOI: 10.2340/16501977-0612] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Perrotta A, Serrao M, Sandrini G, Burstein R, Sances G, Rossi P, Bartolo M, Pierelli F, Nappi G. Sensitisation of spinal cord pain processing in medication overuse headache involves supraspinal pain control. Cephalalgia 2009; 30:272-84. [PMID: 19614707 DOI: 10.1111/j.1468-2982.2009.01914.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Medication overuse could interfere with the activity of critical brain regions involved in the supraspinal control of pain signals at the trigeminal and spinal level, leading to a sensitisation phenomenon responsible for chronic pain. We hypothesised that medication-overuse headache (MOH) patients might display abnormal processing of pain stimuli at the spinal level and defective functioning of the diffuse noxious inhibitory controls. We tested 31 MOH patients before (bWT) and after (aWT) standard inpatient withdrawal treatment, 28 episodic migraine (EM) patients and 23 healthy control subjects. We measured the threshold, the area and the temporal summation threshold (TST) of the nociceptive withdrawal reflex before, during and after activation of the diffuse noxious inhibitory controls by means of the cold pressor test. A significantly lower TST was found in both the MOH (bWT and aWT) and the EM patients compared with the controls, and in the MOH patients bWT compared with both the MOH patients aWT and the EM patients. In the MOH bWT patients the cold pressor test induced a TST increase significantly lower than that found in the MOH aWT, EM and control groups. Abnormal spinal cord pain processing and a decrease of the antinociceptive activity of the supraspinal structures in MOH patients can be hypothesised. These abnormalities could, in part, be related to the medication overuse, given that the withdrawal treatment was related to an improvement in the neurophysiological findings.
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Affiliation(s)
- A Perrotta
- University Centre for Adaptive Disorders and Headache, IRCCS ‘C. Mondino Institute of Neurology’ Foundation, University of Pavia, Pavia
- IRCCS ‘Neuromed’, University of Rome ‘La Sapienza’, Headache Clinic, Pozzilli, Isernia
| | - M Serrao
- University Centre for Adaptive Disorders and Headache, University of Rome ‘La Sapienza’, Polo Pontino-ICOT, Latina
- Rehabilitation Centre, Policlinico Italia
| | - G Sandrini
- University Centre for Adaptive Disorders and Headache, IRCCS ‘C. Mondino Institute of Neurology’ Foundation, University of Pavia, Pavia
| | - R Burstein
- Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Department of Neurobiology, Harvard Medical School, Boston, MA, USA
| | - G Sances
- University Centre for Adaptive Disorders and Headache, IRCCS ‘C. Mondino Institute of Neurology’ Foundation, University of Pavia, Pavia
| | - P Rossi
- Headache Clinic, INI Grottaferrata, Italy
| | - M Bartolo
- University Centre for Adaptive Disorders and Headache, IRCCS ‘C. Mondino Institute of Neurology’ Foundation, University of Pavia, Pavia
- IRCCS ‘Neuromed’, University of Rome ‘La Sapienza’, Headache Clinic, Pozzilli, Isernia
| | - F Pierelli
- University Centre for Adaptive Disorders and Headache, University of Rome ‘La Sapienza’, Polo Pontino-ICOT, Latina
| | - G Nappi
- University Centre for Adaptive Disorders and Headache, IRCCS ‘C. Mondino Institute of Neurology’ Foundation, University of Pavia, Pavia
- Chair of Neurology, University of Rome ‘La Sapienza’, Rome, Italy
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Gelmi C, Sandrini G, Martignoni E, Bruno A, Nappiand G, Trimarchi F. Electroretinograms and visual evoked cortical potentials in Parkinsonian patients with or without L-Dopa treatment. Neuroophthalmology 2009. [DOI: 10.3109/01658109209058128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rossi P, Schoenen J, Bolla M, Tassorelli C, Sandrini G, Nappi G. Implementation and evaluation of existing guidelines on the use of neurophysiological tests in non-acute migraine patients: a questionnaire survey of neurologists and primary care physicians. Eur J Neurol 2009; 16:937-42. [PMID: 19456856 DOI: 10.1111/j.1468-1331.2009.02630.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The main aims of this study were to evaluate: the diffusion, use and perception of the usefulness of the 2004 EFNS guidelines on neurophysiological testing in non-acute headache patients; the frequency with which the different neurophysiological tests were recommended in non-acute migraine patients by physicians aware or unaware of the guidelines; and the appropriateness of the reasons given for recommending neurophysiological tests. METHODS One hundred and fifty physicians selected amongst the members of the Italian societies of general practitioner (GPs), neurologists and headache specialists were contacted via e-mail and invited to fill in a questionnaire specially created for the study. RESULTS Ninety-two percent of the headache specialists, 8.6% of the neurologists and 0% of the GPs were already aware of the EFNS guidelines. A significantly higher proportion of headache specialists had not recommended any neurophysiological tests to the migraine patients they had seen in the previous 3 months, whereas these tests had frequently been prescribed by the GPs and neurologists. Overall, 80%, 42% and 42.6% of the reasons given by headache specialists, neurologists and GPs, respectively, for recommending neurophysiological testing in their migraine patients were appropriate (P < 0.01). CONCLUSIONS The diffusion of the EFNS guidelines on neurophysiological tests and neuroimaging procedures was found to be very limited amongst neurologists and GPs. The physicians aware of the EFNS guidelines recommended neurophysiological tests to migraine patients less frequently and more appropriately than physicians who were not aware of them. The most frequent misconceptions regarding neurophysiological tests concerned their perceived capacity to discriminate between migraine and secondary headaches or between migraine and other primary headaches.
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Affiliation(s)
- P Rossi
- Headache Centre, INI Grottaferrata, Rome, Italy.
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Ghiotto N, Sances G, Galli F, Tassorelli C, Guaschino E, Sandrini G, Nappi G. Medication overuse headache and applicability of the ICHD-II diagnostic criteria: 1-year follow-up study (CARE I protocol). Cephalalgia 2008; 29:233-43. [PMID: 19025549 DOI: 10.1111/j.1468-2982.2008.01712.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Medication overuse headache (MOH) is a growing problem worldwide and a challenge for clinicians and investigators. This study aims to contribute to the ongoing debate surrounding the classification of MOH. Applying the revised diagnostic criteria for MOH contained in the updated International Classification of Headache Disorders (ICHD-II), we enrolled 140 probable MOH (p-MOH) patients. They were submitted to an in-patient detoxification protocol and re-examined 2, 6 and 12 months later to confirm, or otherwise, the diagnosis of MOH and to observe the evolution of their headache. MOH diagnosis was confirmed 2 months after detoxification in 71% of patients, who reverted to an episodic headache pattern and stopped their drug overuse The overall clinical situation at 2 months closely reflected the 1-year trend. The 2-month period after drug withdrawal should be retained as a diagnostic criterion in the ICHD-II because it is useful not only as a diagnostic parameter, but also as predictor of a good outcome of 1-year drug withdrawal. In addition, the present findings point to the need for a more objective criterion to quantify headache frequency after drug withdrawal.
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Affiliation(s)
- N Ghiotto
- Headache Unit & University Centre for Adaptive Disorders and Headache, Mondino Institute of Neurology Foundation, Pavia, Italy
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Perrotta A, Serrao M, Sandrini G, Bogdanova D, Tassorelli C, Bartolo M, Coppola G, Pierelli F, Nappi G. Reduced habituation of trigeminal reflexes in patients with episodic cluster headache during cluster period. Cephalalgia 2008; 28:950-9. [PMID: 18624808 DOI: 10.1111/j.1468-2982.2008.01631.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A growing body of evidence supports the pivotal role of the hypothalamus in the pathophysiology of cluster headache (CH). On the basis of animal studies, it has been suggested that a hypothalamic dysfunction can lead to a habituation deficit of brainstem reflex responses, as result of a stress-like condition. Taking into account these findings, we tested the hypothesis that habituation of brainstem reflexes may be impaired in CH patients. The habituation phenomenon of the late components (R2 and R3) of the blink reflex was studied in 27 CH patients during the cluster period, in 22 migraine patients interictally and in 20 control subjects. A significant habituation deficit in the R2 and R3 components was found in CH compared with both controls and migraineurs. The lack of habituation in CH, more pronounced than in migraine, points to abnormal processing of sensory stimuli at the trigeminal level that could be driven by hypothalamic dysfunction during the cluster period.
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Affiliation(s)
- A Perrotta
- University Centre for Adaptive Disorders and Headache, IRCCS 'C. Mondino Institute of Neurology' Foundation, University of Pavia, Pavia, Italy.
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Greco R, Tassorelli C, Sandrini G, Di Bella P, Buscone S, Nappi G. Role of calcitonin gene-related peptide and substance P in different models of pain. Cephalalgia 2008; 28:114-26. [PMID: 18197882 DOI: 10.1111/j.1468-2982.2007.01468.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Calcitonin gene-related peptide (CGRP) and substance P (SP) play an important role in the development of pain and hyperalgesia. Experimental models have demonstrated that nitroglycerin (NTG)--a nitric oxide donor--provokes a hyperalgesic state, probably via the activation of second-order neurons in the nucleus trigeminalis caudalis. In order to gain further insight into the role of CGRP and SP in different types of experimental pain, we evaluated and compared changes in immunoreactivity (-ir) for these two neuropeptides at different levels of the central nervous system [nucleus trigeminalis caudalis (NTC) and dorsal horns of the lumbar spinal cord] in two animal models of hyperalgesia: systemic NTG administration and formalin test. Following NTG administration, CGRP-ir decreased steadily in the NTC, whereas SP-ir increased transiently. In the lumbar dorsal horns, NTG induced a decrease in SP-ir 1 h after its administration. Formalin injection induced an ipsilateral increase in both CGRP and SP immunostaining at 1 and 2 h in the lumbar dorsal horns. In the NTC, a significant decrease in CGRP-ir was observed at 1 h. The changes in the staining intensities were paralleled by changes in the numbers of CGRP and of SP varicosities in both the NTC and the lumbar dorsal horns. These findings show specific changes in CGRP and SP at different levels of the central nervous system in the different models of pain. In the case of the formalin test, the changes involve both neuropeptides synchronously and to the same extent, whereas in the case of NTG administration, CGRP seems to play a more prevalent and long-lasting role, particularly at the NTC level.
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Affiliation(s)
- R Greco
- Laboratory of Pathophysiology of Integrative Autonomic Systems, University Centre for the Study of Adaptive Disorders and Headache (UCADH), IRCCS C. Mondino Institute of Neurology Foundation, Pavia, Italy
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Sandrini G, Cerbo R, Del Bene E, Ferrari A, Genco S, Grazioli I, Martelletti P, Nappi G, Pinessi L, Sarchielli P, Tamburro P, Uslenghi C, Zanchin G. Efficacy of dosing and re-dosing of two oral fixed combinations of indomethacin, prochlorperazine and caffeine compared with oral sumatriptan in the acute treatment of multiple migraine attacks: a double-blind, double-dummy, randomised, parallel group, multicentre study. Int J Clin Pract 2007; 61:1256-69. [PMID: 17627707 PMCID: PMC1974802 DOI: 10.1111/j.1742-1241.2007.01458.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIMS AND METHODS In this double-blind, double-dummy, randomised, parallel group, multicentre study, the efficacy of dosing and re-dosing of a fixed combination of indomethacin, prochlorperazine and caffeine (Indoprocaf) was compared with encapsulated sumatriptan in the acute treatment of two migraine attacks. Additionally, in the group taking Indoprocaf, two different oral formulations were tested: effervescent tablets and encapsulated coated tablets. RESULTS Of 297 patients randomised (150 assigned to Indoprocaf and 147 to sumatriptan), 281 were included in the intention-to-treat efficacy analysis. The initial dosing of Indoprocaf and sumatriptan was similarly effective with pain-free rates higher than 30% (95% CI of odds-ratio: 0.57-1.28) and headache relief rates of about 60% (95% CI of odds-ratio: 0.82-1.84) with both the drugs. The efficacy of re-dosing of Indoprocaf as rescue medication was more effective than that of sumatriptan with pain-free values of 47% vs. 27% in the total attacks with a statistically significant difference in the first migraine attack in favour of Indoprocaf. The efficacy of re-dosing to treat a recurrence/relapse was very high without differences between the drugs (pain-free: 60% with Indoprocaf and 50% with sumatriptan in the total attacks). Indoprocaf and sumatriptan were well-tolerated. CONCLUSION The study demonstrated that the efficacy of the initial dosing of Indoprocaf was not higher than that of sumatriptan, but that the strategy to use the lowest effective dose as soon as the headache occurred, followed by a second dose if the headache has not relieved or to treat a relapse, was very effective, especially with Indoprocaf.
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Affiliation(s)
- G Sandrini
- University Centre for Adaptive Disorders and Headache (UCADH), IRCCS C. Mondino Institute of Neurology Foundation, Pavia, Italy
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Abstract
Almotriptan is a 5-HT(1B/1D) receptor agonist, or triptan, indicated for the acute treatment of migraine. It has been shown to be effective and well tolerated for the treatment of acute migraine in approximately 5000 patients enrolled in short-term placebo- and active-controlled trials and long-term open-label trials. A recent meta-analysis reported that almotriptan has the highest sustained pain-free (SPF) rate and lowest adverse-event (AE) rate of all oral triptans. Sustained pain free is a composite endpoint of pain freedom at 2 h, no recurrence of moderate-to-severe headache and no use of rescue medication from 2 to 24 h after dosing. Patient surveys have indicated that migraine sufferers consider complete pain relief, no recurrence, rapid onset and no side-effects to be the most important attributes of their acute treatment. Composite endpoints such as SPF and SPF with no AEs (SNAE) contain the attributes that migraine sufferers express as being the most important elements of an acute migraine therapy, and their use in future clinical trials should aid in the selection of agents that can offer patients the highest likelihood of consistent treatment success.
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Affiliation(s)
- G Sandrini
- Department of Neurological Rehabilitation, University Centre for Adaptive Disorders and Headache, Pavia, Italy
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Pucci E, Matozzo F, Luppi P, Micoli G, Sottani C, Minoia C, Sandrini G, Nappi G. [Headache as "sentinel" symptom in personnel involved in the preparation and administration of antineoplastic drugs]. G Ital Med Lav Ergon 2005; 27:412-6. [PMID: 16512337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The increased prevalence of neoplastic diseases observed over the last years has resulted for in more frequent operations of preparation and administration of antiblastic drugs performed by the medical personnel. In this study, we examined a group of subjects involved in the preparation of ACNU, Methotrexate, Novantrone, Vincristine, Cyclophosphamide, Carboplatinum, Mythoxantrone, in order to elucidate whether headache may represent an early symptom of exposure to these products. At the same time, we measured the degree of pollution in the air surrounding the vertical laminar flow aspiration cabinet used for drug preparation. The 66.6% of the 12 subjects studied, 9 females and 3 males, complained of headache. However, the environmental detection using high performance liquid chromatography coupled with triple quadrupole mass spectrometry (HPLC/MS/MS) gave negative results with respect to a possible environmental damage. These findings suggest that headache is the onset symptom of the toxic effect of antiblastic chemiotherapics in the medical personnel involved in drug preparation and administration.
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Affiliation(s)
- E Pucci
- Centro Interuniversitario Cefalee e Disordini Adattativi, Universita degli Studi, Pavia, IRCCS C. Mondino, Pavia, Italy.
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Mancini F, Sandrini G, Moglia A, Nappi G, Pacchetti C. A randomised, double-blind, dose-ranging study to evaluate efficacy and safety of three doses of botulinum toxin type A (Botox) for the treatment of spastic foot. Neurol Sci 2005; 26:26-31. [PMID: 15877184 DOI: 10.1007/s10072-005-0378-9] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2004] [Accepted: 02/03/2005] [Indexed: 12/14/2022]
Abstract
Botulinum toxin A (BTX) injections have been used successfully in the treatment of post-stroke foot spasticity, but the optimal dose-response relationship for selected muscles has yet to be established. The aim of this study was to outline beneficial and unwanted effects of three different doses of BTX in the treatment of spastic foot. In this randomised, double-blind, dose-ranging study, 45 spastic feet were randomly allocated to one of three groups, each of which was treated with a different dosage of BTX. The doses were decided on the basis of suggestions in the literature. Outcome measures (Modified Ashworth Scale, Medical Research Council Scale, gait assessment, presence of Achilles tendon clonus, Visual Analogue Scales for Gait Function and Pain, Adverse Effects scale) were applied at baseline, 4 weeks and 4 months after treatment. All the groups showed significant scales scores improvements after treatment with BTX. Group II (mean BTX total dose: 322 U) and Group III (mean BTX total dose: 540 U) showed a greater and more prolonged response than Group I (mean BTX total dose: 167 U). Group III showed the highest rate of adverse effects 4 weeks post-treatment. BTX injections constitute a useful and safe method of improving post-stroke foot spasticity, associated pain, gait speed and function. In particular, the medium BTX dosages (320 UI spread over 2-5 muscles) were found to be both safe and effective in producing long-lasting improvement of spastic foot dysfunction.
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Affiliation(s)
- F Mancini
- Parkinson's Disease and Movement Disorders Center, IRCCS C. Mondino Institute of Neurology, Via Mondino 2, I-27100, Pavia, Italy.
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Abstract
A rehabilitation program of 6 weeks, including both motor and cognitive training, was applied to 20 patients affected by Parkinson's disease (PD) in the early stages, presenting with mild cognitive deficits, but no dementia. Cognitive rehabilitation has been performed by utilizing a software elaborated for neuropsychological training (TNP). At the end of the scheduled sessions, the patients showed a significant improvement at verbal fluency, logic memory and Raven's matrices tests, as compared to baseline. These results remained stable over the time. We hypothesize that rehabilitative training exerts its positive effects by reinforcing cognitive strategies, in particular, by enhancing frontal function, which are typically impaired in PD, and suggests that this instrument could be implemented in nonpharmacological treatment of this pathology.
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Affiliation(s)
- E Sinforiani
- Laboratory of Neuropsychology and Parkinson's and Movement Disorders Center, IRCCS C. Mondino, I -27100 Pavia, Italy.
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Sandrini G, Friberg L, Jänig W, Jensen R, Russell D, Sanchez del Rìo M, Sand T, Schoenen J, Buchem M, van Dijk JG. Neurophysiological tests and neuroimaging procedures in non-acute headache: guidelines and recommendations. Eur J Neurol 2004; 11:217-24. [PMID: 15061822 DOI: 10.1111/j.1468-1331.2003.00785.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The use of instrumental examinations in headache patients varies widely. In order to evaluate their usefulness, the most common instrumental procedures were evaluated, on the basis of evidence from the literature, by an EFNS Task Force (TF) on neurophysiological tests and imaging procedures in non-acute headache patients. The conclusions of the TF regarding each technique are expressed in the following guidelines for clinical use. 1 Interictal electroencephalography (EEG) is not routinely indicated in the diagnostic evaluation of headache patients. Interictal EEG is, however, indicated if the clinical history suggests a possible diagnosis of epilepsy (differential diagnosis). Ictal EEG could be useful in certain patients suffering from hemiplegic and basilar migraine. 2 Recording of evoked potentials is not recommended for the diagnosis of headache disorders. 3 There is no evidence to justify the recommendation of autonomic tests for the routine clinical examination of headache patients. 4 Manual palpation of pericranial muscles, with standardized palpation pressure, can be recommended for subdividing patient groups but not for diagnosis. Pressure algometry and electromyography (EMG) cannot be recommended as clinical diagnostic tests. 5 In adult and paediatric patients with migraine, with no recent change in attack pattern, no history of seizures, and no other focal neurological signs or symptoms, the routine use of neuroimaging is not warranted. In patients with atypical headache patterns, a history of seizures and/or focal neurological signs or symptoms, magnetic resonance imaging (MRI) may be indicated. 6 If attacks can be fully accounted for by the standard headache classification [International Headache Society (IHS)], a positron emission tomography (PET) or single-photon emission computerized tomography (SPECT) and scan will generally be of no further diagnostic value. 7 Nuclear medicine examinations of the cerebral circulation and metabolism can be carried out in subgroups of headache patients for diagnosis and evaluation of complications, when patients experience unusually severe attacks, or when the quality or severity of attacks has changed. 8 Transcranial Doppler examination is not helpful in headache diagnosis. Although many of the examinations described are of little or no value in the clinical setting, most of the tools have a vast potential for further exploring the pathophysiology of headaches and the effects of pharmacological treatment.
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Affiliation(s)
- G Sandrini
- University Centre for Adaptive Disorders and Headache, IRCCS C. Mondino Foundation, Pavia, Italy.
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Sances G, Tassorelli C, Pucci E, Ghiotto N, Sandrini G, Nappi G. Reliability of the nitroglycerin provocative test in the diagnosis of neurovascular headaches. Cephalalgia 2004; 24:110-9. [PMID: 14728706 DOI: 10.1111/j.1468-2982.2004.00639.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Nitroglycerin administration provokes spontaneous-like migraine attacks in migraine and cluster headache (CH) patients. Nitroglycerin-induced migraine-like headache has been used as an experimental model of migraine. In this paper, we evaluate the possibility of using the nitroglycerin provocative test (NPT) as a supportive measure in the diagnosis of primary neurovascular headaches by assessing its reliability on a large population and adopting strict criteria for rating the response as positive or negative. Our population consisted of 197 migraineurs, 42 subjects suffering from cluster headache and 53 healthy controls. In migraine without aura, the test sensitivity was 82.1%, specificity 96.2% and accuracy 85.5%, while in subjects suffering from migraine with aura, the reliability of the NPT was less satisfactory (sensitivity 13.6%, specificity 96.2% and accuracy 72%). In CH patients tested during the active phase of the disease the sensitivity was 80.6%, specificity 100% and accuracy 92.9%. NPT is an easy, low-cost and reliable method for supporting the diagnosis of migraine without aura and cluster headache.
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Affiliation(s)
- G Sances
- Headache Unit, University Centre for Adaptive Disorders and Headache, IRCCS C Mondino Foundation Institute of Neurology, Pavia, Italy.
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Pucci E, Matozzo F, Arrigo A, Mazza S, Sandrini G, Nappi G. [Prevalence of primary headache related to work activity in a group of hospital workers undergoing periodic visits (D. Lgs. 626/94 s.s.m. ed i.)]. G Ital Med Lav Ergon 2003; 25:448-52. [PMID: 15027692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Since headache is one of the most frequent complaints in clinical practice, its burden in terms of the both social cost and individual sufference is considerable. Headache is a frequent cause of absence from work and decreased productivity; it is therefore clear that investigating its possible relationship with working conditions represents a topic of increasing interest for the scientific community. This study was aimed at identifying specific occupational factors able to modify the prevalence of headache in a population of hospital workers undergoing periodic examinations. It was indeed suspected that the hospital environment could be per se a predisposing factor for headache onset, due to the considerable impact of stress on such working environment. The results obtained suggest that specific occupational conditions such as shift work and P.C. use may play an important role in headache development even in the presence of a wide number of professional risk factors.
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Affiliation(s)
- E Pucci
- Centro Interuniversitario Cefalee e Disordini Adattativi, Università degli Studi di Pavia, IRCCS C. Mondino, Pavia, Italy.
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Abstract
Nociceptive processing in trigeminal system is likely to undergo to significant changes in chronic pain disorders such as in primary headache. The electrophysiological testing of brainstem reflexes seems to offer a valuable adjunct to the clinical evaluation, providing direct evidence for central dysmodulation of sensory and pain neurotransmission, i.e. dishabituation pattern and reduced pain threshold. We review the contribution of trigeminofacial reflex studies in the light of those recent data supporting the view of a dysfunctional sensory processing in primary headache.
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Affiliation(s)
- A Proietti Cecchini
- University Center for Adaptive Disorders and Headache, IRCCS C. Mondino Foundation, University of Pavia, Italy
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