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Migraine Disorders: HELP
Articles from University of Pavia
Based on 79 articles published since 2008

These are the 79 published articles about Migraine Disorders that originated from University of Pavia during 2008-2019.
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4
1 Review Effect of exogenous estrogens and progestogens on the course of migraine during reproductive age: a consensus statement by the European Headache Federation (EHF) and the European Society of Contraception and Reproductive Health (ESCRH). 2018

Sacco, Simona / Merki-Feld, Gabriele S / Ægidius, Karen Lehrmann / Bitzer, Johannes / Canonico, Marianne / Gantenbein, Andreas R / Kurth, Tobias / Lampl, Christian / Lidegaard, Øjvind / Anne MacGregor, E / MaassenVanDenBrink, Antoinette / Mitsikostas, Dimos-Dimitrios / Nappi, Rossella Elena / Ntaios, George / Paemeleire, Koen / Sandset, Per Morten / Terwindt, Gisela Marie / Vetvik, Kjersti Grøtta / Martelletti, Paolo / Anonymous32610960. ·Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy. simona.sacco@univaq.it. · Clinic for Reproductive Endocrinology, Department of Gynecology, University Hospital, Zürich, Switzerland. · Department of Neurology, Bispebjerg Hospital and University of Copenhagen, Copenhagen, Denmark. · Department of Obstetrics and Gynecology, University Hospital of Basel, Basel, Switzerland. · Université Paris-Saclay, University Paris-Sud, UVSQ, CESP, Inserm UMRS1018, Paris, France. · Neurology & Neurorehabilitation, RehaClinic, Bad Zurzach, University of Zurich, Zürich, Switzerland. · Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany. · Headache Medical Center Seilerstaette Linz, Linz, Austria. · Department of Geriatric Medicine Ordensklinikum Linz, Linz, Austria. · Department of Obstetrics & Gynaecology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark. · Centre for Neuroscience & Trauma, BICMS, Barts and the London School of Medicine and Dentistry, London, UK. · Barts Health NHS Trust, London, UK. · Erasmus Medical Center Rotterdam, Department of Internal Medicine, Division of Vascular Medicine and Pharmacology, Rotterdam, The Netherlands. · Department of Neurology, University of Athens, Athens, Greece. · Research Centre for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy. · University Consortium for Adaptive Disorders and Head Pain (UCADH), University of Pavia, Pavia, Italy. · Department of Medicine, University of Thessaly, Larissa, Greece. · Department of Neurology, Ghent University Hospital, Ghent, Belgium. · University Hospital Rikshospitalet, University of Oslo, Oslo, Norway. · Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands. · Department of Neurology, Akershus University Hospital, Lørenskog, Norway. · Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy. ·J Headache Pain · Pubmed #30171365.

ABSTRACT: We systematically reviewed data about the effect of exogenous estrogens and progestogens on the course of migraine during reproductive age. Thereafter a consensus procedure among international experts was undertaken to develop statements to support clinical decision making, in terms of possible effects on migraine course of exogenous estrogens and progestogens and on possible treatment of headache associated with the use or with the withdrawal of hormones. Overall, quality of current evidence is low. Recommendations are provided for all the compounds with available evidence including the conventional 21/7 combined hormonal contraception, the desogestrel only oral pill, combined oral contraceptives with shortened pill-free interval, combined oral contraceptives with estradiol supplementation during the pill-free interval, extended regimen of combined hormonal contraceptive with pill or patch, combined hormonal contraceptive vaginal ring, transdermal estradiol supplementation with gel, transdermal estradiol supplementation with patch, subcutaneous estrogen implant with cyclical oral progestogen. As the quality of available data is poor, further research is needed on this topic to improve the knowledge about the use of estrogens and progestogens in women with migraine. There is a need for better management of headaches related to the use of hormones or their withdrawal.

2 Review Current Prophylactic Medications for Migraine and Their Potential Mechanisms of Action. 2018

Sprenger, Till / Viana, M / Tassorelli, C. ·Department of Neurology, DKD Helios Klinik Wiesbaden, Aukammallee 33, 65191, Wiesbaden, Germany. till.sprenger@helios-gesundheit.de. · Headache Science Centre, IRCCS Mondino Foundation, 27100, Pavia, Italy. · Department of Brain and Behavioral Sciences, University of Pavia, 27100, Pavia, Italy. ·Neurotherapeutics · Pubmed #29671241.

ABSTRACT: A relatively high number of different medications is currently used for migraine prevention in clinical practice. Although these compounds were initially developed for other indications and differ in their mechanisms of action, some general themes can be identified from the mechanisms at play. Efficacious preventive drugs seem to either suppress excitatory nervous signaling via sodium and/or calcium receptors, facilitate GABAergic inhibition, reduce neuronal sensitization, block cortical spreading depression and/or reduce circulating levels of CGRP. We here review such mechanisms for the different compounds.

3 Review Optimizing the long-term management of chronic migraine with onabotulinumtoxinA in real life. 2018

Tassorelli, Cristina / Tedeschi, Gioacchino / Sarchielli, P / Pini, Luigi Alberto / Grazzi, Licia / Geppetti, Pierangelo / De Tommaso, Marina / Aguggia, Marco / Cortelli, P / Martelletti, Paolo. ·a Headache Science Center , National Neurological Institute C. Mondino , Pavia , Italy. · b Department of Brain and Behavioral Sciences , University of Pavia , Pavia , Italy. · c Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences , University of Campania "Luigi Vanvitelli" , Naples , Italy. · d Neurology Clinic , University Hospital of Perugia , Perugia , Italy. · e Center for Neuroscience and Neurotechnology, Polyclinic Hospital , University of Modena and Reggio Emilia , Modena , Italy. · f Headache and Neuroalgology Unit , Neurological Institute "C. Besta" IRCCS Foundation , Milan , Italy. · g Headache Center, Department of Health Sciences , University of Florence , Florence , Italy. · h Applied Neurophysiology and Pain Unit, SMBNOS Department, Polyclinic General Hospital , Bari Aldo Moro University , Bari , Italy. · i Headache Center, Neurology Department , Asti Hospital , Asti , Italy. · j Department of Biomedical and Neuromotor Sciences , University of Bologna , Bologna , Italy. · k IRCCS Institute of Neurological Sciences of Bologna , Bellaria Hospital , Bologna , Italy. · l Department of Clinical and Molecular Medicine, Sapienza University of Rome and Regional Referral Headache Center , Sant'Andrea Hospital , Rome , Italy. ·Expert Rev Neurother · Pubmed #29280408.

ABSTRACT: INTRODUCTION: Management of chronic migraine is challenging. OnabotulinumtoxinA (OBT-A) is the only medication licensed for prevention of chronic migraine, and has been widely adopted in clinical practice. Limited data is available on its long-term use. Areas covered: Data from controlled trials are combined with available data on the long-term use of OBT-A in real-life studies, with information obtained in a recent survey among Italian headache centers, and the clinical experience of the authors. Six areas were identified as relevant to patients with chronic migraine: 1) definition of responders to OBT-A; 2) management of responders to OBT-A; 3) optimal timing of prophylaxis with OBT-A; 4) position of OBT-A in prevention of chronic migraine; 5) management of medication overuse, and 6) patient education. Expert commentary: This review provides an update on the latest evidence regarding the long-term use of OBT-A in chronic migraine and analyzes the critical issues in the decision-making process that emerge from the analysis of the literature and routine practice. A treatment algorithm is proposed for the adoption in the daily practice.

4 Review Migraine with prolonged aura: phenotype and treatment. 2018

Viana, Michele / Afridi, Shazia. ·Headache Science Center, C. Mondino National Neurological Institute, Via Mondino 2, 27100, Pavia, Italy. michele.viana@ymail.com. · Department of Neurology, Guy's and St Thomas' NHS Trust, London, UK. ·Naunyn Schmiedebergs Arch Pharmacol · Pubmed #29143861.

ABSTRACT: We review the published literature on migraine with prolonged aura (PA), specifically with regards to the phenotype and treatment options. PA is not uncommon. A recent study found that about 17% of migraine auras are prolonged and that 26% of patients with migraine with aura have experienced at least one PA. The characteristics of PA are similar to most typical auras with the exception of a higher number of aura symptoms (in particular sensory and/or dysphasic). There are no well-established treatments at present which target the aura component of migraine. Other than case reports, there have been open-label studies of lamotrigine and greater occipital nerve blocks. The only randomised, blinded, controlled trial to date has been of nasal ketamine showing some reduction in aura severity but not duration. A small open-labelled pilot study of amiloride was also promising. Larger randomised, controlled trials are needed to establish whether any of the existing or novel compounds mentioned are significantly effective and safe.

5 Review Botulinum toxin for chronic migraine: Clinical trials and technical aspects. 2018

Tassorelli, Cristina / Sances, Grazia / Avenali, Micol / De Icco, Roberto / Martinelli, Daniele / Bitetto, Vito / Nappi, Giuseppe / Sandrini, Giorgio. ·Headache Science Center and Headache Unit, National Neurological Institute C. Mondino Foundation, Pavia, Italy; Dept of Brain and Behavioral Sciences, University of Pavia, Italy. Electronic address: cristina.tassorelli@unipv.it. · Headache Science Center and Headache Unit, National Neurological Institute C. Mondino Foundation, Pavia, Italy. · Headache Science Center and Headache Unit, National Neurological Institute C. Mondino Foundation, Pavia, Italy; Dept of Brain and Behavioral Sciences, University of Pavia, Italy. ·Toxicon · Pubmed #28877509.

ABSTRACT: OnabotulinumtoxinA has been approved for the prophylaxis of chronic migraine following the demonstration of efficacy in two large controlled trials. Data collected from pragmatic studies in the real-life setting have contributed important additional information useful for the management of this group of extremely disabled and challenging patients. The main findings from these studies are presented and discussed.

6 Review Botulinum neurotoxin type A for the treatment of pain: not just in migraine and trigeminal neuralgia. 2017

Sandrini, Giorgio / De Icco, Roberto / Tassorelli, Cristina / Smania, Nicola / Tamburin, Stefano. ·C. Mondino National Institute of Neurology Foundation, IRCCS, Pavia, Italy. · Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy. · Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, I-37134, Verona, Italy. · Neuromotor and Cognitive Rehabilitation Research Centre, University of Verona, Verona, Italy. · Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, I-37134, Verona, Italy. stefano.tamburin@univr.it. ·J Headache Pain · Pubmed #28324318.

ABSTRACT: BACKGROUND: Despite their huge epidemiological impact, primary headaches, trigeminal neuralgia and other chronic pain conditions still receive suboptimal medical approach, even in developed countries. The limited efficacy of current pain-killers and prophylactic treatments stands among the main reasons for this phenomenon. Botulinum neurotoxin (BoNT) represents a well-established and licensed treatment for chronic migraine, but also an emerging treatment for other types of primary headache, trigeminal neuralgia, neuropathic pain, and an increasing number of pain conditions. METHODS: We searched and critically reviewed evidence for the efficacy of BoNT for the treatment of chronic pain. RESULTS: Meta-analyses and randomized controlled trials (RCTs) suggest that BoNT potentially represents a multi-purpose drug for the treatment of pain in several disorders due to a favorable safety profile and a long-lasting relief after a single injection. CONCLUSIONS: BoNT is an emerging treatment in different pain conditions. Future RCTs should explore the use of BoNT injection therapy combined with systemic drugs and/or physical therapies as new pain treatment strategies.

7 Review Persistent and Repetitive Visual Disturbances in Migraine: A Review. 2017

Schankin, Christoph J / Viana, Michele / Goadsby, Peter J. ·Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. · Department of Neurology, Grosshadern, University Hospital Munich, University of Munich, Munich, Germany. · Headache Science Center, C. Mondino National Neurological Institute, Pavia, Italy. · Headache Group, NIHR-Wellcome Trust King's Clinical Research Facility, King's College London, London, United Kingdom. ·Headache · Pubmed #27714802.

ABSTRACT: Visual disturbances in migraineurs, such as visual aura, are typically episodic, that is, associated with the headache attack, and overlaid by head pain and other symptoms that impact the patient. In some patients, however, visual symptoms are dominant due to frequency (migraine aura status), duration (persistent migraine aura and other persistent positive visual phenomena), or complexity (visual snow syndrome). These syndromes are more rare and challenging to classify in clinical practice resulting in a lack of systematic studies on pathophysiology and treatment. We aim at describing clinical features and pathophysiological concepts of typical migraine aura with a focus on cortical spreading depression and differentiation from non-typical migraine aura. Additionally, we discuss nomenclature and the specifics of migraine aura status, persistent migraine aura, persistent positive visual phenomena, visual snow, and other migrainous visual disturbances. The term migraine with prolonged aura might be a useful bridge between typical aura and persistent aura. Further studies would be necessary to assess whether a return of the classification category eventually helps diagnosing or treating patients more effectively. A practical approach is presented to help the treating physician to assign the correct diagnosis and to choose a medication for treatment that has been successful in case reports of these rare but disabling conditions.

8 Review Association of cinnarizine and betahistine in prophylactic therapy for Ménière's disease with and without migraine. 2014

Teggi, R / Gatti, O / Sykopetrites, V / Quaglieri, S / Benazzo, M / Bussi, M. ·Division of ENT, San Raffaele Scientific Institute, Milan, Italy; · Division of ENT, IRCCS Policlinico San Matteo Foundation, University of Pavia, Italy. ·Acta Otorhinolaryngol Ital · Pubmed #25709150.

ABSTRACT: Prophylactic therapy of Ménière's disease (MD) includes betahistine and calcium-blockers (the latter also useful for migraine prevention). The aim of our work was to assess the efficacy of combined therapy with cinnarizine and betahistine in MD subjects both with and without migraine and poorly responsive to betahistine alone. Fifty-two MD subjects were included who were poorly responsive to betahistine during 6 months of follow-up; 29 were migraineurs. Combined therapy was administered with betahistine 48 mg/day and cinnarizine 20 mg BID for 1 month, 20 mg/day for 2 weeks and 20 mg every 2 days for 2 more weeks, and then repeated. Results were collected over 6 months of follow-up. MD subjects with and without migraine demonstrated a decrease in both vertigo spells and migrainous attacks during combined therapy (from 9.4 to 3.8 and from 6.8 to 5.9 in 6 months, respectively, for vertigo spells, while migraine decreased from 3.8 to 1 in 6 months, respectively). A correlation was seen between decrease of vertigo spells and headaches in the sample of MD subjects with migraine. Our data support a proactive role for cinnarizine in preventing vertigo spells, especially in MD patients with migraine.

9 Review Pharmacogenomics of episodic migraine: time has come for a step forward. 2014

Viana, Michele / Terrazzino, Salvatore / Genazzani, Armando A / Grieco, Gaetano S / Cargnin, Sarah / Santorelli, Filippo M / Pierelli, Francesco / Tassorelli, Cristina / Nappi, Giuseppe / Di Lorenzo, Cherubino. ·Headache Science Centre, C. Mondino National Institute of Neurology Foundation, IRCCS, Pavia, Italy. ·Pharmacogenomics · Pubmed #24624920.

ABSTRACT: Migraine is characterized by heterogeneous behavior in response to drugs. Many resources have been invested in attempting to unravel the genetic basis of migraine, while the role of genetics in responses to currently available drugs has received less attention. We performed a systematic literature search identifying original articles pertaining to pharmacogenomics of episodic migraine. Few primary studies on the pharmacogenomics of symptomatic and preventive medication in episodic migraine were found. The number of patients studied in the individual articles ranged from 40 up to 130. There was a strong heterogeneity among these studies. We believe that pharmacogenomics studies, if properly designed, could contribute towards optimizing the treatment and reducing the burden of migraine, in turn helping patients and optimizing resources. Our knowledge on the pharmacogenomics of migraine is growing too slowly, and concerted measures should be undertaken to speed up the process.

10 Review Triptan nonresponders: do they exist and who are they? 2013

Viana, Michele / Genazzani, Armando A / Terrazzino, Salvatore / Nappi, Giuseppe / Goadsby, Peter J. ·Headache Science Center, C. Mondino National Institute of Neurology Foundation, IRCCS, Pavia, Italy. michele.viana@mondino.it ·Cephalalgia · Pubmed #23564209.

ABSTRACT: BACKGROUND: Triptans represent the best treatment option for most migraine attacks, although this is not as well studied as it might be in controlled trials. Their efficacy and tolerability vary, both between agents, and from patient to patient, with about 30%-40% of patients not responding adequately to therapy. As yet unexplained, the failure of one triptan does not predict failure with another, and therefore triptan nonresponders cannot be defined as individuals who have failed a single triptan. Five clinical studies provide evidence that switching from a triptan that is ineffective to a second one can result in effective treatment in a proportion of patients. Systematic studies investigating whether there are patients who do not respond to all triptans in all formulations are lacking. METHODS: Here we discuss the importance of identifying triptan nonresponders, the literature supporting their existence, and the issues to be resolved to design trials to investigate this. CONCLUSION: So far, no scientific data about the presence of a triptan nonresponder population are available. We propose a pragmatic study design to assess the existence of this subpopulation, recognizing the complexity of the question and the likelihood that more than one issue is at play in nonresponders.

11 Review The typical duration of migraine aura: a systematic review. 2013

Viana, Michele / Sprenger, Till / Andelova, Michaela / Goadsby, Peter J. ·Headache Science Centre, C. Mondino National Institute of Neurology Foundation, IRCCS, Pavia, Italy. ·Cephalalgia · Pubmed #23475294.

ABSTRACT: BACKGROUND: According to ICHD-II, and as proposed for ICHD-III, non-hemiplegic migraine aura (NHMA) symptoms last between five and 60 minutes whereas hemiplegic migraine aura can be longer. In ICHD-III it is proposed to label aura longer than an hour and less than a week as probable migraine with aura. We tested whether this was appropriate based on the available literature. METHODS: We performed a systematic literature search identifying articles pertaining to a typical or prolonged duration of NHMA. We also performed a comprehensive literature search in order to identify all population-based studies or case series in which clinical features of NHMA, including but not restricted to aura duration, were reported, in order to gain a complete coverage of the available scientific data on aura duration. RESULTS: We did not find any article exclusively focusing on the prevalence of a prolonged aura or more generally on typical NHMA duration. We found 10 articles that investigated NHMA features, including the aura duration. Five articles recorded the proportion of patients in whom whole NHMA lasted for more than one hour, which was the case in 12%-37% of patients. Six articles reported some information on the duration of single NHMA symptoms: visual aura disturbances lasting for more than one hour occurred in 6%-10% of patients, sensory aura in 14%-27% of patients and aphasic aura in 17%-60% of patients. CONCLUSIONS: The data indicate the duration of NHMA may be longer than one hour in a significant proportion of migraineurs. This seems to be especially true for non-visual aura symptoms. The term probable seems inappropriate in ICHD-III so we propose reinstating the category of prolonged aura for patients with symptoms longer than an hour and less than one week.

12 Review Transdermal hormonal therapy in perimenstrual migraine: why, when and how? 2012

Tassorelli, Cristina / Greco, Rosaria / Allena, Marta / Terreno, Erica / Nappi, Rossella E. ·Headache Science Centre, IRCCS National Neurological Institute C. Mondino Foundation, Pavia, Italy. cristina.tassorelli@mondino.it ·Curr Pain Headache Rep · Pubmed #22932815.

ABSTRACT: Experimental and clinical evidence is strongly in favor of a role for estrogens in migraine. It is clear that estrogen fluctuations represent trigger factors for the attacks, while the resolution of these fluctuations (menopause) may be associated to the remission or, conversely, to the worsening of the disease. However, the exact mechanisms and mediators underlying the effects of estrogens in migraine are largely unknown. The exact mechanisms and mediators underlying the effects of estrogens in migraine are largely unknown. In this review, we summarize clinical and preclinical data that are relevant for the role of estrogens in migraine and we discuss how estrogen modulation can be exploited positively to improve hormonal-related migraine.

13 Review Migraine and depression: common pathogenetic and therapeutic ground? 2011

Moschiano, F / D'Amico, D / Canavero, I / Pan, I / Micieli, G / Bussone, G. ·National Institute of Neurology, IRCCS C. Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy. franca.moschiano@mondino.it ·Neurol Sci · Pubmed #21533720.

ABSTRACT: Migraine and depression are recognized as comorbid disorders on the basis of several epidemiological data and on the possibility of shared mechanisms. On the other hand, there is a lack of studies concerning therapeutic strategies in patients with this comorbidity. The aim of this paper is to briefly review the literature about the migraine and depression comorbidity and on the putative common neurobiological mechanisms, as well to discuss the possible therapeutic options in treating patients with both disorders.

14 Review Headaches during pregnancy. 2011

Nappi, Rossella E / Albani, Francesca / Sances, Grazia / Terreno, Erica / Brambilla, Emanuela / Polatti, Franco. ·Research Center for Reproductive Medicine, Section of Obstetrics and Gynecology, Department of Morphological, Eidological and Clinical Sciences, University of Pavia, IRCCS Policlinico San Matteo, Piazzale Golgi 2, Pavia 27100, Italy. renappi@tin.it ·Curr Pain Headache Rep · Pubmed #21465113.

ABSTRACT: Among primary headaches, migraine is the form more sensitive to the ovarian hormonal milieu. Migraine without aura (MO) benefits from the hyperestrogenic state of pregnancy and the lack of hormonal fluctuations, while migraine with aura (MA) presents distinctive features. Indeed, a very strong improvement of MO has been documented across gestation, and only a minority of pregnant women still suffers during the third trimester. On the other hand, fewer women with MA report improvement or remission, and new onset of aura may be observed during pregnancy. After delivery, breastfeeding exerts a protective action on migraine recurrence. The persistence of migraine during gestation seems to affect neonatal outcomes, and several studies indicate a link between migraine and an increased risk of developing gestational hypertension/preeclampsia and other vascular complications.

15 Review Migraine and psychiatric comorbidity: a review of clinical findings. 2011

Antonaci, Fabio / Nappi, Giuseppe / Galli, Federica / Manzoni, Gian Camillo / Calabresi, Paolo / Costa, Alfredo. ·University Centre for Adaptive Disorders and Head pain (UCADH), Pavia, Italy. fabio.antonaci@unipv.it ·J Headache Pain · Pubmed #21210177.

ABSTRACT: Migraine is an extremely common disorder. The underlying mechanisms of this chronic illness interspersed with acute symptoms appear to be increasingly complex. An important aspect of migraine heterogeneity is comorbidity with other neurological diseases, cardiovascular disorders, and psychiatric illnesses. Depressive disorders are among the leading causes of disability worldwide according to WHO estimation. In this review, we have mainly considered the findings from general population studies and studies on clinical samples, in adults and children, focusing on the association between migraine and psychiatric disorders (axis I of the DSM), carried over after the first classification of IHS (1988). Though not easily comparable due to differences in methodology to reach diagnosis, general population studies generally indicate an increased risk of affective and anxiety disorders in patients with migraine, compared to non-migrainous subjects. There would also be a trend towards an association of migraine with bipolar disorder, but not with substance abuse/dependence. With respect to migraine subtypes, comorbidity mainly involves migraine with aura. Patients suffering from migraine, however, show a decreased risk of developing affective and anxiety disorders compared to patients with daily chronic headache. It would also appear that psychiatric disorders prevail in patients with chronic headache and substance use than in patients with simple migraine. The mechanisms underlying migraine psychiatric comorbidity are presently poorly understood, but this topic remains a priority for future research. Psychiatric comorbidity indeed affects migraine evolution, may lead to chronic substance use, and may change treatment strategies, eventually modifying the outcome of this important disorder.

16 Review The endocannabinoid system and migraine. 2010

Greco, Rosaria / Gasperi, Valeria / Maccarrone, Mauro / Tassorelli, Cristina. ·Headache Science Centre, IRCCS Neurological Institute C. Mondino Foundation, Pavia, Italy. ·Exp Neurol · Pubmed #20353780.

ABSTRACT: The recently discovered endocannabinoid system (ECS), which includes endocannabinoids and the proteins that metabolize and bind them, has been implicated in multiple regulatory functions both in health and disease. Several studies have suggested that ECS is centrally and peripherally involved in the processing of pain signals. This finding is corroborated by the evidence that endocannabinoids inhibit, through a cannabinoid type-1 receptor (CB1R)-dependent retrograde mechanism, the release of neurotransmitters controlling nociceptive inputs and that the levels of these lipids are high in those regions (such as sensory terminals, skin, dorsal root ganglia) known to be involved in transmission and modulation of pain signals. In this review we shall describe experimental and clinical data that, intriguingly, demonstrate the link between endocannabinoids and migraine, a neurovascular disorder characterized by recurrent episodic headaches and caused by abnormal processing of sensory information due to peripheral and/or central sensitization. Although the exact ECS-dependent mechanisms underlying migraine are not fully understood, the available results strongly suggest that activation of ECS could represent a promising therapeutical tool for reducing both the physiological and inflammatory components of pain that are likely involved in migraine attacks.

17 Review Almotriptan for the treatment of acute migraine: a review of early intervention trials. 2010

Antonaci, Fabio / De Cillis, Ilaria / Cuzzoni, Maria Giovanna / Allena, Marta. ·University Centre for Adaptive Disorders and Headache (UCADH), Section of Pavia, Headache Medicine Centre, Polyclinic of Monza, Via Mondino 2, 27100 Pavia, Italy. fabio.antonaci@unipv.it. ·Expert Rev Neurother · Pubmed #20187858.

ABSTRACT: Almotriptan is a serotonin (5-hydroxytryptamine)(1B/1D) receptor agonist (triptan) that has shown consistent efficacy in the acute treatment of migraine with excellent tolerability. It is an effective, well-tolerated and cost-effective triptan, as demonstrated by improvement in rigorous, patient-orientated end points, such as 'sustained pain-free without adverse events'. Results from post hoc analyses, observational studies and well-controlled, prospective clinical trials have shown that significant improvements can be achieved if almotriptan 12.5 mg is administered within an hour of migraine onset, particularly when pain is mild, rather than waiting until pain is moderate-to-severe. Benefits were also achieved with early treatment of moderate-to-severe pain. Time-to-treatment was the best predictor of headache duration, whereas initial headache intensity best predicted most other efficacy outcomes. Early administration of almotriptan 12.5 mg not only produced rapid symptomatic relief, it also improved the patient's quality of life and ability to resume normal daily functioning. Furthermore, the efficacy of almotriptan is not significantly affected by allodynia (purported to reduce the efficacy of triptans). Thus, the excellent efficacy and tolerability profile of almotriptan administered early in a migraine attack indicate that it may be a first-line treatment option in this common, underdiagnosed and undertreated disorder.

18 Review A review of current European treatment guidelines for migraine. 2010

Antonaci, Fabio / Dumitrache, Cezar / De Cillis, Ilaria / Allena, Marta. ·University Centre for Adaptive Disorders and Headache (UCADH), Pavia, Italy. fabio.antonaci@unipv.it ·J Headache Pain · Pubmed #20020170.

ABSTRACT: Migraine is one of the ten most disabling disorders worldwide, and despite recent developments in the management of migraine, it remains underdiagnosed and undertreated. Guidelines for the management of migraine aim to improve the quality of patient care and to assist professionals in decision making in relation to the overall healthcare process. Most European countries have published national clinical practice guidelines for migraine treatment. These guidelines need to be kept up-to-date with the most recent best clinical evidence and therapeutic strategies to ensure their optimal use to improve health outcomes. The aim of this review is to compare the English language guidelines available across Europe, analyzing differences and similarities, in order to provide a general overview to assist in assessing whether a European consensus on migraine treatment can be achieved.

19 Review Eletriptan. 2009

Sandrini, Giorgio / Perrotta, Armando / Tassorelli, Cristina / Nappi, Giuseppe. ·IRCCS C Mondino Institute of Neurology Foundation, Department of Neurology, via Mondino 2, Pavia, Italy. ·Expert Opin Drug Metab Toxicol · Pubmed #19929447.

ABSTRACT: Migraine is a multifactorial chronic central nervous system disorder, characterized by recurrent disabling attacks of moderate-to-severe headache. Symptomatic acute treatment of migraine should provide rapid and effective relief of the headache pain. The introduction of the 5-HT(1B/1D) receptor agonists (triptans) expanded the armamentarium for acute migraine pain treatment. Eletriptan is a second-generation triptan with favorable bioavailability and half-life, a high affinity for 5-HT(1B/1D) receptors and selectivity for cranial arteries. Eletriptan (40 and 80 mg) has been shown to be effective as early as 30 min after administration and well tolerated when compared to placebo. In comparative clinical trials, eletriptan 40 and 80 mg were superior or equivalent to other triptans and have shown a very high safety and tolerability profile across the studies performed. Eletriptan showed the most favorable cost-effectiveness profile when compared with other agents in its class.

20 Review Migralepsy: a call for a revision of the definition. 2009

Sances, Grazia / Guaschino, Elena / Perucca, Piero / Allena, Marta / Ghiotto, Natascia / Manni, Raffaele. ·Headache Unit, IRCCS C. Mondino Institute of Neurology Foundation, Pavia, Italy. grazia.sances@mondino.it ·Epilepsia · Pubmed #19694799.

ABSTRACT: Migralepsy is an ill-defined nosologic entity, with only a few cases described in the literature. In the 2004 International Classification for Headache Disorders (ICHD-II), the International Headache Society proposed that the following diagnostic criteria should be met: (1) migraine fulfilling criteria for 1.2 Migraine with aura (MA) and (2) a seizure fulfilling diagnostic criteria for one type of epileptic attack occurs during or within 1 h after a migraine aura. Herein, by presenting a case with symptoms suggestive of migralepsy and by reviewing all previous cases described in the literature, we discuss the challenges of differentiating this condition from epileptic seizures, as well as the inaccuracy of the current ICHD-II definition.

21 Review Hormonal management of migraine at menopause. 2009

Nappi, Rossella E / Sances, Grazia / Detaddei, Silvia / Ornati, Alessandra / Chiovato, Luca / Polatti, Franco. ·Department of Morphological, Etiological and Clinical Sciences, Research Center of Reproductive Medicine, University of Pavia, Via Ferrata 8, 27100 Pavia, Italy. renappi@tin.it ·Menopause Int · Pubmed #19465675.

ABSTRACT: In this review, we underline the importance of linking migraine to reproductive stages for optimal management of such a common disease across the lifespan of women. Menopause has a variable effect on migraine depending on individual vulnerability to neuroendocrine changes induced by estrogen fluctuations and on the length of menopausal transition. Indeed, an association between estrogen 'milieu' and attacks of migraine is strongly supported by several lines of evidence. During the perimenopause, it is likely to observe a worsening of migraine, and a tailored hormonal replacement therapy (HRT) to minimize estrogen/progesterone imbalance may be effective. In the natural menopause, women experience a more favourable course of migraine in comparison with those who have surgical menopause. When severe climacteric symptoms are present, postmenopausal women may be treated with continuous HRT. Even tibolone may be useful when analgesic overuse is documented. However, the transdermal route of oestradiol administration in the lowest effective dose should be preferred to avoid potential vascular risk.

22 Review From drug-induced headache to medication overuse headache. A short epidemiological review, with a focus on Latin American countries. 2009

Allena, Marta / Katsarava, Zaza / Nappi, Giuseppe / Anonymous4560622. ·IRCCS Neurological Institute C. Mondino Foundation, University Centre for Headache and Adaptive Disorders, Pavia Section, Via Mondino 2, 27100 Pavia, Italy. marta.allena@mondino.it ·J Headache Pain · Pubmed #19238511.

ABSTRACT: Medication overuse headache (MOH) is a daily or almost-daily type of headache that results from the chronicization, usually migraine or tension-type headache, as a consequence of the progressive increase of intake of symptomatic drugs. MOH is now the third most frequent type of headache and affects a percentage of 1-1.4% of the general population. The currently available data on the impact of chronic headache associated with analgesic overuse in specialist headache centres confirm, beyond doubt, the existence of a serious health problem. Limited amount of data exists on the burden and impact of MOH in Latin American Countries. In this review, we summarise the reliable information from the literature on the epidemiological impact of MOH.

23 Review Meeting patient expectations in migraine treatment: what are the key endpoints? 2008

Antonaci, Fabio / Sances, Grazia / Guaschino, Elena / De Cillis, Ilaria / Bono, Giorgio / Nappi, Giuseppe. ·University Centre for Adaptive Disorders and Headache (UCADH), Section of Varese, Pavia, Italy. fabio.antonaci@unipv.it ·J Headache Pain · Pubmed #18607535.

ABSTRACT: Clinical outcomes of migraine treatment are generally based on two major endpoints: acute pain resolution and effects on quality of life (QOL). Resolution of acute pain can be evaluated in a number of ways, each increasingly challenging to achieve; pain relief, pain freedom at 2 h, sustained pain-freedom, and SPF plus no adverse events (SNAE, the most challenging). QOL questionnaires help assess the burden of migraine and identify optimal treatments. Pain resolution and improved QOL form the basis of the ultimate target-meeting patient expectations, to achieve patient satisfaction. To achieve this, it is crucial to choose appropriate endpoints that reflect realistic treatment goals for individual patients. Moreover, SNAE can help discriminate between triptans, with almotriptan having the highest SNAE score. Kaplan-Meier plots are also relevant when evaluating migraine treatments. The use of symptomatic medication may lead to the paradoxical development of medication-overuse headache. In general practice, patients should use simple tools for pain measurement (e.g. headache diary) and a QOL questionnaire. A composite endpoint of pain resolution and QOL restoration would constitute a step forward in migraine management.

24 Clinical Trial Monocentric Prospective Study into the Sustained Effect of Incobotulinumtoxin A (XEOMIN 2018

Ion, Ioana / Renard, Dimitri / Le Floch, Anne / De Verdal, Marie / Bouly, Stephane / Wacongne, Anne / Lozza, Alessandro / Castelnovo, Giovanni. ·Department of Neurology, Nimes University Hospital, 30900 Nimes, France. IOANAMARIA.ION@chu-nimes.fr. · Department of Neurology, Nimes University Hospital, 30900 Nimes, France. dimitri.RENARD@chu-nimes.fr. · Department of Neurology, Nimes University Hospital, 30900 Nimes, France. anne.LEFLOCH@chu-nimes.fr. · Department of Neurology, Nimes University Hospital, 30900 Nimes, France. marie.DEVERDAL@chu-nimes.fr. · Department of Neurology, Nimes University Hospital, 30900 Nimes, France. stephane.BOULY@chu-nimes.fr. · Department of Neurology, Nimes University Hospital, 30900 Nimes, France. anne.WACONGNE@chu-nimes.fr. · Neurological Institute, Foundation Casimiro Mondino, 27100 Pavia, Italy. alessandro.lozza@mondino.it. · Department of Neurology, Nimes University Hospital, 30900 Nimes, France. giovanni.castelnovo@chu-nimes.fr. ·Toxins (Basel) · Pubmed #29857565.

ABSTRACT: Refractory chronic migraine is a disabling disorder impacting quality of life. BOTOX

25 Clinical Trial The usefulness and applicability of a basic headache diary before first consultation: results of a pilot study conducted in two centres. 2008

Tassorelli, C / Sances, G / Allena, M / Ghiotto, N / Bendtsen, L / Olesen, J / Nappi, G / Jensen, R. ·University Centre for the Study of Adaptive Disorders and Headache (UCADH), IRCCS 'C. Mondino Institute of Neurology' Foundation, Pavia, Italy. cristina.tassorelli@mondino.it ·Cephalalgia · Pubmed #18624804.

ABSTRACT: We tested the usefulness and applicability of a simplified headache diary in the diagnosis of migraine (M), tension-type headache (TTH) and medication overuse headache (MOH). The diary was given to headache patients before their first consultation at the headache centre. Seventy-six naive headache patients completed the study. Their understanding of the diary proved highly satisfactory. The patients' level of compliance was also good, with 71% returning the diary completely filled in. The data entered in the diary were deemed complete for the diagnostic purpose in 93% of cases. The level of agreement between headache information gathered through clinical interview and the headache diary was satisfactory. When comparing the diary with the clinical interview, sensitivity was 92% for M, 75% for TTH and MOH. Specificity was 58% for M and TTH, 87% for MOH. Combined use of a diagnostic diary and clinical interview is recommended from the first consultation for headache.