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Migraine Disorders: HELP
Articles from Milan
Based on 219 articles published since 2008

These are the 219 published articles about Migraine Disorders that originated from Milan during 2008-2019.
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9
1 Editorial The evolution of migraine therapy: a new concept of care. 2018

Frediani, Fabio. ·Headache Center, Neurological and Stroke Unit, ASST Santi Paolo e Carlo, San Carlo Borromeo Hospital, Via Pio II, 3, 20153, Milan, Italy. fabio.frediani@asst-santipaolocarlo.it. ·Neurol Sci · Pubmed #29904880.

ABSTRACT: -- No abstract --

2 Review CGRP and migraine from a cardiovascular point of view: what do we expect from blocking CGRP? 2019

Favoni, Valentina / Giani, Luca / Al-Hassany, Linda / Asioli, Gian Maria / Butera, Calogera / de Boer, Irene / Guglielmetti, Martina / Koniari, Chrysoula / Mavridis, Theodoros / Vaikjärv, Marge / Verhagen, Iris / Verzina, Angela / Zick, Bart / Martelletti, Paolo / Sacco, Simona / Anonymous4181134. ·Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy. valentina.favoni2@unibo.it. · IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura, 3 Pad. G, 40139, Bologna, Italy. valentina.favoni2@unibo.it. · Ricovero Ferdinando Uboldi, Paderno Dugnano, Italy. · Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands. · Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy. · IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura, 3 Pad. G, 40139, Bologna, Italy. · Dipartimento Neurologico e INSPE, IRCCS Ospedale San Raffaele, Milan, Italy. · Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy. · Regional Referral Headache Center, Sant'Andrea Hospital, Rome, Italy. · Department of Clinical Pathology, University of Sassari, Sassari, Italy. · 1st Neurology Department, Aeginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. · Faculty of Medicine, University of Tartu, Tartu, Estonia. · Neurology Clinic, University of Perugia, Perugia, Italy. · S. Maria della Misericordia Hospital, Perugia, Italy. · UOC Neurologia e Stroke Unit, Ospedale SS Filippo e Nicola, Avezzano, Italy. · Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy. ·J Headache Pain · Pubmed #30866804.

ABSTRACT: Calcitonin gene-related peptide (CGRP) is a neuropeptide with a pivotal role in the pathophysiology of migraine. Blockade of CGRP is a new therapeutic target for patients with migraine. CGRP and its receptors are distributed not only in the central and peripheral nervous system but also in the cardiovascular system, both in blood vessels and in the heart. We reviewed the current evidence on the role of CGRP in the cardiovascular system in order to understand the possible short- and long-term effect of CGRP blockade with monoclonal antibodies in migraineurs.In physiological conditions, CGRP has important vasodilating effects and is thought to protect organs from ischemia. Despite the aforementioned cardiovascular implication, preventive treatment with CGRP antibodies has shown no relevant cardiovascular side effects. Results from long-term trials and from real life are now needed.

3 Review Pharmacotherapy for acute migraines in children and adolescents. 2019

Barbanti, P / Grazzi, L / Egeo, G. ·a Headache and Pain Unit, Department of Neurological , Motor and Sensorial Sciences; IRCCS San Raffaele Pisana , Rome , Italy. · b San Raffaele University , Rome , Italy. · c Neuroalgology Unit , Headache Center Fondazione IRCCS Istituto Neurologico "Carlo Besta" , Milan , Italy. ·Expert Opin Pharmacother · Pubmed #30526161.

ABSTRACT: INTRODUCTION: Migraine is increasingly recognized as an extremely burdensome and disabling disorder in both children and adolescents. A proper treatment plan is needed to improve the quality of life of both children and families as well as to minimize the risk of disease progression. AREAS COVERED: This review focuses on the current pharmacotherapy for acute migraine in pediatric populations, taking into account specific considerations for those drugs tested in randomized, placebo-controlled trials (RCTs). EXPERT OPINION: A large number of RCTs have documented the efficacy, tolerability, and safety of different compounds. Triptans appears more effective than placebo but results are variable and inconsistent. Almotriptan and rizatriptan are effective as oral formulations, as well as sumatriptan and zolmitriptan as both oral and nasal spray formulations. Adding non-steroidal anti-inflammatory drugs (NSAIDs) reinforces triptan's effectiveness. Furthermore, small RCTs have documented both the efficacy of ibuprofen and the ineffectiveness of acetaminophen. Naproxen, ketoprofen, diclofenac, and indomethacin - NSAIDs effective in acute migraines in adults - should be tested also in pediatric subjects. Furthermore, the authors suggest that dopamine receptor antagonists should be considered in cases of severe migraines. Lastly, better designed RCTs are needed to fine-tune current therapeutic resources.

4 Review Can we now say that commonalities between restless leg syndrome and migraine exist? 2019

Raggi, Alberto. ·Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milano, Italy. alberto.raggi@istituto-besta.it. ·Neurol Sci · Pubmed #30280360.

ABSTRACT: The recent manuscript by Xinglong Yang and colleagues provided the first relatively reliable estimate of restless leg syndrome (RLS) prevalence among migraine sufferers, which was estimated at 19% (95% CI 14-24%). The implications of the association between the two conditions are wide, and call for further action aimed to address common disease mechanism-associated conditions such as sleep-related ones and associated burden.

5 Review Is Medication Overuse Drug Specific or Not? Data from a Review of Published Literature and from an Original Study on Italian MOH Patients. 2018

Grazzi, Licia / Grignani, Eleonora / D'Amico, Domenico / Sansone, Emanuela / Raggi, Alberto. ·Division of Neuroalgology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy. licia.grazzi@istituto-besta.it. · Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy. · Division of Neuroalgology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy. ·Curr Pain Headache Rep · Pubmed #30151604.

ABSTRACT: PURPOSE OF REVIEW: The aim is twofold. First, to give an insight on the role exerted by different classes of drugs in favouring migraine chronification. Second, to explore the relationship between type and amount of overused medications and history of previous withdrawal treatment and of frequent relapses. RECENT FINDINGS: All drug classes were found to favour migraine chronification. No data are available for the association with relapses into CM-MOH. Our clinical study shows that patients who underwent previous withdrawal treatments were more likely to be overusers of multiple drug classes and overuse higher amounts of symptomatic medications, particularly, indomethacin, eletriptan and tramadol. Frequent relapsers were more likely to be overusers of opioids or ergotamine and caffeine derivates or of multiple classes, particularly acetylsalicylic acid and ergotamine/caffeine derivates. The joint results our review and clinical study do not seem to support the idea that MOH is drug-specific: rather, it points out that all drug classes may induce migraine chronification. Those drugs which are at higher risk of overuse are among those preferred by the "worst" patients, i.e. those who needed one or more withdrawal treatments for MOH. Our results reinforce the clinical impression that patients with CM and MOH, and particularly the most difficult to treat for their poor response to withdrawal treatments, are characterised by a particular drive towards the consumption of "whatever is likely to be perceived to provide some relief", despite these drugs that are perceived as "more powerful", are often indicated as second- or third-line medications.

6 Review Pediatric sporadic hemiplegic migraine (ATP1A2 gene): a case report and brief literature review. 2018

Schwarz, Ghil / Anzalone, Nicoletta / Baldoli, Cristina / Impellizzeri, Matteo / Minicucci, Fabio / Comi, Giancarlo / Colombo, Bruno. ·Department of Neurology and Neurophysiology, San Raffaele Scientific Institute, Milan, Italy. · Department of Neuroradiology, San Raffaele Scientific Institute, Milan, Italy. · Department of Neurology, Division of Neurosciences, Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, via Olgettina 58, 20122, Milan, Italy. · Department of Neurology and Neurophysiology, San Raffaele Scientific Institute, Milan, Italy. colombo.bruno@hsr.it. · Department of Neurology, Division of Neurosciences, Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, via Olgettina 58, 20122, Milan, Italy. colombo.bruno@hsr.it. ·Neurol Sci · Pubmed #29904856.

ABSTRACT: -- No abstract --

7 Review Migraine and cerebrovascular disease: still a dangerous connection? 2018

Agostoni, Elio Clemente / Longoni, Marco. ·Neurology and Stroke Unit, Department of Neurosciences, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy. · Neurology and Stroke Unit, Department of Neurosciences, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy. marco.longoni@ospedaleniguarda.it. ·Neurol Sci · Pubmed #29904830.

ABSTRACT: Migraine is a common type of headache in young adults, with an estimated prevalence of 4% before puberty and as high as 25% in women by their mid to late 30s. About one third of migraineurs experience transient neurological symptoms known as auras, which characterize a variant known as migraine with aura. Many evidences have shown an increased risk of vascular events in patients affected by migraine, particularly among women and among migraine patients with aura. Potential underlying mechanisms include endothelial dysfunction, hypercoagulability, platelet aggregation, vasospasm, cardiovascular risk factors, paradoxical embolism, spreading depolarization, shared genetic risk, use of non-steroidal anti-inflammatory drugs, and immobilization. The risk of vascular events in migraine patients is also linked by concomitant oral contraception; moreover, the common finding of increased incidence of right to left cardiac shunt in migraine patients might have a pathogenetic role. Finally, many MRI studies in migraine patients, particularly in migraine with aura, have shown subcortical lesions particularly in the cerebellum as a common finding. In this review, we analyzed the more recent findings regarding the topic of migraine as a risk factor in stroke.

8 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.

9 Review Vestibular migraine: who is the patient? 2017

Colombo, Bruno / Teggi, Roberto / Anonymous1520907. ·Headache Unit, Department of Neurology, IRCCS Ospedale San Raffaele, Vita-Salute University, Milan, Italy. colombo.bruno@hsr.it. · ENT Department, IRCCS Ospedale San Raffaele, Vita-Salute University, Milan, Italy. ·Neurol Sci · Pubmed #28527080.

ABSTRACT: Vestibular migraine has been classified as a specific entity in which vestibular symptomatology is defined as part of the migrainous disorder. New and appropriate diagnostic criteria have been proposed by the Barany and International Headache Societies. The diagnosis of vestibular migraine mainly depends on the patient history. The NIVE project is a prospectic multicentric study on vestibular migraine. The aim of this project is to evaluate demographics, epidemiology, clinical manifestations of migraine and vertigo in a large cohort of Caucasian patients affected by vestibular migraine.

10 Review The role of visual system in migraine. 2017

Marzoli, Stefania Bianchi / Criscuoli, Alessandra. ·Neuro-ophthalmology Service and Ocular Electrophysiology Laboratory, Scientific Institute Capitanio Hospital, IRCCS Istituto Auxologico Italiano, via Mercalli, 28, 20122, Milan, Italy. s.bianchimarzoli@auxologico.it. · Neuro-ophthalmology Service and Ocular Electrophysiology Laboratory, Scientific Institute Capitanio Hospital, IRCCS Istituto Auxologico Italiano, via Mercalli, 28, 20122, Milan, Italy. ·Neurol Sci · Pubmed #28527076.

ABSTRACT: The visual system is involved in different ways in migraine. Visual auras are the most common form of migraine aura. It may consist of positive or negative visual symptoms and cortical spreading depression is felt to be the phenomenon that underlies it. Even in migraine without aura, vision it is not totally excluded given that one of the major criteria for the diagnosis of migraine is photophobia. In persistent visual aura, patients refer symptoms defined as visual snow and television static. In retinal migraine unilateral decreased vision or complete visual loss occurs. Ophthalmoplegic migraine is characterized by palsy of one among the three ocular motor nerves. Migraine visual aura, particularly when occurring without headache, is a diagnosis of exclusion. Imaging studies and laboratory tests should exclude neurologic disease, included seizures and central nervous system tumor, ocular pathologies, carotid or cardiac disease, thrombosis and connective tissue disease.

11 Review Usefulness of nutraceuticals in migraine prophylaxis. 2017

D'Onofrio, Florindo / Raimo, Simona / Spitaleri, Daniele / Casucci, Gerardo / Bussone, Gennaro. ·Institute of Neurology San G. Moscati Hospital, Avellino, Italy. · Department of Psychology, University of Campania Luigi Vanvitelli, Viale Ellittico 31, 81100, Caserta, Italy. simonaraimo.sun@gmail.com. · San Francesco Hospital, Telese Terme, Benevento, Italy. · C. Besta Neurological Institute and Foundation, Milan, Italy. ·Neurol Sci · Pubmed #28527067.

ABSTRACT: Several studies have supported the efficacy of complementary and alternative medicine approaches (physical, behavioral and nutraceutical therapies) in the treatment of headache disorders. Nutraceutical treatment consists of taking vitamins, supplements (magnesium, riboflavin, coenzyme Q10, and alpha lipoic acid) and herbal preparations (feverfew and butterbur), and its usage is frequently determined by dissatisfaction with conventional medical therapies. There is a growing body of research on nutraceutical use for migraine prophylaxis. This brief overview provides information about the potential efficacy and side effects of various nutraceutical products summarizing randomized controlled trials of some of the most commonly used non-pharmacological treatments for the prophylaxis and treatment of migraine, including magnesium, coenzyme Q10, riboflavin (vitamin B

12 Review Action mechanisms of Onabotulinum toxin-A: hints for selection of eligible patients. 2017

Lovati, Carlo / Giani, Luca. ·Neurology Unit, Headache Center, Osp. L.Sacco, University of Milan, Via G.B. Grassi 74, 20157, Milan, Italy. carlo.lovati@asst-fbf-sacco.it. · Neurology Unit, Headache Center, Osp. L.Sacco, University of Milan, Via G.B. Grassi 74, 20157, Milan, Italy. ·Neurol Sci · Pubmed #28527052.

ABSTRACT: In the past few decades, the so-feared botulinum toxin has conversely acquired the role of a ever more versatile therapeutic substance, used in an increasing number of pathological situations, including chronic headache and more precisely in the prophylaxis of chronic migraine. The medical use of botulinum toxin allowed to better understand its multiple mechanisms of action. Investigations about the pathophysiology of primary and secondary headaches has shown a series of common biological elements that frequently are also targets of the action of botulinum toxin. These increasing evidences allowed to identify some biochemical, neurophysiological and radiological markers that may be useful in the individuation of patients which probably will respond to the treatment with Onabotulinum toxin-A among chronic migraineurs. These predictors include CGRP plasmatic levels, specific laser-evoked potential responses, peculiar brain MRI and fMRI and characteristic clinical manifestations. Unfortunately, at now, these predictors are still not available for the clinical practice. Furthermore, the better knowledge about biology of headaches and regarding botulinum toxin activities may also help in directing investigations on the possible use of Onabotulinum toxin-A in other headaches different from migraine. This review tries to show in detail these biological mechanisms and their implication in selecting patients eligible for the treatment with Onabotulinum toxin-A.

13 Review The link between obesity and migraine in childhood: a systematic review. 2017

Farello, G / Ferrara, P / Antenucci, A / Basti, C / Verrotti, A. ·Department of Pediatrics, University of L'Aquila, Via Vetoio 1, Coppito, 67100, L'Aquila, Italy. giovanni.farello@cc.univaq.it. · Department of Pediatrics, Catholic University, A. Gemelli Hospital, Rome, Italy. · Department of Pediatrics, University of L'Aquila, Via Vetoio 1, Coppito, 67100, L'Aquila, Italy. ·Ital J Pediatr · Pubmed #28270183.

ABSTRACT: Obesity and headache are two highly prevalent diseases both in adults and children and they are associated with a strong personal and social impact. Many studies suggest that obesity is comorbid with headache in general, and migraine in particular and obesity seems to be a risk factor for migraine progression and for migraine frequency both in adults and in children. Research shows that there are multiple areas of overlap between migraine pathophysiology and the central and peripheral pathways regulating feeding: inflammatory mediators such as the calcitonin gene-related protein (CGRP), neurotransmitters such as serotonin, peptides such as orexin and adipocytokines such as adiponectin (ADP) and leptin could explain the common pathogenesis. In this paper we discussed the association between obesity and migraine through the analysis of the most recent studies in children and we reviewed data from literature in order to assess the association between obesity and headache and to clarify the possible common pathogenic mechanisms.

14 Review Brain plasticity and migraine transformation: fMRI evidences. 2016

Lovati, Carlo / Giani, Luca / Mele, Francesco / Sinelli, Alessandro / Tien, Thien Trung / Preziosa, Giulia / Mariani, Claudio. ·a Neurology Unit, Luigi Sacco Hospital , University of Milan , Milan , Italy. · b University of Milan , Milan , Italy. ·Expert Rev Neurother · Pubmed #27388277.

ABSTRACT: INTRODUCTION: Chronification transforms episodic migraine into the pathologic chronic form. Biological characteristics of the migrainous brain progressively change, in predisposed subjects, under the repetition of external and internal stimuli. Modifications involve neurons, synapses, neurotransmitters, receptors, connectivity and pain control. f-MRI is a promising way to explore the still unclear biology of this progression. Areas covered: Data included were obtained from the most relevant and updated works available on PubMed about this topic. We summarized the pathophysiology of migraine chronification and of brain plasticity, and we described the different fMRI techniques and their main evidences about migraine transformation. Expert commentary: Functional-MRI has revealed many aspects regarding the peculiarity of the migrainous brain and its tendency toward chronicity but a series of questions are still open: What are the hallmarks of the predisposition to chronification? Which elements are the cause and which the consequence of this process?

15 Review A review of recent literature on functional MRI and personal experience in two cases of definite vestibular migraine. 2016

Teggi, Roberto / Colombo, B / Rocca, M A / Bondi, S / Messina, R / Comi, G / Filippi, M. ·ENT Department, San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy. teggi.roberto@hsr.it. · Department of Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy. · Neuroimaging Research Unit, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy. · ENT Department, San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy. ·Neurol Sci · Pubmed #27225278.

ABSTRACT: The pathophysiology of vestibular migraine (VM) is at present poorly understood. Functional magnetic resonance imaging (fMRI), a technique that measures brain activity by detecting changes associated with blood flow oxygenation, has been used to study neural pathways involved in VM pathophysiology. In this study, we summarize results of previous fMRI studies in VM patients, both during and between vertigo attacks. Moreover, we report our experience in two patients with definite VM, who underwent fMRI during a visual stimulation in a vertigo-free period. Compared with 15 matched healthy controls, fMRI demonstrated activation of brain areas related to integration of visual and vestibular cues (increased activation of the paracentral lobule and bilateral inferior parietal lobule and decreased activation of the left superior frontal gyrus, head of the caudate nucleus, left superior temporal gyrus, left parahippocampal gyrus, and right lingual gyrus). Our results partially confirm those of other authors, reporting increased activation of multimodal association brain areas (BA 40, BA 31/5) and decreased activation of occipital regions In addition, we also found a decreased activation of fronto-temporal areas, such as the parahippocampal region, functionally involved in space memory and navigation.

16 Review SMART (stroke-like migraine attack after radiation therapy) syndrome: a case report with review of the literature. 2016

Rigamonti, Andrea / Lauria, Giuseppe / Mantero, Vittorio / Filizzolo, Marco / Salmaggi, Andrea. ·Department of Neurology, "Alessandro Manzoni" General Hospital, Via Dell'Eremo 9/11, 23900, Lecco, Italy. rig74@libero.it. · Neuroalgology and Headache Unit, National Neurological Institute C. Besta, Via Celoria 11, 20133, Milan, Italy. · Department of Neurology, "Alessandro Manzoni" General Hospital, Via Dell'Eremo 9/11, 23900, Lecco, Italy. · Neuroradiology, A.O Manzoni, Via Dell'Eremo 9/11, 23900, Lecco, Italy. ·Neurol Sci · Pubmed #26466588.

ABSTRACT: -- No abstract --

17 Review Nimodipine in otolaryngology: from past evidence to clinical perspectives. 2015

Monzani, D / Genovese, E / Pini, L A / Di Berardino, F / Alicandri Ciufelli, M / Galeazzi, G M / Presutti, L. ·Unità Operativa Complessa di Otorinolaringoiatria. Azienda Ospedaliero-Universitaria Policlinico di Modena, Italy; · Cattedra di Farmacologia Clinica, Azienda Ospedaliero-Universitaria Policlinico di Modena, Italy; · Unità Operativa Complessa di Audiologia, Fondazione "IRCCS Ca' Granda", Ospedale Maggiore Policlinico di Milano, Italy; · Dipartimento di Medicina Diagnostica, Clinica e di Sanità Pubblica, Università degli Studi di Modena e Reggio Emilia. ·Acta Otorhinolaryngol Ital · Pubmed #26246657.

ABSTRACT: As L-type voltage-gated calcium channels (VGCCs) control Ca(2+) influx and depolarisation of cardiac and vascular smooth muscle, they represent a specific therapeutic target for calcium channel blockers (CCBs), which are approved and widely used to treat hypertension, myocardial ischaemia and arrhythmias. L-type currents also play a role in calcium entry in the sensory cells of the inner ear. In hair cells of both cochlea and labyrinth, calcium cytoplasmic influx is the first physiological process that activates complex intracellular enzymatic reactions resulting in neurotransmitter release. Excessive calcium ion entry into sensory cells, as a consequence of L-VGCCs malfunction is responsible for over-activation of phospholipase A2 and C, protein kinase II and C, nitric oxide synthase and both endonucleases and depolymerases, which can cause membrane damage and cellular death if the cytoplasmic buffering capacity is overcome. Nimodipine, a highly lipophilic 1-4 dihydropyridine that easily crosses the brain-blood barrier, is generally used to reduce the severity of neurological deficits resulting from vasospasm in patients with subarachnoid haemorrhage. Moreover, due to its selective blocking activity on L-channel calcium currents, nimodipine is also suggested to be an effective countermeasure for cochlear and vestibular dysfunctions known as channelopathies. Indeed, experimental data in amphibians and mammalians indicate that nimodipine has a stronger efficacy than other CCBs (aminopyridine, nifedipine) on voltage-dependent whole-cell currents within hair cells at rest and it is the only agent that is also effective during their mechanically induced depolarisation. In humans, the efficacy of nimodipine is documented in the medical management of peripheral vestibular vertigo, sensorineural hearing loss and tinnitus, even in a pathology as complex as Ménière's disease. Nimodipine is also considered useful in the prophylaxis of damage to the facial and cochlear nerves caused by ablative surgery of cerebellopontine tumours; it has been recently hypothesised to accelerate functional recovery of recurrent nerve lesions during thyroid cancer surgery. Further trials with adequate study design are needed to test the efficacy of nimodipine in the treatment of vertigo due to cerebrovascular disease and vestibular migraine.

18 Review Resting-state fMRI functional connectivity: a new perspective to evaluate pain modulation in migraine? 2015

Colombo, Bruno / Rocca, Maria Assunta / Messina, Roberta / Guerrieri, Simone / Filippi, Massimo. ·Headache Research Unit, Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, Milan, Italy, colombo.bruno@hsr.it. ·Neurol Sci · Pubmed #26017510.

ABSTRACT: Resting-state (RS) functional magnetic resonance imaging (fMRI) is a relatively novel tool which explores connectivity between functionally linked, but anatomically separated, brain regions. The use of this technique has allowed the identification, at rest, of the main brain functional networks without requiring subjects to perform specific active tasks. Methodologically, several approaches can be applied for the analysis of RS fMRI, including seed-based, independent component analysis-based and/or cluster-based methods. The most consistently described RS network is the so-called "default mode network". Using RS fMRI, several studies have identified functional connectivity abnormalities in migraine patients, mainly located at the level of the pain-processing network. RS functional connectivity is generally increased in pain-processing network, whereas is decreased in pain modulatory circuits. Significant abnormalities of RS functional connectivity occur also in affective networks, the default mode network and the executive control network. These results provide a strong characterization of migraine as a brain dysfunction affecting intrinsic connectivity of brain networks, possibly reflecting the impact of long lasting pain on brain function.

19 Review Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) for the prevention of migraine in adults. 2015

Banzi, Rita / Cusi, Cristina / Randazzo, Concetta / Sterzi, Roberto / Tedesco, Dario / Moja, Lorenzo. ·Laboratory of Regulatory Policies, IRCCS - Mario Negri Institute for Pharmacological Research, via G La Masa 19, Milan, Italy, 20156. ·Cochrane Database Syst Rev · Pubmed #25829028.

ABSTRACT: BACKGROUND: This is an updated version of the original Cochrane review published in 2005 on selective serotonin reuptake inhibitors (SSRIs) for preventing migraine and tension-type headache. The original review has been split in two parts and this review now only regards migraine prevention. Another updated review is under development to cover tension-type headache.Migraine is a common disorder. The chronic forms are associated with disability and have a high economic impact. In view of discoveries about the role of serotonin and other neurotransmitters in pain mechanisms, selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) have been evaluated for the prevention of migraine. OBJECTIVES: To determine the efficacy and tolerability of SSRIs and SNRIs compared to placebo and other active interventions in the prevention of episodic and chronic migraine in adults. SEARCH METHODS: For the original review, we searched MEDLINE (1966 to January 2004), EMBASE (1994 to May 2003), the Cochrane Central Register of Controlled Trials (CENTRAL 2003, Issue 4), and Headache Quarterly (1990 to 2003). For this update, we applied a revised search strategy to reflect the broader type of intervention (SSRIs and SNRIs). We searched CENTRAL (2014, Issue 10), MEDLINE (1946 to November 2014), EMBASE (1980 to November 2014), and PsycINFO (1987 to November 2014). We also checked the reference lists of retrieved articles and searched trial registries for ongoing trials. SELECTION CRITERIA: We included randomised controlled trials comparing SSRIs or SNRIs with any type of control intervention in participants 18 years and older of either sex with migraine. DATA COLLECTION AND ANALYSIS: Two authors independently extracted data (migraine frequency, index, intensity, and duration; use of symptomatic/analgesic medication; days off work; quality of life; mood improvement; cost-effectiveness; and adverse events) and assessed the risk of bias of trials. The primary outcome of this updated review is migraine frequency. MAIN RESULTS: The original review included eight studies on migraine. Overall, we now include 11 studies on five SSRIs and one SNRI with a total of 585 participants. Six studies were placebo-controlled, four compared a SSRI or SNRI to amitriptyline, and one was a head-to-head comparison (escitalopram versus venlafaxine). Most studies had methodological or reporting shortcomings (or both): all studies were at unclear risk of selection and reporting bias. Follow-up rarely extended beyond three months. The lack of adequate power of most of the studies is also a major concern.Few studies explored the effect of SSRIs or SNRIs on migraine frequency, the primary endpoint. Two studies with unclear reporting compared SSRIs and SNRIs to placebo, suggesting a lack of evidence for a difference. Two studies compared SSRIs or SNRIs versus amitriptyline and found no evidence for a difference in terms of migraine frequency (standardised mean difference (SMD) 0.04, 95% confidence interval (CI) -0.72 to 0.80; I(2) = 72%), or other secondary outcomes such as migraine intensity and duration.SSRIs or SNRIs were generally more tolerable than tricyclics. However, the two groups did not differ in terms of the number of participants who withdrew due to adverse advents or for other reasons (one study, odds ratio (OR) 0.39, 95% CI 0.10 to 1.50 and OR 0.42, 95% CI 0.13 to 1.34).We did not find studies comparing SSRIs or SNRIs with pharmacological treatments other than antidepressants (e.g. antiepileptics and anti-hypertensives). AUTHORS' CONCLUSIONS: Since the last version of this review, the new included studies have not added high quality evidence to support the use of SSRIs or venlafaxine as preventive drugs for migraine. There is no evidence to consider SSRIs or venlafaxine as more effective than placebo or amitriptyline in reducing migraine frequency, intensity, and duration over two to three months of treatment. No reliable information is available at longer-term follow-up. Our conclusion is that the use of SSRIs and SNRIs for migraine prophylaxis is not supported by evidence.

20 Review Pediatric migraine and episodic syndromes that may be associated with migraine. 2014

Spiri, Daniele / Rinaldi, Victoria Elisa / Titomanlio, Luigi. ·Department of Pediatrics, Luigi Sacco Hospital, Università degli Studi di Milano, Milan, Italy. danielespiri@libero.it. · Department of Pediatrics, Università degli Studi di Perugia, Perugia, Italy. victoria.rinaldi87@gmail.com. · Department of Pediatric Emergency Care, APHP-Hospital Robert Debré, Paris, France. victoria.rinaldi87@gmail.com. · Department of Pediatric Emergency Care, APHP-Hospital Robert Debré, Paris, France. luigi.titomanlio@rdb.aphp.fr. · Pediatric Migraine and Neurovascular Diseases Unit, APHP-Hospital Robert Debré, Paris, France. luigi.titomanlio@rdb.aphp.fr. · Pediatric Emergency Department, Robert Debré University Hospital, 48, Bld Sérurier, Paris, 75019, France. luigi.titomanlio@rdb.aphp.fr. ·Ital J Pediatr · Pubmed #25928129.

ABSTRACT: IMPORTANCE: Migraine is a common disorder and a frequent cause of medical consultation in children. Many childhood episodic syndromes have been described as common precursors of migraine. OBJECTIVE: To review current knowledge on migraine and childhood episodic syndromes, and to discuss future directions for research and clinical practice. FINDINGS: For most children it is difficult to describe a headache and fully verbalize symptoms such as photophobia and phonophobia that must be inferred from behaviour. Classical migraine features are rare before the age of 6 years, but some migraine-related syndromes have been described. Benign paroxysmal torticollis of infancy, benign paroxysmal vertigo of childhood, cyclic vomiting syndrome and abdominal migraine are currently classified as childhood episodic syndromes, and therefore common precursors of migraine. A strong association between infantile colic and migraine has recently been reported. There are similarities between children with episodic syndromes and children with migraine, regarding social and demographic factors, precipitating and relieving factors, and accompanying gastrointestinal, neurologic, and vasomotor features. The real pathophysiological mechanisms of migraine are not fully understood. Current data obtained through molecular and functional studies provide a complex model in which vascular and neurologic events cooperate in the pathogenesis of migraine attacks. Genetic factors causing disturbances in neuronal ion channels, make a migraineur more sensitive to multiple trigger factors that activate the nociception cascade. The expanding knowledge on migraine genetics and pathophysiology may be applicable to childhood episodic syndromes. Migraine preventive strategies are particularly important in children, and could be beneficial in childhood episodic syndromes. Nonspecific analgesics like ibuprofen and acetaminophen are widely used in pediatrics to control pain and have been found to be effective also in the treatment of acute migraine attacks. Triptans are the specific fist-line drugs for acute migraine treatment. CONCLUSIONS AND RELEVANCE: Migraine phenotype differs somewhat in the developing brain, and childhood episodic syndromes may arise before typical migraine headache. Diagnosing pediatric migraine may be difficult because of children's language and cognitive abilities. The risk of underestimating migraine in pediatric age is high. An adequate diagnosis is important to maintain a good quality of life and to avoid inappropriate therapy.

21 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.

22 Review Pharmacokinetics and safety of a new aspirin formulation for the acute treatment of primary headaches. 2014

Lecchi, Marzia / D'Alonzo, Lidia / Negro, Andrea / Martelletti, Paolo. ·University of Milan, Department of Biotechnology and Biosciences , Bicocca, Milan , Italy. ·Expert Opin Drug Metab Toxicol · Pubmed #25219631.

ABSTRACT: INTRODUCTION: For more than a century, aspirin has been used for the acute treatment of primary headaches. However, the many formulations available are characterized by differences in the pharmacokinetic profile that could affect therapy effectiveness. AREAS COVERED: The formulations of aspirin affect the speed of absorption of the drug. This feature, in turn, moduates the peak plasmatic concentration (the faster the absorption, the higher the peak plasmatic concentration of aspirin). Recently, a new formulation, consisting in a micronized tablet with an effervescent nucleus, has been shown to be comparable to the formulations associated to the faster absorption. The efficacy of aspirin in migraine is well characterized: the drug is able to rapidly reduce pain and restore functionality, acting also on associated symptoms, in a manner comparable to that of oral sumatriptan. In tension-type headache, aspirin acts in a dose-dependent fashion. The safety profile of the drug is favorable: gastrointestinal complaints are generally mild in intensity and with an incidence comparable to that of ibuprofen and paracetamol. EXPERT OPINION: According to international guidelines, aspirin should be considered as first-line therapy in primary headaches. Formulations that allow fast absorption, like the new micronized tablets, and portability, are to be preferred.

23 Review Difficulties in work-related activities among migraineurs are scarcely collected: results from a literature review. 2014

Raggi, A / Covelli, V / Leonardi, M / Grazzi, L / Curone, M / D'Amico, D. ·Neurology, Public Health and Disability Unit, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133, Milan, Italy, araggi@istituto-besta.it. ·Neurol Sci · Pubmed #24867830.

ABSTRACT: Migraine affects work productivity in terms of missed workdays and days with reduced productivity. In this literature review, we looked for papers addressing specific difficulties in work-related activities. Twenty-three papers were included in the review, reporting data on 51,135 patients. Results showed that there is some evidence for limitations in skills such as problem solving, and activities such as speaking and driving. However, the way in which problems with remunerative employment are addressed is limited to concepts such as reduced performance or inability to work as usual. Given the paucity of data, a return to patient-derived data will be needed to develop an assessment instrument that is able to collect information on headache-related problems in work activities.

24 Review Emerging therapies for chronic migraine. 2014

Proietti Cecchini, Alberto / Grazzi, Licia. ·Headache Centre - Neuromodulation Unit, National Neurological Institute IRCCS "C.Besta" Foundation, Via Celoria, 11, 27100, Milano, Italy, proietti.a@istituto-besta.it. ·Curr Pain Headache Rep · Pubmed #24523001.

ABSTRACT: Not all chronic migraines are medication-overuse headaches and so the challenge is how to treat them. Currently available pharmacological therapies may be ineffective or they are abandoned because of intolerable side effects. There is still much room for novel therapeutic approaches in those with drug refractory migraine (RM). Occipital nerve stimulation (ONS) and botulinum toxin type A have finally gained a level of evidence based on the results of RCTs and pooled analysis, which by and large have shown at least a modest but valuable therapeutic effect. For a long time, these two approaches were only supported by clinical experience and open-label studies. Considering the disabling nature of migraine disorder, the large prevalence and serious impact on health-related quality of life and health care costs, any degree of response to treatment is acceptable and welcomed by the patient. An important issues for future studies would be better patient selection when finding candidates for each procedure.

25 Review Efficacy of frovatriptan and other triptans in the treatment of acute migraine of hypertensive and normotensive subjects: a review of randomized studies. 2013

Tullo, V / Bussone, G / Omboni, S / Barbanti, P / Cortelli, P / Curone, M / Peccarisi, C / Benedetto, C / Pezzola, D / Zava, D / Allais, G. ·Department of Clinical Neuroscience, Headache Unit, C. Besta Neurological Institute and Foundation, Milan, Italy. ·Neurol Sci · Pubmed #23695053.

ABSTRACT: Migraine might be associated with high blood pressure (BP), which can cause more severe and more difficult to treat forms of headache. To evaluate the efficacy of frovatriptan and other triptans in the acute treatment of migraine, in patients classified according to a history of arterial hypertension, enrolled in three randomized, double-blind, crossover, Italian studies. Migraineurs with or without aura were randomized to frovatriptan 2.5 mg or rizatriptan 10 mg (study 1), frovatriptan 2.5 mg or zolmitriptan 2.5 mg (study 2), frovatriptan 2.5 mg or almotriptan 12.5 mg (study 3). After treating up to three episodes of migraine in 3 months with the first treatment, patients switched to the alternate treatment for the next 3 months. The present analysis assessed triptan efficacy in 60 subjects with a history of treated or untreated essential arterial hypertension (HT) and in 286 normotensive (NT) subjects. During the study, migraine attacks with aura were significantly more prevalent in HT subjects (21 vs. 13 % NT, p < 0.001). The proportion of pain free at 2 h did not significantly differ between HTs and NTs for either frovatriptan (25 vs. 26 %) or the comparators (33 vs. 32 %). Pain relief was achieved in significantly (p < 0.05) fewer episodes in HT subjects for both frovatriptan (41 vs. 52 % NT) and the comparators (48 vs. 58 %). Relapses at 48 h were similarly low in HTs and NTs with frovatriptan (29 vs. 31 %), while they were significantly (p < 0.05) larger in HTs (62 %) than in NTs (44 %) with comparators. No BP or heart rate increment was observed during the study in HT subjects. No difference in tolerability was reported between HTs and NTs. In conclusion, HT individuals tend to be less responsive than NT migraineurs to triptan therapy. However, frovatriptan, in contrast to other triptans, seems to have a sustained antimigraine effect in both HT and NT patients.