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Migraine Disorders: HELP
Articles from Torino
Based on 74 articles published since 2008

These are the 74 published articles about Migraine Disorders that originated from Torino during 2008-2019.
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Review Targeting MTHFR for the treatment of migraines. 2019

Rainero, Innocenzo / Vacca, Alessandro / Roveta, Fausto / Govone, Flora / Gai, Annalisa / Rubino, Elisa. ·a Headache Center, Department of Neuroscience "Rita Levi Montalcini" , University of Torino , Torino , Italy. ·Expert Opin Ther Targets · Pubmed #30451038.

ABSTRACT: INTRODUCTION: Migraine is a common neurovascular disorder classified by the World Health Organization as one of the most debilitating diseases. Migraine is a complex disease and is a consequence of an interaction between genetic, epigenetic and environmental factors. The MTHFR gene is one of the few replicated genetic risk factors for migraine and encodes an enzyme that is crucial for the folate and the methionine cycles. Individuals carrying the T allele of the MTHFR C677T polymorphism have increased plasma concentrations of homocysteine which leads to endothelial cell injury and alterations in coagulant properties of blood. Areas covered: This review focuses on the recent advances in genetics and the role of the MTHFR gene and homocysteine metabolism in migraine etiopathogenesis. The article summarizes the potential of targeting MTHFR and homocysteine for disease prevention. Expert opinion: Determination of MTHFR C677T polymorphisms as well as measurement of homocysteine concentrations may be useful to migraine patients, particularly those suffering from migraine with aura. Preliminary studies support the use of folate, vitamin B6 and vitamin B12 for the prevention of migraine. However, the results of these studies await replication in larger randomized controlled clinical trials.

2 Review Estrogen, migraine, and vascular risk. 2018

Allais, Gianni / Chiarle, Giulia / Sinigaglia, Silvia / Airola, Gisella / Schiapparelli, Paola / Benedetto, Chiara. ·Women's Headache Center, Department of Surgical Sciences, University of Turin, Via Ventimiglia 3, 10126, Turin, Italy. gb.allais@tiscali.it. · Women's Headache Center, Department of Surgical Sciences, University of Turin, Via Ventimiglia 3, 10126, Turin, Italy. ·Neurol Sci · Pubmed #29904828.

ABSTRACT: Migraine has a predilection for female sex and the course of symptoms is influenced by life stage (presence of menstrual cycle, pregnancy, puerperium, menopause) and use of hormone therapy, such as hormonal contraception and hormone replacement therapy. Hormonal changes figure among common migraine triggers, especially sudden estrogen drop. Moreover, estrogens can modulate neuronal excitability, through serotonin, norepinephrine, dopamine, and endorphin regulation, and they interact with the vascular endothelium of the brain. The risk of vascular disease, and ischemic stroke in particular, is increased in women with migraine with aura (MA), but the link is unclear. One hypothesis posits for a causal association: migraine may cause clinical or subclinical brain lesions following repeated episodes of cortical spreading depression (CSD) and a second hypothesis that may explain the association between migraine and vascular diseases is the presence of common risk factors and comorbidities. Estrogens can play a differential role depending on their action on healthy or damaged endothelium, their endogenous or exogenous origin, and the duration of their treatment. Moreover, platelet activity is increased in migraineurs women, and it is further stimulated by estrogens.This review article describes the course of migraine during various life stages, with a special focus on its hormonal pathogenesis and the associated risk of vascular diseases.

3 Review Is Migraine Primarily a Metaboloendocrine Disorder? 2018

Rainero, Innocenzo / Govone, Flora / Gai, Annalisa / Vacca, Alessandro / Rubino, Elisa. ·Neurology I, Headache Center, Department of Neuroscience, University of Torino, Via Cherasco 15, Turin, 10126, Italy. innocenzo.rainero@unito.it. · Neurology I, Headache Center, Department of Neuroscience, University of Torino, Via Cherasco 15, Turin, 10126, Italy. ·Curr Pain Headache Rep · Pubmed #29619630.

ABSTRACT: PURPOSE OF THE REVIEW: The goals of this review are to evaluate recent studies regarding comorbidity between migraine and different metabolic and endocrine disorders and to discuss the role of insulin resistance as a common pathogenetic mechanism of these diseases. RECENT FINDINGS: Recently, several studies showed that migraine is associated with insulin resistance, a condition in which a normal amount of insulin induces a suboptimal physiological response. All the clinical studies that used the oral glucose tolerance test to examine insulin sensitivity found that, after glucose load, there is in migraine patients a significant increase of both plasmatic insulin and glucose concentrations in comparison with controls. On the contrary, no association was found between migraine and type 2 diabetes, while type 1 diabetes seems to have a protective effect in the disease. Obesity and hypertension were shown to be risk factors for both episodic and chronic migraine. Metabolic syndrome has been recently associated mainly with migraine with aura and is now considered a risk factor also for medication overuse headache. Finally, a bidirectional association between migraine and hypothyroidism has been recently demonstrated, suggesting that common genetic or autoimmune mechanisms underlie both diseases. Recent studies showed that insulin receptor signaling and the related physiological responses are altered in migraine and may have a relevant pathogenic role in the disease. Further studies are warranted in order to better elucidate mechanisms underlying insulin resistance in migraine in order to develop new therapeutic strategies for this debilitating disease.

4 Review Menstrual migraine: a review of current and developing pharmacotherapies for women. 2018

Allais, G / Chiarle, Giulia / Sinigaglia, Silvia / Benedetto, Chiara. ·a Department of Gynecology and Obstetrics , University of Turin, Women's Headache Center , Turin , Italy. ·Expert Opin Pharmacother · Pubmed #29212383.

ABSTRACT: INTRODUCTION: Migraine is one of the most common neurological disorders in the general population. It affects 18% of women and 6% of men. In more than 50% of women migraineurs the occurrence of migraine attacks correlates strongly with the perimenstrual period. Menstrual migraine is highly debilitating, less responsive to therapy, and attacks are longer than those not correlated with menses. Menstrual migraine requires accurate evaluation and targeted therapy, that we aim to recommend in this review. AREAS COVERED: This review of the literature provides an overview of currently available pharmacological therapies (especially with triptans, anti-inflammatory drugs, hormonal strategies) and drugs in development (in particular those acting on calcitonin gene-related peptide) for the treatment of acute migraine attacks and the prophylaxis of menstrual migraine. The studies reviewed here were retrieved from the Medline database as of June 2017. EXPERT OPINION: The treatment of menstrual migraine is highly complex. Accurate evaluation of its characteristics is prerequisite to selecting appropriate therapy. An integrated approach involving neurologists and gynecologists is essential for patient management and for continuous updating on new therapies under development.

5 Review Treating migraine with contraceptives. 2017

Allais, Gianni / Chiarle, Giulia / Sinigaglia, Silvia / Airola, Gisella / Schiapparelli, Paola / Bergandi, Fabiola / Benedetto, Chiara. ·Department of Surgical Sciences, Women's Headache Center, University of Turin, Via Ventimiglia 3, 10126, Turin, Italy. gb.allais@tiscali.it. · Department of Surgical Sciences, Women's Headache Center, University of Turin, Via Ventimiglia 3, 10126, Turin, Italy. ·Neurol Sci · Pubmed #28527064.

ABSTRACT: At least 18% of women suffers from migraine. Clinically, there are two main forms of migraine: migraine with aura (MA) and migraine without aura (MO) and more than 50% of MO is strongly correlated to the menstrual cycle. The high prevalence of migraine in females, its correlation with the menstrual cycle and with the use of combined hormonal contraceptives (CHCs) suggest that the estrogen drop is implicated in the pathogenesis of the attacks. Although CHCs may trigger or worsen migraine, their correct use may even prevent or reduce some forms of migraine, like estrogen withdrawal headache. Evidence suggested that stable estrogen levels have a positive effect, minimising or eliminating the estrogenic drop. Several contraceptive strategies may act in this way: extended-cycle CHCs, CHCs with shortened hormone-free interval (HFI), progestogen-only contraceptives, CHCs containing new generation estrogens and estrogen supplementation during the HFI.

6 Review Spotlight on frovatriptan: a review of its efficacy in the treatment of migraine. 2016

Allais, Gianni / Benedetto, Chiara. ·Department of Surgical Sciences, Women's Headache Center, University of Turin, Turin, Italy. ·Drug Des Devel Ther · Pubmed #27757013.

ABSTRACT: Migraine is a common neurovascular disorder, affecting millions of people worldwide. Current guidelines recommend triptans as first-line treatment for moderate-to-severe migraine attacks. Frovatriptan is a second-generation triptan with a longer terminal elimination half-life in blood than other triptans (~26 hours). Three double-blind, randomized crossover preference studies have been recently conducted, assessing efficacy and safety of frovatriptan versus rizatriptan, zolmitriptan, and almotriptan, respectively. Frovatriptan showed favorable tolerability and sustained effect, with a significantly lower rate of relapse over 48 hours versus the other triptans. These findings were confirmed in a series of analyses of patient subsets from the three studies, including patients with menstrually related and oral contraceptive-induced migraine, hypertension, obesity, weekend migraine, as well as patients with migraine with aura. In all patient subsets analyzed, lower headache recurrence rates were observed versus the comparator triptans, indicating a more sustained pain-relieving effect on migraine symptoms. A further randomized, double-blind study demonstrated that frovatriptan given in combination with the fast-acting cyclooxygenase inhibitor dexketoprofen provided improved migraine pain-free activity at 2 hours, and gave more sustained pain-free activity at 24 hours, versus frovatriptan alone. These benefits were observed both when the combination was administered early (<1 hour after symptom onset) or late (>1 hour after onset). Different pharmacokinetic, but synergistic, properties between frovatriptan and dexketoprofen may make the combination of these agents particularly effective in migraine treatment, with rapid onset of action and sustained effect over 48 hours. These benefits, together with potential cost-effectiveness advantages versus other triptans could drive selection of the most appropriate treatment for acute migraine attacks.

7 Review The use of progestogen-only pill in migraine patients. 2016

Allais, Gianni / Chiarle, Giulia / Bergandi, Fabiola / Benedetto, Chiara. ·a Department of Surgical Sciences, Women's Headache Center , University of Turin , Turin , Italy. ·Expert Rev Neurother · Pubmed #26630354.

ABSTRACT: Migraine is a debilitating neurovascular disorder which is estimated to affect 18% of women and 6% of men. Two main forms of this neurological disorder must be considered: Migraine without Aura and Migraine with Aura. Migraine without aura often has a strict menstrual relationship: the International Headache Society classification gives criteria for Pure Menstrual Migraine and Menstrually Related Migraine. The higher prevalence of migraine among women suggests that this sex difference probably results from the trigger of fluctuating hormones during the menstrual cycle. Safe and effective contraception is essential for all women of childbearing age, but Combined Oral Contraceptives have been associated with worsening of attacks and cardiovascular risk in these patients. We analyzed characteristics, effects and benefits of progestogen-only pill, a possible alternative for contraception in women with migraine.

8 Review Migraine in perimenopausal women. 2015

Allais, G / Chiarle, G / Bergandi, F / Benedetto, C. ·Department of Surgical Sciences, Women's Headache Center, University of Turin, Via Ventimiglia 3, 10126, Turin, Italy, gb.allais@tiscali.it. ·Neurol Sci · Pubmed #26017518.

ABSTRACT: Hormonal changes during the reproductive cycle are thought to account for the variation in migraine occurrence and intensity. Although the majority of women and the specialists treating them do not consider migraine as a component of the climacteric syndrome, many women, in fact, do experience migraine during perimenopause. If a woman already suffers from migraine, the attacks often worsen during menopausal transition. Initial onset of the condition during this period is relatively rare. Women with the premenstrual syndrome (PMS) prior to entering menopause are more likely to experience, during late menopausal transition, an increased prevalence of migraine attacks. Hormone replacement therapy (HRT) can be initiated during the late premenopausal phase and the first years of postmenopause to relieve climacteric symptoms. The effect of HRT on migraine, either as a secondary effect of the therapy or as a preventive measure against perimenopausal migraine, has been variously investigated. HRT preparations should be administered continuously, without intervals, to prevent sudden estrogen deprivation and the migraine attacks that will ensue. Wide varieties of formulations, both systemic and topical, are available. Treatment with transdermal patches and estradiol-based gels is preferable to oral formulations as they maintain constant blood hormone levels. Natural menopause is associated with a lower incidence of migraine as compared with surgical menopause; data on the role of hysterectomy alone or associated with ovariectomy in changing the occurrence of migraine are till now unclear.

9 Review Migraine and depression comorbidity: antidepressant options. 2012

Torta, R / Ieraci, V. ·Clinical and Oncologic Psychology Unit, University of Turin, Turin, Italy. riccardo.torta@unito.it ·Neurol Sci · Pubmed #22644185.

ABSTRACT: Migraine and mood depression demonstrate a high clinical relation and share, also with pain, neurobiological mechanisms, particularly neuro-transmettitorial and phlogistic ones. The choice of an antidepressant to treat both depression and migraine is determined by its efficacy, safety, and tolerability. Antidepressants share comparable effectiveness for the treatment of depressive disorders, but their efficacy on headache varies widely: Tricyclic antidepressants are more effective than SNRIs and SSRIs, but demonstrate dose-limiting side effects.

10 Review Premenstrual syndrome and migraine. 2012

Allais, Gianni / Castagnoli Gabellari, Ilaria / Burzio, Chiara / Rolando, Sara / De Lorenzo, Cristina / Mana, Ornella / Benedetto, Chiara. ·Department of Gynecology and Obstetrics, Women's Headache Center, University of Turin, Via Ventimiglia 3, 10126 Turin, Italy. gb.allais@tiscali.it ·Neurol Sci · Pubmed #22644184.

ABSTRACT: Premenstrual syndrome (PMS) includes a wide variety of physical, psychological, and cognitive symptoms that occur recurrently and cyclically during the luteal phase of the menstrual cycle and disappear soon after the onset of menstruation. Headache, often of migrainous type, is one of physical symptoms often reported in the diagnostic criteria for PMS. Menstrual migraine (MM) is a particular subtype of migraine occurring within the 2 days before and the 3 days after the onset of menses. According to this definition, therefore, some attacks of MM certainly occur in conjunction with the period of maximum exacerbation of PMS symptoms. The relationship between MM and PMS has been investigated through diary-based studies which have confirmed the possible correlation between these two conditions. In this paper we provide indications for the treatment of MM, making particular reference to those therapies that may be useful in the treatment of PMS symptoms. Even if triptans are the gold standard for the acute treatment, if symptomatic treatment is not sufficient one can resort to a short-term perimenstrual prophylaxis. Non-steroidal anti-inflammatory drugs have been demonstrated effective in MM prophylaxis. Among natural products there is some evidence of efficacy for magnesium, phytoestrogens, and ginkgolide B. Finally, also a combined oral contraceptive containing drospirenone, taken continuously for 168 days, has shown promising results.

11 Review Evaluation of the use of sumatriptan-naproxen sodium for menstrual migraine and dysmenorrhea. 2011

Allais, Gianni / Castagnoli Gabellari, Ilaria / Rolando, Sara / Benedetto, Chiara. ·Women's Headache Centre, Department of Gynecology and Obstetrics, University of Turi, Via Ventimiglia 3, Torino, IT-10126, Italy. gb.allais@tiscali.it ·Expert Rev Neurother · Pubmed #21955195.

ABSTRACT: Menstrual migraine (MM) is a form of headache that tends to occur with prolonged, intense and extremely disabling attacks in a short period around the menstrual cycle (usually 2 days before to 3 days after the onset of the menstrual flow). At least 50% of the female migraine population suffers from this subtype of migraine. The possible presence of other perimenstrual pain, such as dysmenorrhea, can make the attacks even more disabling. Since both of these conditions have a common pathological background consisting of a secretion of abnormally high levels of prostaglandins, it can be particularly useful to use a combination of sumatriptan, the progenitor of the triptans and the drug of choice in the treatment of migraine attack, and naproxen sodium, a potent inhibitor of prostaglandin biosynthesis. The combination of sumatriptan 85 mg and naproxen sodium 500 mg has been tested in women suffering from MM and dysmenorrhea, and this combination has been shown to achieve greater satisfaction when compared with placebo. Moreover, sumatriptan-naproxen was also better than placebo in reducing functional disability and improving productivity. The study is discussed in the context of the current state of knowledge about MM treatment.

12 Review Do we need a new procedure for the assessment of adverse events in anti-migraine clinical trials? 2011

Amanzio, Martina. ·Department of Psychology and Neuroscience Institute of Torino (NIT), University of Torino, Via Verdi 10, 10123 Torino, Italy. martina.amanzio@unito.it ·Recent Pat CNS Drug Discov · Pubmed #21118096.

ABSTRACT: The large number of randomized controlled clinical trials on migraine have drawn the attention of some authors to the need to improve the design of such trials. In particular, adequate methodology is a critical issue in their planning and execution, as different methodological approaches can translate into different results. The side-effects observed in both the active medication arm and the placebo arm--considering anti-migraine randomized clinical trials--are often influenced by non specific factors. This issue can be quantified by using a systematic review approach to study the rates of adverse events reported in the placebo arms of clinical trials. Such a study requires increased standardization of the methods used to collect adverse data in clinical trials. This focused review article provides a critical re-analysis of the results obtained, by our group, in a recent systematic review of adverse events reported in the placebo groups of clinical trials for three classes of anti-migraine drugs: NSAIDs, triptans and anticonvulsants [Amanzio et al., 2009]. We consider the need for caution in interpreting side-effect profiles of the different placebo groups. In particular, since the side-effects observed in both the active medication and placebo arms of randomized clinical trials are often influenced by patients' and investigators' expectations, the nocebo phenomenon may help to understand the occurrence of (adverse) non-specific side effects observed in these groups. We also discuss the importance of evaluating the role of contributing factors in the results obtained, such as the need for the examiner to be blind to the expected side-effects of the drug being evaluated and a better rationalization of informed consent in order to avoid the occurrence of negative expectations in patients, aimed at preventing negative expectation effects among both investigators and patients. Currently, there is one patented design for investigating reductions in the placebo effect in controlled clinical trials. This paper discusses how these ideas may be helpful in the assessment of adverse events in active and placebo groups.

13 Review Non-pharmacological approach to migraine prophylaxis: part II. 2010

Schiapparelli, Paola / Allais, Gianni / Castagnoli Gabellari, Ilaria / Rolando, Sara / Terzi, Maria Grazia / Benedetto, Chiara. ·Department of Gynecology and Obstetrics, Women's Headache Center, University of Turin, Via Ventimiglia 3, 10126, Turin, Italy. ·Neurol Sci · Pubmed #20464605.

ABSTRACT: Acupuncture has been used to both prevent and treat diseases for over 3,000 years. Recently, a Cochrane review on its use in migraine concluded that acupuncture is effective and should be considered as a prophylactic measure for patients with frequent or insufficiently controlled migraine attacks. In contrast, there is no clear evidence to support or refute the use of homeopathy in the management of migraine. Among vitamins and other supplements, riboflavin and coenzyme Q10 significantly decreased the frequency of migraine attacks. Alpha lipoic acid also reduced migraine frequency, albeit not significantly as compared to placebo. The prophylactic efficacy of magnesium, particularly for children and menstrually related migraine, has recently been substantiated. Among the herbal remedies, butterbur significantly decreases attack frequency, whereas the efficacy of feverfew was not confirmed in a Cochrane review, probably because of the 400% variations in the dosage of its active principle. Finally, ginkgolide B has proved significantly effective in controlling migraine with aura and pediatric migraine in uncontrolled studies that need a confirmation.

14 Review Non-pharmacological management of migraine during pregnancy. 2010

Airola, Gisella / Allais, Gianni / Castagnoli Gabellari, Ilaria / Rolando, Sara / Mana, Ornella / Benedetto, Chiara. ·Department of Gynecology and Obstetrics, Women's Headache Center, University of Turin, Via Ventimiglia 3, 10126, Turin, Italy. ·Neurol Sci · Pubmed #20464586.

ABSTRACT: Migrainous women note a significant improvement in their headaches during pregnancy. However, persistent or residual attacks need to be treated, keeping in mind that many drugs have potential dangerous effects on embryo and foetus. It is evident, therefore, that hygiene and behaviour measures capable of ensuring the best possible well-being (regular meals and balanced diet, restriction of alcohol and smoking, regular sleeping pattern, moderate physical exercise and relaxation) are advisable during pregnancy. Among non-pharmacological migraine prophylaxis only relaxation techniques, in particular biofeedback, and acupuncture have accumulated sufficient evidence in support of their efficacy and safety. Some vitamins and dietary supplements have been proposed: the prophylactic properties of magnesium, riboflavin and coenzyme Q10 are probably low, but their lack of severe adverse effects makes them good treatment options.

15 Review The risks of women with migraine during pregnancy. 2010

Allais, Gianni / Gabellari, Ilaria Castagnoli / Borgogno, Paola / De Lorenzo, Cristina / Benedetto, Chiara. ·Women's Headache Center, Department of Gynecology and Obstetrics, University of Turin, Via Ventimiglia 3, 10126, Turin, Italy. gb.allais@tiscali.it ·Neurol Sci · Pubmed #20464585.

ABSTRACT: Most epidemiological studies demonstrate that women suffering from migraine note a significant improvement in their headaches during pregnancy. Both headache specialists and gynecologists commonly hold that migraine does not involve any risks to either the mother, or the fetus. Despite this, recent studies into the medical complications of pregnancy in migrainous women have cast doubts on this assumption. Indeed, most of these studies have revealed a significant association between migraine and hypertension in pregnancy (i.e. preeclampsia and gestational hypertension). Migraine has also been recently postulated as one of the major risk factors for stroke during pregnancy and the puerperium. Therefore, there is an urgent need for prospective studies on large numbers of pregnant women to determine the real existence and extent of the risks posed by migraine during pregnancy. In the meantime, while awaiting verification of this hypothesis, a pregnant woman with migraine must be subject to a particularly attentive screening by both the obstetrician and the headache specialist.

16 Review A systematic review of adverse events in placebo groups of anti-migraine clinical trials. 2009

Amanzio, Martina / Corazzini, Luca Latini / Vase, Lene / Benedetti, Fabrizio. ·Department of Psychology, University of Turin, Via Verdi 10, 10123 Turin, Italy. amanzio@psych.unito.it ·Pain · Pubmed #19781854.

ABSTRACT: In analgesic clinical trials, adverse events are reported for the painkiller under evaluation and compared with adverse events in the placebo group. Interestingly, patients who receive the placebo often report a high frequency of adverse events, but little is understood about the nature of these negative effects. In the present study, we compared the rates of adverse events reported in the placebo arms of clinical trials for three classes of anti-migraine drugs: NSAIDs, triptans and anticonvulsants. We identified 73 clinical trials in 69 studies describing adverse events in placebo groups: 8 were clinical trials with NSAIDs, 56 were trials with triptans, and 9 were trials with anticonvulsants. Studies were selected of all Medline/PubMed or CENTRAL referenced trials published until 2007. Adverse event profiles of the three classes were compared using a systematic review approach. We found that the rate of adverse events in the placebo arms of trials with anti-migraine drugs was high. In addition, and most interestingly, the adverse events in the placebo arms corresponded to those of the anti-migraine medication against which the placebo was compared. For example, anorexia and memory difficulties, which are typical adverse events of anticonvulsants, were present only in the placebo arm of these trials. These results suggest that the adverse events in placebo arms of clinical trials of anti-migraine medications depend on the adverse events of the active medication against which the placebo is compared. These findings are in accordance with the expectation theory of placebo and nocebo effects.

17 Review Perceptive aspects of visual aura. 2009

Aleci, Carlo / Liboni, William. ·Ophthalmology Department, Gradenigo Hospital, Cso R Margherita 8, 10153 Turin, Italy. carlo.aleci@gradenigo.it ·Neurol Sci · Pubmed #19779857.

ABSTRACT: Visual aura is the most common feature associated with migraine, though it can occur separately. In both cases it often represents a dramatic event, especially for patients who experience it for the first time. Besides, its subjective characteristics may illuminate on the functional architecture of the visual cortex. Repetitive events of migraine and visual aura have been suggested to affect the visual system in the long run, both on the cortical and precortical level. In effect, objective investigation of visual functions in patients support the idea that a selective damage does occur, so that more attention to visual examination seems to be justified. In this paper, subjective and psychophysical aspects of visual aura are examined, lastly highlighting and discussing the interesting correlations found between this condition and normal-tension glaucoma.

18 Review Oral contraceptives in migraine. 2009

Allais, Gianni / Gabellari, Ilaria Castagnoli / De Lorenzo, Cristina / Mana, Ornella / Benedetto, Chiara. ·Department of Gynecology and Obstetrics, Women's Headache Center, University of Turin, Turin, Italy. gb.allais@tiscali.it ·Expert Rev Neurother · Pubmed #19271947.

ABSTRACT: Combined oral contraceptives are a safe and highly effective method of birth control, but they can also raise problems of clinical tolerability and/or safety in migraine patients. It is now commonly accepted that, in migraine with aura, the use of combined oral contraceptives is always contraindicated, and that their intake must also be suspended by patients suffering from migraine without aura if aura symptoms appear. The newest combined oral contraceptive formulations are generally well tolerated in migraine without aura, and the majority of migraine without aura sufferers do not show any problems with their use; nevertheless, the last International Classification of Headache Disorders identifies at least two entities evidently related to the use of combined oral contraceptives: exogenous hormone-induced headache and estrogen-withdrawal headache. As regards the safety, even if both migraine and combined oral contraceptive intake are associated with an increased risk of ischemic stroke, migraine without aura per se is not a contraindication for combined oral contraceptive use. Other risk factors (tobacco use, hypertension, hyperlipidemia, obesity and diabetes) must be carefully considered when prescribing combined oral contraceptives in migraine without aura patients, in particular in women aged over 35 years. Furthermore, the exclusion of a hereditary thrombophilia and of alterations of coagulative parameters should precede any decision of combined oral contraceptive prescription in migraine patients.

19 Review The diagnostic iter of patent foramen ovale in migraine patients: an update. 2008

Liboni, William / Molinari, Filippo / Chiribiri, Amedeo / Allais, Gianni / Mana, Ornella / Negri, Emanuela / Grippi, Gianfranco / Giacobbe, Massimiliano / Badalamenti, Sergio / Benedetto, Chiara. ·Department of Neuroscience, Gradenigo Hospital, Turin, Italy. ·Neurol Sci · Pubmed #18545889.

ABSTRACT: Patent foramen ovale (PFO) is a frequent finding in migraine patients. The standard technique for PFO diagnosis is actually trans-oesophageal echocardiography (TEE). It requires the injection of a contrast agent unable to pass the pulmonary filter; hence, it is possible to detect a right-to-left shunt by observing the presence of the contrast medium in the cardiac left compartment. The transcranial Doppler (TCD) device accurately measures the blood flow velocities in different cerebral arteries. It can record microembolic signals (MES) backscattered by microbubbles travelling in the cerebral circulation, and distinguish cardiac shunts from pulmonary shunts. The number of MES is correlated to the entity of the shunt. The near-infrared spectroscopy (NIRS) technique tracks the changes in the concentration of oxygenated and reduced haemoglobin in the brain tissue. PFO is revealed by an alteration of the normal vasoreactivity pattern of the subject during functional stimuli. Magnetic resonance imaging (MRI) provides, at the same time, detailed anatomical information and functional measurements. MRI dynamic perfusion sequences can be used to reliably detect PFO either by visual assessment or by signal-time curves in the pulmonary artery and in the left atrium. A good correlation between TEE and MRI grading scores has been demonstrated, even though the interindividual variability of performing the Valsalva manoeuvre could greatly reduce the sensitivity of the method. Further prospective studies are needed to confirm the PFO MRI grading and to assess the sensitivity and specificity of the method.

20 Review Migraine and stroke: the role of oral contraceptives. 2008

Allais, Gianni / Gabellari, Ilaria Castagnoli / Mana, Ornella / Schiapparelli, Paola / Terzi, Maria Grazia / Benedetto, Chiara. ·Women's Headache Center Department of Gynecology and Obstetrics, University of Turin, Via Ventimiglia 3, 10126 Turin, Italy. gb.allais@tiscali.it ·Neurol Sci · Pubmed #18545887.

ABSTRACT: The use of oral contraceptives (OCs) confers an increased risk for ischaemic stroke (IS). This risk slightly decreases, but remains significant, if low-dose formulations are used, particularly if other risk factors, such as hypertension or smoking, are associated. Some inherited prothrombotic conditions (e.g., Factor V Leiden, G20210A prothrombin or methylenetetrahydrofolate reductase C677T polymorphism) could also greatly increase the IS risk if present in OC users. Migraine, particularly with aura, is an independent risk factor for IS, and the patient's IS risk is probably affected by other individual risk factors (e.g., age, genetic predisposition to thrombosis, presence of patent foramen ovale or enhanced platelet aggregation) which seem to be over-represented in migraine patients. IS risk among migraineurs is further increased when OCs are currently used and can become very high if associated with smoking. Consequently, in 2004 the WHO stated in its 'Medical Eligibility Criteria for Contraceptive Use' that women suffering from migraine with aura at any age should never use OCs. Moreover, since the exposure to the effects of OCs may greatly increase the IS risk in some migraine subpopulations with specific personal characteristic, testing for these risk factors may allow for more accurate stratification of the population at risk before long-term use of OCs is prescribed.

21 Review Hypocretins and primary headaches: neurobiology and clinical implications. 2008

Rainero, Innocenzo / De Martino, Paola / Pinessi, Lorenzo. ·Neurology II - Headache Centre, Department of Neuroscience, University of Turin, Via Cherasco 15-10126, Torino, Italy. irainero@molinette.piemonte.it ·Expert Rev Neurother · Pubmed #18345971.

ABSTRACT: Hypocretins (or orexins) are two neuropeptides synthesized by neurons located exclusively in the hypothalamus. Hypocretin-containing neurons have widespread projections throughout the CNS; with particularly dense excitatory projections to monoaminergic and serotonergic brainstem centers. The hypocretin system influences a wide range of physiological processes in mammals, such as feeding, arousal, rewards and drug addiction. Recently, a number of studies in experimental animals showed that hypocretins are involved in pain modulation within the CNS, and suggested the presence of a link between these peptides and nociceptive phenomena observed in primary headaches. The aim of this review is to describe and discuss recent studies in humans suggesting a role for the hypocretin neuronal system in cluster headache and chronic migraine.

22 Clinical Trial Frovatriptan plus dexketoprofen in the treatment of menstrually related migraine: an open study. 2013

Allais, Gianni / Rolando, Sara / Schiapparelli, Paola / Airola, Gisella / Borgogno, Paola / Mana, Ornella / Benedetto, Chiara. ·Women's Headache Center, Department of Gynecology and Obstetrics, University of Turin, Via Ventimiglia 3, 10126 Turin, Italy. gb.allais@tiscali.it ·Neurol Sci · Pubmed #23695075.

ABSTRACT: At least 50 % of female migraineurs experience migraine associated with the perimenstrual period, even though they may also suffer from attacks at other times of the cycle (menstrually related migraine, MRM). MRM attacks tend to be longer and more intense than those arising in other phases of the menstrual cycle, and are often aggravated by more pronounced vegetative phenomena. In this open preliminary trial, we tested the efficacy of associating frovatriptan and dexketoprofen for the treatment of an acute attack of MRM, diagnosed according to the criteria of the International Headache Society, in 24 patients between 19 and 45 years of age (mean 31.33 ± 7.33). Twenty-one of them completed the study. Pain relief was achieved by 76 % of patients at 2 h and by 86 % at 4 h. A pain-free state was achieved by 48 % at 2 h and by 62 % at 4 h from taking the product. A pain-free state at 24 h was present in 76 % of MRM sufferers, 33 % of whom showed a sustained pain-free state at 24 h. A rescue medication was needed by eight patients. While decidedly encouraging, the data of this study obviously need confirmation with double blind studies involving a greater number of patients.

23 Clinical Trial The efficacy of ginkgolide B in the acute treatment of migraine aura: an open preliminary trial. 2013

Allais, Gianni / D'Andrea, Giovanni / Maggio, Maurizio / Benedetto, Chiara. ·Department of Gynecology and Obstetrics, Women's Headache Center, University of Turin, Via Ventimiglia 3, 10126 Turin, Italy. gb.allais@tiscali.it ·Neurol Sci · Pubmed #23695070.

ABSTRACT: In this open trial we evaluated the possible efficacy of Ginkgolide B in the treatment of acute aura in a group of patients suffering from migraine with aura, considering in particular the effect of the treatment on aura duration. Twenty-five patients (16 females, 9 males, mean age 39.7 ± 13.5 years, range 18-65) suffering from migraine with aura were enrolled in the study. The diagnosis was made according to the diagnostic criteria of the international classification of headache disorders, second edition (ICHD-II), for typical aura with migraine headache (n = 19) or typical aura without headache (n = 6). Patients were asked to use a diary card to register the exact duration of the aura symptoms in two consecutive attacks of aura. In the first one, they only took note of the duration of neurological symptoms in minutes. In the following attack, they were instructed to take orally, immediately at the onset of the first symptoms of aura, two capsules of a combination of 60 mg Ginkgo biloba terpenes phytosome, 11 mg coenzyme Q 10 and 8.7 mg vitamin B2 (Migrasoll). Aura duration (expressed in minutes) was significantly (p < 0.001) reduced by Migrasoll intake, being 33.6 ± 11.5 in the first untreated attack and 21.9 ± 11.8 during the second attack. In general, there was a marked amelioration of the features of the neurological symptoms of aura in the treated attack. In four patients (18.1 %) suffering from typical aura with migraine, the pain phase disappeared. Among the patients who completed the study no serious adverse events were reported.

24 Clinical Trial Perimenstrual migraines and their response to preventive therapy with topiramate. 2011

Allais, Gianni / Sanchez del Rio, Margarita / Diener, Hans-Christoph / Benedetto, Chiara / Pfeil, Joop / Schäuble, Barbara / van Oene, Joop. ·Women's Headache Center, Department of Gynecology and Obstetrics, University of Turin, Italy. gb.allais@tiscali.it ·Cephalalgia · Pubmed #20650999.

ABSTRACT: INTRODUCTION: Preventive treatment with topiramate is effective for overall reduction of migraine frequency, but there are few data regarding its efficacy on perimenstrual migraines. To determine whether topiramate can prevent perimenstrual migraines, we analyzed data from premenopausal women as a subgroup of the Prolonged Migraine Prevention with Topiramate (PROMPT) study. METHODS: In total, 198 women from the PROMPT study with menstrually related migraine (MRM) were evaluated. After a one-to-two-month prospective baseline period, patients received open-label topiramate (50-200 mg/day) for six months. RESULTS: During topiramate treatment, mean monthly migraine frequency was reduced from 7.03 at baseline to 4.36 (mean change: -2.66; p < .001, endpoint analysis). Mean percentage reductions were similar for migraines during and outside the perimenstrual period (-45.9% and -46.1%, respectively). In patients with aura, reductions in migraine days with (-48.3%) or without (-43.4%) aura were similar to those in patients without aura (-45.4%). Reductions were also similar whether women were taking combined oral contraceptives (-47.0%) or were not (-46.6%). CONCLUSIONS: Topiramate reduces the frequency, but not severity or duration, of perimenstrual migraines in women with MRM, including migraines with and without aura, and regardless of combined oral contraceptive use.

25 Clinical Trial Oral contraceptive-induced menstrual migraine. Clinical aspects and response to frovatriptan. 2008

Allais, Gianni / Bussone, Gennaro / Airola, Gisella / Borgogno, Paola / Gabellari, Ilaria Castagnoli / De Lorenzo, Cristina / Pavia, Elena / Benedetto, Chiara. ·Women's Headache Center Department of Gynecology and Obstetrics, University of Turin, Via Ventimiglia 3, 10126 Turin, Italy. gb.allais@tiscali.it ·Neurol Sci · Pubmed #18545931.

ABSTRACT: Oral contraceptive-induced menstrual migraine (OCMM) is a poorly defined migraine subtype mainly triggered by the cyclic pill suspension. In this pilot, open-label trial we describe its clinical features and evaluate the efficacy of frovatriptan in the treatment of its acute attack. During the first 3 months of the study 20 women (mean age 32.2+/-7.0, range 22-46) with a 6-month history of pure OCMM recorded, in monthly diary cards, clinical information about their migraine. During the 4th menstrual cycle they treated an OCMM attack with frovatriptan 2.5 mg. The majority of attacks were moderate/severe and lasted 25-72 h or more, in the presence of usual treatment. Generally an OCMM attack appeared within the first 5 days after the pill suspension, but in 15% of cases it started later. After frovatriptan administration, headache intensity progressively decreased (2.4 at onset, 1.6 after 2 h, 1.1 after 4 h and 0.8 after 24 h; p=0.0001). In 55% of patients pain relief was reported after 2 h. Ten percent of subjects were pain-free subjects after 2 h, 35% after 4 h and 60% after 24 h (p=0.003 for trend); 36% relapsed within 24 h. Rescue medication was needed by 35% of patients; 50% of frovatriptan-treated required a second dose. Concomitant nausea and/or vomiting, photophobia and phonophobia decreased significantly after drug intake. OCMM is a severe form of migraine; actually its clinical features are not always exactly identified by the ICHD-II classification. However, treatment with frovatriptan 2.5 mg might be effective in its management.