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Delussi M, Piraino G, Guerzoni S, Castro FL, Sances G, Guaschino E, Vaghi G, Grazzi L, Sacco S, Onofri A, Paparella G, Prudenzano MP, Roca ME, Fallacara A, Cevoli S, Pierangeli G, Sarchielli P, Bellotti A, Invitto S, de Tommaso M. Gender-related stress factors and emotional perception in migraine: a structured online questionnaire in migraine patients and controls. Neurol Sci 2024; 45:1645-1654. [PMID: 37936018 PMCID: PMC10942877 DOI: 10.1007/s10072-023-07152-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 10/17/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND While migraine is markedly prevalent in women, gender-related phenotype differences were rarely assessed. For this reason, we investigated, through a multicenter observational cross-sectional study, based on an online questionnaire, gender-related differences in stress factors, emotions, and pain perception in migraine patients and controls and their impact on migraine severity. METHODS The study was designed as an online questionnaire. The link was emailed to healthy subjects (C) and migraine patients (MIG) (age 18-75, education ≥ 13 years) recruited during the first visit in 8 Italian Headache Centers adhering to Italian Society for Headache Study (SISC). The questionnaire included personal/social/work information, the Perceived Stress Scale, the Romance Quality Scale, the Emotion Regulation Questionnaire, the Beck Anxiety Inventory, the Body Perception Questionnaire, the pain perception, and a self-assessment of migraine severity in the last 3 months. RESULTS 202 MIG and 202 C completed the survey. Independently from gender, migraine was characterized by higher pain sensitivity and more severe partner relationships. The female gender, in MIG, exhibited higher anxiety scores, body awareness, and reduced emotional suppression. Body awareness and emotional suppression were discriminating factors between genders in control and migraine groups without relevant influence on disease features. Perceived perception of migraine severity was similar between genders. CONCLUSION Gender-related emotional and stress factors did not contribute to delineate a distinct phenotype in migraine men and women. The possible impact of emotional and stress factors characterizing genders could be considered for a single case-tailored therapeutic approach.
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Affiliation(s)
- Marianna Delussi
- Department of Education, Psychology and Communication University of Bari Aldo Moro, Bari, Italy
| | - Giulia Piraino
- Department of Biological and Environmental Sciences and Technologies, University of Salento, Lecce, Italy
| | - Simona Guerzoni
- Digital and Predictive Medicine, Pharmacology and Clinical Metabolic Toxicology-Headache Center and Drug Abuse-Laboratory of Clinical; Pharmacology and Pharmacogenomics, Department of Specialist Medicines, AOU Policlinico Di Modena, Modena, Italy
| | - Flavia Lo Castro
- Digital and Predictive Medicine, Pharmacology and Clinical Metabolic Toxicology-Headache Center and Drug Abuse-Laboratory of Clinical; Pharmacology and Pharmacogenomics, Department of Specialist Medicines, AOU Policlinico Di Modena, Modena, Italy
| | - Grazia Sances
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Elena Guaschino
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Gloria Vaghi
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Licia Grazzi
- Headache Center, Neuroalgology Dpt IRCCS Fondazione C Besta -Istituto Neurologico, Milan, Italy
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Agnese Onofri
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Giulia Paparella
- Department of Translational Biomedicine and Neuroscience, Neurophysiopathology Unit, Headache and Chronic Pain Section, University of Bari Aldo Moro, Bari, Italy
| | - Maria Pia Prudenzano
- Headache Center, Amaducci Neurological Clinic, Policlinico General Hospital, Bari, Italy
| | - Maria Elena Roca
- Headache Center, Amaducci Neurological Clinic, Policlinico General Hospital, Bari, Italy
| | - Adriana Fallacara
- Headache Center, Amaducci Neurological Clinic, Policlinico General Hospital, Bari, Italy
| | - Sabina Cevoli
- IRCCS Istituto Di Scienze Neurologiche Di Bologna, Bologna, Italy
| | | | | | | | - Sara Invitto
- Department of Biological and Environmental Sciences and Technologies, University of Salento, Lecce, Italy
| | - Marina de Tommaso
- Department of Translational Biomedicine and Neuroscience, Neurophysiopathology Unit, Headache and Chronic Pain Section, University of Bari Aldo Moro, Bari, Italy.
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Vernieri F, Iannone LF, Guerzoni S, Russo A, Barbanti P, Sances G, Cevoli S, Rao R, Lovati C, Ambrosini A, Buzzoni C, Battisti F, Vatteone L, King SML, Torelli F. Long-Term Effectiveness of Galcanezumab in the Prevention of Migraine: An Italian Retrospective Analysis (REALITY). Neurol Ther 2024; 13:415-435. [PMID: 38329615 PMCID: PMC10951161 DOI: 10.1007/s40120-024-00582-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 01/15/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Galcanezumab is approved in the European Union (EU) as migraine prophylaxis in adults with at least four migraine days per month. The aim of this retrospective observational study was to evaluate the long-term effectiveness of galcanezumab on migraine-related burdens and its impact on the use of healthcare resources for migraine prophylaxis in an Italian setting. METHODS This retrospective study was conducted in patients with migraine who initiated treatment with galcanezumab for migraine prevention between September 2019 and December 2020. Patient data for monthly migraine days (MMDs) and MMDs with acute medication intake were obtained by medical chart reviews. Information on patient-reported outcomes (using the Migraine Disability Assessment [MIDAS] questionnaire and Headache Impact Test 6 [HIT-6] questionnaire) and on the use of healthcare resources were also collected. The time points of interest were 1, 3, 6, 9, 12 months after the initiation of galcanezumab, and the most recent time point available during follow-up. RESULTS A total of 207 patients were enrolled in the study. Starting from month 3 after treatment initiation, more than half of the patients presented at least a 50% reduction in MMDs, and approximately one-third of non-responders at month 3 became responders at month 6. From month 3 to month 12, MMDs decreased on average by 10 days. Headache impact and disability, as well as migraine-associated health resource utilization decreased significantly during the treatment period. A positive significant association among the three dimensions of clinical burden (MMDs, MIDAS and days of acute medication intake) was also observed. CONCLUSION The results of this Italian real-world study confirmed that galcanezumab has a rapid onset of effect and provides a long-term response among patients over different migraine-related burdens. The use of healthcare resources was also remarkably reduced.
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Affiliation(s)
- Fabrizio Vernieri
- Headache and Neurosonology Unit, Fondazione Policlinico Campus Bio-Medico-Università Campus Bio-Medico Di Roma, Rome, Italy.
| | | | - Simona Guerzoni
- Digital and Predictive Medicine, Pharmacology and Clinical Metabolic Toxicology-Headache Center and Drug Abuse-Laboratory of Clinical Pharmacology and Pharmacogenomics, AOU Policlinico Di Modena, Modena, Italy
| | - Antonio Russo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Piero Barbanti
- IRCCS San Raffaele, Rome, Italy
- University San Raffaele, Rome, Italy
| | - Grazia Sances
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Sabina Cevoli
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
| | - Renata Rao
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Carlo Lovati
- L. Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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3
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Bottiroli S, Rosi A, Lecce S, Sances G, Allena M, De Icco R, Vecchi T, Tassorelli C, Cavallini E. Theory of mind in chronic migraine with medication overuse assessed with the MASC. Sci Rep 2024; 14:6998. [PMID: 38523197 PMCID: PMC10961316 DOI: 10.1038/s41598-024-57559-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 03/19/2024] [Indexed: 03/26/2024] Open
Abstract
Theory of Mind (ToM) is the ability to infer one's own and others' mental states. Growing research indicates that ToM is impaired in Chronic Migraine with Medication Overuse (CM + MO). However, the research in this field has been conducted using static scenario-based tasks, often failing to test mentalization in everyday situations and measuring only performance accuracy. We filled this gap by administering the Movie for the Assessment of Social Cognition (MASC) to subjects with CM + MO compared to episodic migraine (EM). This test allows us to assess both affective and cognitive ToM and which, in addition to being accurate, also analyzes the type of error in attribution of mental states, distinguishing between hypo-mentalization and hyper-mentalization. Thirty patients suffering from CM + MO and 42 from EM were enrolled. Results showed that CM + MO patients were less accurate in mental state attribution than EM. In addition, compared to EM, CM + MO individuals were more impaired in the affective ToM dimensions and committed more errors of hypo-mentalization. In conclusion, the application of MASC in patients with CM + MO allowed for the detection of an alteration in their ability to correctly draw conclusions about other people's mental states. This latter contributes critically to appropriate social reactions and also, possibly, to satisfactory social interactions.
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Affiliation(s)
- Sara Bottiroli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
- Headache Science and Neurorehabilitation Centre, IRCCS C. Mondino Foundation, National Neurological Institute, Via Mondino 2, 27100, Pavia, Italy.
| | - Alessia Rosi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Serena Lecce
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Grazia Sances
- Headache Science and Neurorehabilitation Centre, IRCCS C. Mondino Foundation, National Neurological Institute, Via Mondino 2, 27100, Pavia, Italy
| | - Marta Allena
- Headache Science and Neurorehabilitation Centre, IRCCS C. Mondino Foundation, National Neurological Institute, Via Mondino 2, 27100, Pavia, Italy
| | - Roberto De Icco
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Headache Science and Neurorehabilitation Centre, IRCCS C. Mondino Foundation, National Neurological Institute, Via Mondino 2, 27100, Pavia, Italy
| | - Tomaso Vecchi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Applied Psychology Centre, IRCCS C. Mondino Foundation, Pavia, Italy
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Headache Science and Neurorehabilitation Centre, IRCCS C. Mondino Foundation, National Neurological Institute, Via Mondino 2, 27100, Pavia, Italy
| | - Elena Cavallini
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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Bottiroli S, Greco R, Franco V, Zanaboni A, Palmisani M, Vaghi G, Sances G, De Icco R, Tassorelli C. Peripheral Endocannabinoid Components and Lipid Plasma Levels in Patients with Resistant Migraine and Co-Morbid Personality and Psychological Disorders: A Cross-Sectional Study. Int J Mol Sci 2024; 25:1893. [PMID: 38339171 PMCID: PMC10855606 DOI: 10.3390/ijms25031893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
Resistant migraine characterizes those patients who have failed at least three classes of migraine prophylaxis. These difficult-to-treat patients are likely to be characterized by a high prevalence of psychological disturbances. A dysfunction of the endocannabinoid system (ECS), including alteration in the levels of endocannabinoid congeners, may underlie several psychiatric disorders and the pathogenesis of migraines. Here we explored whether the peripheral gene expression of major components of the ECS and the plasma levels of endocannabinoids and related lipids are associated with psychological disorders in resistant migraine. Fifty-one patients (age = 46.0 ± 11.7) with resistant migraine received a comprehensive psychological evaluation according to the DSM-5 criteria. Among the patients, 61% had personality disorders (PD) and 61% had mood disorders (MD). Several associations were found between these psychological disorders and peripheral ECS alterations. Lower plasma levels of palmitoiletanolamide (PEA) were found in the PD group compared with the non-PD group. The MD group was characterized by lower mRNA levels of diacylglycerol lipase α (DAGLα) and CB2 (cannabinoid-2) receptor. The results suggest the existence of peripheral dysfunction in some components of the ECS and an alteration in plasma levels of PEA in patients with resistant migraine and mood or personality disorders.
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Affiliation(s)
- Sara Bottiroli
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (S.B.); (A.Z.); (G.V.); (R.D.I.); (C.T.)
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy; (V.F.); (M.P.); (G.S.)
| | - Rosaria Greco
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy; (V.F.); (M.P.); (G.S.)
| | - Valentina Franco
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy; (V.F.); (M.P.); (G.S.)
- Clinical and Experimental Pharmacology Unit, Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
| | - Annamaria Zanaboni
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (S.B.); (A.Z.); (G.V.); (R.D.I.); (C.T.)
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy; (V.F.); (M.P.); (G.S.)
| | - Michela Palmisani
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy; (V.F.); (M.P.); (G.S.)
- Clinical and Experimental Pharmacology Unit, Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
| | - Gloria Vaghi
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (S.B.); (A.Z.); (G.V.); (R.D.I.); (C.T.)
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy; (V.F.); (M.P.); (G.S.)
| | - Grazia Sances
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy; (V.F.); (M.P.); (G.S.)
| | - Roberto De Icco
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (S.B.); (A.Z.); (G.V.); (R.D.I.); (C.T.)
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy; (V.F.); (M.P.); (G.S.)
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (S.B.); (A.Z.); (G.V.); (R.D.I.); (C.T.)
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy; (V.F.); (M.P.); (G.S.)
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5
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Caponnetto V, Russo A, Silvestro M, Tessitore A, De Icco R, Vaghi G, Sances G, Tassorelli C, Baraldi C, Castro FL, Guerzoni S, Prudenzano MP, Fallacara A, Gentile M, Ornello R, Onofri A, Burgalassi A, Chiarugi A, De Cesaris F, Granato A, Casalena A, De Tommaso M, Mampreso E, Merlo P, Coppola G, Battistini S, Rebecchi V, Rainero I, Sepe FN, Dalla Volta G, Sacco S, Geppetti P, Iannone LF. Long-Term Treatment Over 52 Weeks with Monthly Fremanezumab in Drug-Resistant Migraine: A Prospective Multicenter Cohort Study. CNS Drugs 2023; 37:1069-1080. [PMID: 37999868 PMCID: PMC10703741 DOI: 10.1007/s40263-023-01050-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Real-world studies on fremanezumab, an anti-calcitonin gene-related peptide monoclonal antibody for migraine prevention, are few and with limited follow-up. OBJECTIVE We aimed to evaluate the long-term (up to 52 weeks) effectiveness and tolerability of fremanezumab in high-frequency episodic migraine and chronic migraine. METHODS This s an independent, prospective, multicenter cohort study enrolling outpatients in 17 Italian Headache Centers with high-frequency episodic migraine or chronic migraine and multiple preventive treatment failures. Patients were treated with fremanezumab 225 mg monthly. The primary outcomes included changes from baseline (1 month before treatment) in monthly headache days, response rates (reduction in monthly headache days from baseline), and persistence in medication overuse at months 3, 6, and 12 (all outcome timeframes refer to the stated month). Secondary outcomes included changes from baseline in acute medication intake and disability questionnaires scores at the same timepoints. A last observation carried forward analysis was also performed. RESULTS A total of 90 patients who received at least one dose of fremanezumab and with a potential 12-month follow-up were included. Among them, 15 (18.0%) patients discontinued treatment for the entire population, a reduction in monthly headache days compared with baseline was reported at month 3, with a significant median [interquartile range] reduction in monthly headache days (- 9.0 [11.5], p < 0.001). A statistically different reduction was also reported at month 6 compared with baseline (- 10.0 [12.0]; p < 0.001) and at 12 months of treatment (- 10.0 [14.0]; p < 0.001). The percentage of patients with medication overuse was significantly reduced compared with baseline from 68.7% (57/83) to 29.6% (24/81), 25.3% (19/75), and 14.7% (10/68) at 3, 6, and 12 months of treatment, respectively (p < 0.001). Acute medication use (days and total number) and disability scores were also significantly reduced (p < 0.001). A ≥ 50% response rate was achieved for 51.9, 67.9, and 76.5% of all patients at 3, 6, and 12 months, respectively. Last observation carried forward analyses confirmed these findings. Fremanezumab was well tolerated, with just one patient discontinuing treatment because of adverse events. CONCLUSIONS This study provides evidence for the real-world effectiveness of fremanezumab in treating both high-frequency episodic migraine and chronic migraine, with meaningful and sustained improvements in multiple migraine-related variables. No new safety issue was identified.
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Affiliation(s)
- Valeria Caponnetto
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Antonio Russo
- Department of Advanced Medical and Surgical Sciences, Headache Centre, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marcello Silvestro
- Department of Advanced Medical and Surgical Sciences, Headache Centre, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessandro Tessitore
- Department of Advanced Medical and Surgical Sciences, Headache Centre, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Roberto De Icco
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Gloria Vaghi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Grazia Sances
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Carlo Baraldi
- Laboratory of Clinical Pharmacology and Pharmacogenomics, Department of Specialist Medicines, Digital and Predictive Medicine, Pharmacology and Clinical Metabolic Toxicology-Headache Center and Drug Abuse, AOU Policlinico di Modena, Modena, Italy
| | - Flavia Lo Castro
- Laboratory of Clinical Pharmacology and Pharmacogenomics, Department of Specialist Medicines, Digital and Predictive Medicine, Pharmacology and Clinical Metabolic Toxicology-Headache Center and Drug Abuse, AOU Policlinico di Modena, Modena, Italy
| | - Simona Guerzoni
- Laboratory of Clinical Pharmacology and Pharmacogenomics, Department of Specialist Medicines, Digital and Predictive Medicine, Pharmacology and Clinical Metabolic Toxicology-Headache Center and Drug Abuse, AOU Policlinico di Modena, Modena, Italy
| | - Maria Pia Prudenzano
- Headache Center, Amaducci Neurological Clinic, Policlinico General Hospital, Bari, Italy
| | - Adriana Fallacara
- Headache Center, Amaducci Neurological Clinic, Policlinico General Hospital, Bari, Italy
| | - Martino Gentile
- Headache Center, Amaducci Neurological Clinic, Policlinico General Hospital, Bari, Italy
| | - Raffaele Ornello
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Agnese Onofri
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Andrea Burgalassi
- Headache Center and Clinical Pharmacology Unit, Careggi University Hospital, Florence, Italy
| | - Alberto Chiarugi
- Headache Center and Clinical Pharmacology Unit, Careggi University Hospital, Florence, Italy
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Francesco De Cesaris
- Headache Center and Clinical Pharmacology Unit, Careggi University Hospital, Florence, Italy
| | - Antonio Granato
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Headache Centre, School of Neurology, University Hospital and Health Services of Trieste, ASUGI, University of Trieste, Trieste, Italy
| | | | - Marina De Tommaso
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Edoardo Mampreso
- Headache Centre, Neurology-Euganea, Padua Health Unit, Padua, Italy
| | - Paola Merlo
- Neurological Unit, Headache Centre, Humanitas Gavazzeni, Bergamo, Italy
| | - Gianluca Coppola
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino ICOT, Latina, Italy
| | - Stefania Battistini
- Neurology and Clinical Neurophysiology Unit, Headache Center, Siena University Hospital Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | | | - Innocenzo Rainero
- Department of Neuroscience "Rita Levi Montalcini", Headache Center, University of Torino, Torino, Italy
| | - Federica Nicoletta Sepe
- Neurology Department, Azienda Ospedaliera Nazionale Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Giorgio Dalla Volta
- U.O. Neurologia, Headache Center Istituto Clinico "Città di Brescia", Gruppo San Donato Brescia, Brescia, Italy
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Pierangelo Geppetti
- Headache Center and Clinical Pharmacology Unit, Careggi University Hospital, Florence, Italy
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Luigi Francesco Iannone
- Headache Center and Clinical Pharmacology Unit, Careggi University Hospital, Florence, Italy.
- Department of Health Sciences, University of Florence, Viale Pieraccini 6, Florence, Italy.
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Bottiroli S, Renzi A, Ballante E, De Icco R, Sances G, Tanzilli A, Vecchi T, Tassorelli C, Galli F. Personality in Chronic Headache: A Systematic Review with Meta-Analysis. Pain Res Manag 2023; 2023:6685372. [PMID: 37671122 PMCID: PMC10477030 DOI: 10.1155/2023/6685372] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/21/2023] [Accepted: 08/16/2023] [Indexed: 09/07/2023]
Abstract
Background Chronic headache (CH) is a condition that includes different subtypes of headaches and that can impair different life domains. Personality traits can play a relevant role both in the development and in coping with this medical condition. The first aim of the present study is to realize a systematic review of the personality traits associated with CH compared to healthy controls; the second objective is to carry out a quantitative meta-analysis with the studies using the same instrument to assess personality traits. Method The literature search encompassed articles published from 1988 until December 2022 on the major databases in the field of health and social sciences: PubMed, Scopus, PsychInfo, and Web of Science. Results Thirteen studies were included in the systematic review, but only three studies were deeply explored in a meta-analysis since the only ones used a common instrument for personality assessment (Minnesota Multiphasic Personality Inventory). According to the meta-analysis, different subtypes of CH patients scored higher than healthy controls on Hypochondriasis and Hysteria Scales. The systematic review showed higher levels of depressive and anxious personality dimensions and pain catastrophizing in CH compared to healthy controls. Moreover, frequent-chronic forms and medication-overuse headache were the most symptomatic and frail categories showing higher levels of dysfunctional personality traits and psychopathological symptoms. Conclusions These results seem to confirm a "neurotic profile" in patients suffering from CH. The identification of the main personality traits involved in the onset and maintenance of headache disorders represents an important objective for developing psychological interventions.
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Affiliation(s)
- Sara Bottiroli
- Giustino Fortunato University, Benevento, Italy
- Headache Science and Neurorehabilitation Centre, IRCCS C. Mondino Foundation, Pavia, Italy
| | - Alessia Renzi
- Department of Dynamic and Clinical Psychology and Health Studies, “Sapienza” University of Rome, Rome, Italy
| | - Elena Ballante
- BioData Science Unit, IRCCS C. Mondino Foundation, Pavia, Italy
- Department of Political and Social Sciences, University of Pavia, Italy
| | - Roberto De Icco
- Headache Science and Neurorehabilitation Centre, IRCCS C. Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Grazia Sances
- Headache Science and Neurorehabilitation Centre, IRCCS C. Mondino Foundation, Pavia, Italy
| | - Annalisa Tanzilli
- Department of Dynamic and Clinical Psychology and Health Studies, “Sapienza” University of Rome, Rome, Italy
| | - Tomaso Vecchi
- Headache Science and Neurorehabilitation Centre, IRCCS C. Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Cristina Tassorelli
- Headache Science and Neurorehabilitation Centre, IRCCS C. Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Federica Galli
- Department of Dynamic and Clinical Psychology and Health Studies, “Sapienza” University of Rome, Rome, Italy
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7
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Martinelli D, Pocora MM, De Icco R, Allena M, Vaghi G, Sances G, Castellazzi G, Tassorelli C. Searching for the Predictors of Response to BoNT-A in Migraine Using Machine Learning Approaches. Toxins (Basel) 2023; 15:364. [PMID: 37368665 DOI: 10.3390/toxins15060364] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023] Open
Abstract
OnabotulinumtoxinA (BonT-A) reduces migraine frequency in a considerable portion of patients with migraine. So far, predictive characteristics of response are lacking. Here, we applied machine learning (ML) algorithms to identify clinical characteristics able to predict treatment response. We collected demographic and clinical data of patients with chronic migraine (CM) or high-frequency episodic migraine (HFEM) treated with BoNT-A at our clinic in the last 5 years. Patients received BoNT-A according to the PREEMPT (Phase III Research Evaluating Migraine Prophylaxis Therapy) paradigm and were classified according to the monthly migraine days reduction in the 12 weeks after the fourth BoNT-A cycle, as compared to baseline. Data were used as input features to run ML algorithms. Of the 212 patients enrolled, 35 qualified as excellent responders to BoNT-A administration and 38 as nonresponders. None of the anamnestic characteristics were able to discriminate responders from nonresponders in the CM group. Nevertheless, a pattern of four features (age at onset of migraine, opioid use, anxiety subscore at the hospital anxiety and depression scale (HADS-a) and Migraine Disability Assessment (MIDAS) score correctly predicted response in HFEM. Our findings suggest that routine anamnestic features acquired in real-life settings cannot accurately predict BoNT-A response in migraine and call for a more complex modality of patient profiling.
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Affiliation(s)
- Daniele Martinelli
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Maria Magdalena Pocora
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Roberto De Icco
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Marta Allena
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Gloria Vaghi
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Grazia Sances
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Gloria Castellazzi
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Cristina Tassorelli
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
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8
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Bottiroli S, Rosi A, Sances G, Allena M, De Icco R, Lecce S, Vecchi T, Tassorelli C, Cavallini E. Social cognition in chronic migraine with medication overuse: a cross-sectional study on different aspects of mentalization and social relationships. J Headache Pain 2023; 24:47. [PMID: 37106347 PMCID: PMC10139829 DOI: 10.1186/s10194-023-01578-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Social cognition refers to all mental operations to decipher information needed in social interactions. Here we aimed to outline the socio-cognitive profile of Chronic Migraine with Medication Overuse (CM + MO), given they are recognized to be at risk of socio-cognitive difficulties. Given the multidimensionality of this construct, we considered: (1) socio-cognitive abilities, (2) socio-cognitive beliefs, (3) alexithymia and autism traits, and (4) social relationships. METHODS Seventy-one patients suffering from CM + MO, 61 from episodic migraine (EM), and 80 healthy controls (HC) were assessed with a comprehensive battery: (1) the Faux Pas test (FP), the Strange Stories task (SS), the Reading Mind in the Eyes test (RMET), (2) the Tromsø Social Intelligence Scale, (3) the Toronto Alexithymia Scale, the Autism Spectrum Quotient, (4) the Lubben Social Network Scale, the Friendship Scale. RESULTS CM + MO: (1) performed similar to EM but worse than HC in the FP and SS, while they were worse than EM and HC in the RMET; (2) were similar to EM and HC in social intelligence; (3) had more alexithymic/autistic traits than EM and HC; (4) reported higher levels of contact with their family members but felt little support from the people around them than HC. CONCLUSIONS CM + MO results characterized by a profile of compromised socio-cognitive abilities that affects different dimensions. These findings may have a relevant role in multiple fields related to chronic headache: from the assessment to the management.
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Affiliation(s)
- Sara Bottiroli
- Giustino Fortunato University, Benevento, Italy.
- IRCCS Mondino Foundation, Pavia, Italy.
| | - Alessia Rosi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | | | - Roberto De Icco
- IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Serena Lecce
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Tomaso Vecchi
- IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Cristina Tassorelli
- IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Elena Cavallini
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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9
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Onofri A, Iannone LF, Granato A, Garascia G, Bartole L, Manganotti P, Vollono C, Romozzi M, Sottani C, Calabresi P, Tassorelli C, Sances G, Allena M, De Icco R, De Cesaris F, Burgalassi A, Chiarugi A, Baraldi C, Guerzoni S, Prudenzano MP, Fallacara A, Albanese M, Rainero I, Coppola G, Casalena A, Mampreso E, Pistoia F, Sarchielli P, Morson M, Sacco S, Geppetti P, Ornello R. Validation of the Italian version of the Cluster Headache Impact Questionnaire (CHIQ). Neurol Sci 2023:10.1007/s10072-023-06758-0. [PMID: 36939946 DOI: 10.1007/s10072-023-06758-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 03/14/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND The Cluster Headache Impact Questionnaire (CHIQ) is a specific and easy-to-use questionnaire to assess the current impact of cluster headache (CH). The aim of this study was to validate the Italian version of the CHIQ. METHODS We included patients diagnosed with episodic CH (eCH) or chronic CH (cCH) according to the ICHD-3 criteria and included in the "Italian Headache Registry" (RICe). The questionnaire was administered to patients through an electronic form in two sessions: at first visit for validation, and after 7 days for test-retest reliability. For internal consistency, Cronbach's alpha was calculated. Convergent validity of the CHIQ with CH features and the results of questionnaires assessing anxiety, depression, stress, and quality of life was evaluated using Spearman's correlation coefficient. RESULTS We included 181 patients subdivided in 96 patients with active eCH, 14 with cCH, and 71 with eCH in remission. The 110 patients with either active eCH or cCH were included in the validation cohort; only 24 patients with CH were characterized by a stable attack frequency after 7 days, and were included in the test-retest cohort. Internal consistency of the CHIQ was good with a Cronbach alpha value of 0.891. The CHIQ score showed a significant positive correlation with anxiety, depression, and stress scores, while showing a significant negative correlation with quality-of-life scale scores. CONCLUSION Our data show the validity of the Italian version of the CHIQ, which represents a suitable tool for evaluating the social and psychological impact of CH in clinical practice and research.
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Affiliation(s)
- Agnese Onofri
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1 Coppito, 67100, L'Aquila, Italy
| | - Luigi Francesco Iannone
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Antonio Granato
- Headache Centre, Clinical Unit of Neurology, School of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, ASUGI, University of Trieste, Trieste, Italy
| | - Gabriele Garascia
- Headache Centre, Clinical Unit of Neurology, School of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, ASUGI, University of Trieste, Trieste, Italy
| | - Luca Bartole
- Headache Centre, Clinical Unit of Neurology, School of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, ASUGI, University of Trieste, Trieste, Italy
| | - Paolo Manganotti
- Headache Centre, Clinical Unit of Neurology, School of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, ASUGI, University of Trieste, Trieste, Italy
| | - Catello Vollono
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marina Romozzi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Costanza Sottani
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paolo Calabresi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Grazia Sances
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Marta Allena
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Roberto De Icco
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Francesco De Cesaris
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Andrea Burgalassi
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Alberto Chiarugi
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Carlo Baraldi
- Department of Specialist Medicines, Digital and Predictive Medicine, Pharmacology and Clinical Metabolic Toxicology-Headache Center and Drug Abuse, Laboratory of Clinical Pharmacology and Pharmacogenomics, AOU Policlinico di Modena, Modena, Italy
| | - Simona Guerzoni
- Department of Specialist Medicines, Digital and Predictive Medicine, Pharmacology and Clinical Metabolic Toxicology-Headache Center and Drug Abuse, Laboratory of Clinical Pharmacology and Pharmacogenomics, AOU Policlinico di Modena, Modena, Italy
| | - Maria Pia Prudenzano
- Headache Center, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Adriana Fallacara
- Headache Center, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Maria Albanese
- Regional Referral Headache Center, Neurology Unit, University Hospital Tor Vergata, 00133, Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, 00133, Rome, Italy
| | - Innocenzo Rainero
- Headache Center, Department of Neuroscience "Rita Levi Montalcini", University of Torino, Turin, Italy
| | - Gianluca Coppola
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy
| | | | - Edoardo Mampreso
- Headache Centre, Neurology - Euganea, Health Unit, Padua, Padua, Italy
| | - Francesca Pistoia
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1 Coppito, 67100, L'Aquila, Italy
| | - Paola Sarchielli
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Marisa Morson
- Italian Society for the Study of Headache (SISC), Rome, Italy
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1 Coppito, 67100, L'Aquila, Italy
| | - Pierangelo Geppetti
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Raffaele Ornello
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1 Coppito, 67100, L'Aquila, Italy.
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10
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De Icco R, Vaghi G, Allena M, Ghiotto N, Guaschino E, Martinelli D, Ahmad L, Corrado M, Bighiani F, Tanganelli F, Bottiroli S, Cammarota F, Sances G, Tassorelli C. Does MIDAS reduction at 3 months predict the outcome of erenumab treatment? A real-world, open-label trial. J Headache Pain 2022; 23:123. [PMID: 36115947 PMCID: PMC9482180 DOI: 10.1186/s10194-022-01480-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/10/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
In Italy, monoclonal antibodies targeting the CGRP pathway are subsidized for the preventive treatment of high frequency and chronic migraine (CM) in patients with a MIgraine Disability ASsessment (MIDAS) score ≥ 11. Eligibility to treatment continuation requires a ≥ 50% MIDAS score reduction at three months (T3). In this study, we evaluate whether a ≥ 50% MIDAS score reduction at T3 is a reliable predictor of response to one-year erenumab treatment.
Methods
In this prospective, open-label, real-world study, 77 CM patients were treated with erenumab 70–140 mg s.c. every 28 days for one year (T13). We collected the following variables: monthly migraine days (MMDs), monthly headache days (MHDs), days of acute medication intake, MIDAS, HIT-6, anxiety, depression, quality of life and allodynia. Response to erenumab was evaluated as: i) average reduction in MMDs during the 1-year treatment period; and ii) percentage of patients with ≥ 50% reduction in MMDs during the last 4 weeks after the 13th injection (RespondersT13).
Results
Erenumab induced a sustained reduction in MMDs, MHDs and intake of acute medications across the 12-month treatment period, with 64.9% of patients qualifying as RespondersT13. At T3, 55.8% of patients reported a ≥ 50% reduction in MIDAS score (MIDASRes) and 55.4% of patients reported a ≥ 50% reduction in MMDs (MMDRes). MIDASRes and MMDRes patients showed a more pronounced reduction in MMDs during the 1-year treatment as compared to NON-MIDASRes (MIDASRes: T0: 23.5 ± 4.9 vs. T13: 7.7 ± 6.2; NON- MIDASRes: T0: 21.6 ± 5.4 vs. T13: 11.3 ± 8.8, p = 0.045) and NON-MMDRes (MMDRes: T0: 23.0 ± 4.5 vs. T13: 6.6 ± 4.8; NON-MMDRes: T0: 22.3 ± 6.0 vs. T13: 12.7 ± 9.2, p < 0.001) groups. The percentage of RespondersT13 did not differ between MIDASRes (74.4%) and NON-MIDASRes (52.9%) patients (p = 0.058), while the percentage of RespondersT13 was higher in the MMDRes group (83.3%) when compared to NON-MMDRes (42.9%) (p = 0.001). MMDRes predicted the long-term outcome according to a multivariate analysis (Exp(B) = 7.128; p = 0.001), while MIDASRes did not. Treatment discontinuation based on MIDASRes would have early excluded 36.0% of RespondersT13. Discontinuation based on “either MIDASResor MMDRes” would have excluded a lower percentage (16%) of RespondersT13.
Conclusion
MIDASRes only partly reflects the 12-month outcome of erenumab treatment in CM, as it excludes more than one third of responders. A criterion based on the alternative consideration of ≥ 50% reduction in MIDAS score or MMDs in the first three months of treatment represents a more precise and inclusive option.
Trial registration
The trial was retrospectively registered at www.clinicaltrials.gov (NCT05442008).
Graphical Abstract
CGRP: Calcitonin Gene Related Peptide. MIDAS: MIgraine Disability Assessment. MMDs: monthly migraine days. MIDASRes: Patients with a MIDAS score reduction of at least 50% at T3. MMDRes: Patients with a MMDs reduction of at least 50% at T3. ResponderT13: Patients with a MMDs reduction from baseline of at least 50% in the last 4 weeks of observation period (after 13 erenumab administrations). T0: First erenumab administration. T3, T6, T9, T12: Follow-up visits at three, six, nine, and twelve months after first erenumab administration. T13: Last visit of the protocol.
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11
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Bottiroli S, Matamala-Gomez M, Allena M, Guaschino E, Ghiotto N, De Icco R, Sances G, Tassorelli C. The Virtual "Enfacement Illusion" on Pain Perception in Patients Suffering from Chronic Migraine: A Study Protocol for a Randomized Controlled Trial. J Clin Med 2022; 11:jcm11226876. [PMID: 36431353 PMCID: PMC9699363 DOI: 10.3390/jcm11226876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND given the limited efficacy, tolerability, and accessibility of pharmacological treatments for chronic migraine (CM), new complementary strategies have gained increasing attention. Body ownership illusions have been proposed as a non-pharmacological strategy for pain relief. Here, we illustrate the protocol for evaluating the efficacy in decreasing pain perception of the enfacement illusion of a happy face observed through an immersive virtual reality (VR) system in CM. METHOD the study is a double-blind randomized controlled trial with two arms, involving 100 female CM patients assigned to the experimental group or the control group. The experimental group will be exposed to the enfacement illusion, whereas the control group will be exposed to a pleasant immersive virtual environment. Both arms of the trial will consist in three VR sessions (20 min each). At the baseline and at the end of the intervention, the patients will fill in questionnaires based on behavioral measures related to their emotional and psychological state and their body satisfaction. Before and after each VR session, the level of pain, the body image perception, and the affective state will be assessed. DISCUSSION this study will provide knowledge regarding the relationship between internal body representation and pain perception, supporting the effectiveness of the enfacement illusion as a cognitive behavioral intervention in CM.
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Affiliation(s)
- Sara Bottiroli
- Faculty of Law, Giustino Fortunato University, 82100 Benevento, Italy
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy
- Correspondence:
| | - Marta Matamala-Gomez
- Mind and Behavior Technological Center, Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy
| | - Marta Allena
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Elena Guaschino
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Natascia Ghiotto
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Roberto De Icco
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Grazia Sances
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Cristina Tassorelli
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, 27100 Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
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12
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Corrado M, Demartini C, Greco R, Zanaboni A, Bighiani F, Vaghi G, Grillo V, Sances G, Allena M, Tassorelli C, De Icco R. Oculo-vestibular signs in experimentally induced migraine attacks: an exploratory analysis. Neurol Sci 2022; 43:6561-6564. [PMID: 35953579 PMCID: PMC9616776 DOI: 10.1007/s10072-022-06312-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/30/2022] [Indexed: 11/29/2022]
Abstract
Vestibular symptoms accompanying headache are quite common in migraine patients. Based on the association of vertigo with migraine, vestibular migraine was included in the appendix of the 3rd edition of the International Classification of Headache Disorders as a possible migraine subtype worthy of further investigation. In this post hoc, exploratory analysis, we investigated the occurrence of oculo-vestibular signs (OVSs) during experimentally induced migraine attacks in 24 episodic migraine patients and 19 healthy controls exposed to sublingual nitroglycerin (NTG - 0.9 mg). A comprehensive clinical examination was performed at baseline, at the onset of the migraine-like attack, and immediately before hospital discharge (180 minutes after NTG administration). Three of the 13 migraine patients who developed a spontaneous-like migraine attack during the hospital observation period (23.1%) also developed OVSs during the induction test. Noteworthy, none of the patients with a negative induction test developed OVSs and no OVSs were reported in healthy subjects at any time point. The exploratory nature of our study does not allow to draw definite conclusions on the possible implications of a vestibular dysfunction in migraine pathophysiology. Our results however suggest that NTG administration may lend itself to investigate vestibular dysfunction in migraine, at least in a subset of patients. The present findings represent a starting point for designing future ad hoc and well-powered studies.
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13
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Geppetti P, De Cesaris F, Benemei S, Cortelli P, Cevoli S, Pierangeli G, Favoni V, Lisotto C, Usai S, Frediani F, Di Fiore P, D'Arrigo G, Tassorelli C, Sances G, Cainazzo MM, Baraldi C, Sarchielli P, Corbelli I, De Vanna G, Tedeschi G, Russo A. Self-administered subcutaneous diclofenac sodium in acute migraine attack: A randomized, double-blind, placebo-controlled dose-finding pilot study. Cephalalgia 2022; 42:1058-1070. [PMID: 35469478 DOI: 10.1177/03331024221093712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A novel formulation of diclofenac, complexed with hydroxypropyl-β-cyclodextrin (HPβCD) as a solubility enhancer, in a prefilled syringe for self-administered subcutaneous injection may overcome the limitations of acute migraine treatments administered by oral, rectal, intramuscular, or intravenous routes. METHODS This multicentre, phase 2, double-blind, randomized, placebo-controlled, dose-finding pilot study evaluated the efficacy, safety and tolerability of three different doses (25/50/75 mg/1 mL) of subcutaneous diclofenac sodium in the treatment of an acute migraine attack in 122 subjects. The primary efficacy endpoint was the percentage of patients pain-free at 2 hours after the study drug injection. RESULTS A significantly higher percentage of patients in the 50 mg diclofenac group 14 (46.7%) were pain-free at 2 hours when compared with placebo: 9 (29.0%) (p = 0.01). The 50 mg dose proved superior to placebo also in the majority of the secondary endpoints. The overall global impression favoured diclofenac vs placebo. There were no adverse events leading to study withdrawal. The majority of treatment-emergent adverse events were mild. CONCLUSIONS The 50 mg dose of this novel formulation of diclofenac represents a valuable self-administered option for the acute treatment of migraine attacks.Trial registration: EudraCT Registration No. 2017-004828-29.
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Affiliation(s)
- Pierangelo Geppetti
- Università degli studi di Firenze, Dipartimento di Scienze della Salute, Florence, Italy.,SOD Centro Cefalee e Farmacologia Clinica, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Francesco De Cesaris
- SOD Centro Cefalee e Farmacologia Clinica, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Silvia Benemei
- SOD Centro Cefalee e Farmacologia Clinica, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Pietro Cortelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,DIBINEM - Università di Bologna Ospedale Bellaria, Bologna, Italy
| | - Sabina Cevoli
- DIBINEM - Università di Bologna Ospedale Bellaria, Bologna, Italy
| | - Giulia Pierangeli
- DIBINEM - Università di Bologna Ospedale Bellaria, Bologna, Italy.,Azienda per l'Assistenza Sanitaria n. 5 Friuli Occidentale-Centro Cefalee, Presidio Ospedaliero di San Vito al Tagliamento, San Vito al Tagliamento, Italy
| | - Valentina Favoni
- DIBINEM - Università di Bologna Ospedale Bellaria, Bologna, Italy
| | - Carlo Lisotto
- Azienda per l'Assistenza Sanitaria n. 5 Friuli Occidentale-Centro Cefalee, Presidio Ospedaliero di San Vito al Tagliamento, San Vito al Tagliamento, Italy
| | - Susanna Usai
- Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, UO Neurologia 3, Milan, Italy
| | - Fabio Frediani
- Centro Cefalee, UOC Neurologia e Stroke Unit, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo, Milan, Italy
| | - Paola Di Fiore
- Centro Cefalee, UOC Neurologia e Stroke Unit, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo, Milan, Italy
| | - Giacomo D'Arrigo
- Centro Cefalee, UOC Neurologia e Stroke Unit, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo, Milan, Italy
| | - Cristina Tassorelli
- Headache Science & Neurorehabilitation Center, IRCCS C. Mondino Foundation Pavia, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Grazia Sances
- Headache Science & Neurorehabilitation Center, IRCCS C. Mondino Foundation Pavia, Pavia, Italy
| | - Maria Michela Cainazzo
- AOU Policlinico di Modena, Struttura Semplice Dipartimentale -Centro Cefalee e Abuso di Farmaci e Tossicologia Medica, Modena, Italy
| | - Carlo Baraldi
- Università degli studi di Modena e Reggio Emilia, Struttura Semplice Dipartimentale Centro Cefalee ed abuso di Farmaci-Tossicologia Medica, Modena, Italy
| | - Paola Sarchielli
- Headache Center, Neurological Clinic, University of Perugia, Perugia, Italy
| | - Ilenia Corbelli
- Headache, Center, Neurological Clinic, Azienda Ospedaliera Santa Maria della Misericordia, Perugia, Perugia, Italy
| | | | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Science, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Russo
- Department of Advanced Medical and Surgical Science, University of Campania "Luigi Vanvitelli", Naples, Italy
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Bentivegna E, Tassorelli C, De Icco R, Sances G, Martelletti P. Tele-healthcare in migraine medicine: from diagnosis to monitoring treatment outcomes. Expert Rev Neurother 2022; 22:237-243. [PMID: 35196206 DOI: 10.1080/14737175.2022.2045954] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION : Primary headaches represent a huge cost in terms of decreased productivity and migraine occupies the first position among disabilities in working population. Migraine has a high incidence, disproportionate to the available primary care centres. In most cases, migraine can be managed through the simple and accurate collection of clinical history, which makes it an ideal candidate for tele-healthcare. AREAS COVERED : In this narrative review we retrace the most important scientific evidence regarding use of tele-healthcare in headache medicine. Over the last few years, it has proved to be a valid and useful tool for the management of migraine. Furthermore, current pandemic has imposed a drastic change in the way of thinking and setting up medicine, forcing clinicians and patients to a huge expansion of telemedicine. EXPERT OPINION : We should permanently insert the culture of telemedicine in the headache care not only in academies and scientific societies, but extend it to specialized hospitals for the treatment of headaches. Only by broadening the old book-based strategy, we will be able to open the door to the multidimensional culture of headache medicine. Experts of excellence centres should set an example and pave the way for the rest of the clinicians.
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Affiliation(s)
- Enrico Bentivegna
- Emergency Medicine Unit, Regional Referral Headache Center, Sant'Andrea University Hospital, Rome, Italy.,Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Cristina Tassorelli
- Headache Science and Neurorehabilitation Center, National Neurological Institute C. Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Roberto De Icco
- Headache Science and Neurorehabilitation Center, National Neurological Institute C. Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Grazia Sances
- Headache Science and Neurorehabilitation Center, National Neurological Institute C. Mondino Foundation, Pavia, Italy
| | - Paolo Martelletti
- Emergency Medicine Unit, Regional Referral Headache Center, Sant'Andrea University Hospital, Rome, Italy.,Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
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15
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Matamala-Gomez M, Bottiroli S, Sances G, Allena M, De Icco R, Ghiotto N, Guaschino E, Sandrini G, Tassorelli C. Facial expressions modulate pain perception in patients with chronic migraine. Cephalalgia 2022; 42:739-748. [PMID: 35166163 DOI: 10.1177/03331024221075081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM First, we investigated whether the exposure to different visual feedback conditions may modulate pain perception by means of visual induced analgesia in patients with chronic migraine. Second, to comprehend the way emotional face expressions could induce visual analgesia, we evaluated the degree of identification with the four experimental conditions. METHODS In a 1 × 4 within-subject study design, 38 female chronic migraine patients were exposed to different visual stimuli - positive face, neutral face, negative face, and control (white screen) - during a migraine attack. Visual stimuli were presented 3 times in a randomized order (each condition lasted 40 seconds). Migraine pain ratings and identification scores were assessed immediately after the observation of each visual condition. RESULTS We observed a significant difference in pain ratings between the positive (median: 30, 95% CI 26.69 to 38.20) and the negative (median: 30, 95% CI 33.09 to 44.13) (z = -4.46, p < 0.0001) facial expressions or the neutral facial expression (median: 30, 95% CI 31.89 to 42.41) (z = 3.41, p < 0.001). Participants identified more with the neutral face condition than with the other conditions. CONCLUSIONS Observation of a positive emotional face resulted sufficient to modulate pain perception possibly via the mediation of emotion regulation for positive emotions. This study paves the way for the integration of new cognitive behavioural interventions based on the adoption of visual induced analgesia to further control pain perception in chronic migraine patients.
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Affiliation(s)
- Marta Matamala-Gomez
- Mind and Behavior Technological Center, Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Sara Bottiroli
- Faculty of Law, Giustino Fortunato University, Benevento, Italy.,Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Grazia Sances
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Marta Allena
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Roberto De Icco
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Natascia Ghiotto
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Elena Guaschino
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Giorgio Sandrini
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Cristina Tassorelli
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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16
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Cerami C, Crespi C, Bottiroli S, Santi GC, Sances G, Allena M, Vecchi T, Tassorelli C. High perceived isolation and reduced social support affect headache impact levels in migraine after the Covid-19 outbreak: A cross sectional survey on chronic and episodic patients. Cephalalgia 2021; 41:1437-1446. [PMID: 34256651 PMCID: PMC8619713 DOI: 10.1177/03331024211027568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/14/2021] [Accepted: 06/01/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Psychosocial variables are key factors influencing psycho-physical equilibrium in migraine patients. Social isolation and vulnerability to stressors may prevent efficient psychological adjustment negatively affecting adaptation to life changes, as that imposed during Covid-19 lockdown. Here, we explored psychosocial dimensions and changes in clinical condition during Covid-19 lockdown in migraine patients, with regard to migraine type and headache impact. METHODS Sixty-four migraine patients (32 episodic and 32 chronic) and 64 healthy control subjects were included in a case-control cross-sectional study. A two-step clustering procedure split patients into two clusters, based on the Headache Impact Test. Perceived global distress, loneliness, empathy, and coping levels were compared in groups, as well as changes in clinical condition. RESULTS Migraine patients reported higher general loneliness and lower social support compared to healthy control subjects. Emotional loneliness was more marked in patients with higher headache impact. This subgroup of patients more frequently reported changes in the therapeutic and care paths as the perceived cause of the occurrence of motor or extra-motor symptomatology. CONCLUSIONS Migraine patients, especially those more severely affected, proved more vulnerable than healthy control subjects to Covid-19 lockdown. Long-lasting interruption of social interactions may be detrimental in fragile patients that are in need of structured support interventions to maintain psycho-physical wellbeing.
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Affiliation(s)
- Chiara Cerami
- Scuola Universitaria Superiore IUSS Pavia, Pavia, Italy
- Cognitive Computational Neuroscience Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Chiara Crespi
- Cognitive Computational Neuroscience Research Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, University of Pavia, Pavia, Italy
| | - Sara Bottiroli
- Faculty of Law, Giustino Fortunato University, Benevento, Italy
- Headache Science and Neurorehabilitation Centre, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Grazia Sances
- Headache Science and Neurorehabilitation Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Marta Allena
- Headache Science and Neurorehabilitation Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Tomaso Vecchi
- Department of Brain and Behavioral Sciences, University of Pavia, University of Pavia, Pavia, Italy
- Cognitive Psychology Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, University of Pavia, Pavia, Italy
- Headache Science and Neurorehabilitation Centre, IRCCS Mondino Foundation, Pavia, Italy
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17
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Bottiroli S, De Icco R, Vaghi G, Pazzi S, Guaschino E, Allena M, Ghiotto N, Martinelli D, Tassorelli C, Sances G. Correction to: Psychological predictors of negative treatment outcome with Erenumab in chronic migraine: data from an open label long-term prospective study. J Headache Pain 2021; 22:131. [PMID: 34732140 PMCID: PMC8564953 DOI: 10.1186/s10194-021-01342-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Sara Bottiroli
- Faculty of Law, Giustino Fortunato University, Benevento, Italy. .,Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy.
| | - Roberto De Icco
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Gloria Vaghi
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Stefania Pazzi
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Elena Guaschino
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Marta Allena
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Natascia Ghiotto
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Daniele Martinelli
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Cristina Tassorelli
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Grazia Sances
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
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18
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Bottiroli S, De Icco R, Vaghi G, Pazzi S, Guaschino E, Allena M, Ghiotto N, Martinelli D, Tassorelli C, Sances G. Psychological predictors of negative treatment outcome with Erenumab in chronic migraine: data from an open label long-term prospective study. J Headache Pain 2021; 22:114. [PMID: 34600468 PMCID: PMC8487575 DOI: 10.1186/s10194-021-01333-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/22/2021] [Indexed: 12/23/2022] Open
Abstract
Background Monoclonal antibodies (mABs) targeting the calcitonin gene-related peptide (CGRP) pathway represent the first disease-specific preventive migraine therapy. Growing evidence suggests that they are effective in the preventive treatment of difficult-to-treat patients. In this study, we evaluated the psychological predictors of the outcome of treatment with the anti-CGRP monoclonal antibody erenumab in patients with chronic migraine (CM). Methods Seventy-five patients with CM who had already failed at least 3 preventive therapies received erenumab every 28 days for a period of 12 months. Before the first administration, patients received a full psychological evaluation using The Structured Clinical Interview for DSM-5 Clinician Version (SCID-5-CV) to assess personality disturbances (primary outcome), mood and anxiety disorders, and as well specific questionnaires to evaluate alexithymia traits, childhood traumas, and current stressors (secondary outcomes). Results After 12 months of treatment, 53 patients reported a reduction of at least 50% in headache days/per month (Responders), whereas 22 did not (Non Responders). When compared to Responders, Non Responders were characterized by a higher prevalence of personality disorders belonging to Cluster C (avoidant, dependent, and obsessive-compulsive) (77% vs 37%, p = .001). Non Responders were also characterized by a higher prevalence of anxiety disorders (90% vs 60%, p = 0.007), showed more alexithymic traits (51.7 ± 13.7 vs 42.9 ± 14.3, p = 0.017), and reported a higher number of 'at least serious' current stressors (3.2 ± 4.0 vs 0.8 ± 1.4, p < .0001) than Responders. At the multivariate analysis, higher prevalence of Cluster C personality disorders (OR 3.697; p = 0.05) and higher number of ‘at least serious’ life events (OR 1.382; p = 0.017) arose as prognostic factors of erenumab failure. Conclusions Erenumab confirmed its effectiveness in a population of difficult-to-treat migraine. The presence of “anxious-fearful” personality together with current stressors and anxiety represent negative predictors of treatment outcome. Trial registration The study protocol was registered at clinicaltrials.gov (NCT04361721).
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Affiliation(s)
- Sara Bottiroli
- Faculty of Law, Giustino Fortunato University, Benevento, Italy. .,Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy.
| | - Roberto De Icco
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Gloria Vaghi
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Stefania Pazzi
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Elena Guaschino
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Marta Allena
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Natascia Ghiotto
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Daniele Martinelli
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Cristina Tassorelli
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Grazia Sances
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
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19
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Martinelli D, Arceri S, De Icco R, Allena M, Guaschino E, Ghiotto N, Castellazzi G, Cosentino G, Sances G, Tassorelli C. BONT-A efficacy in high frequency migraine: An open label, single arm, exploratory study applying the preempt paradigm. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.117695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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Vaghi G, Bitetto V, De Icco R, Guaschino E, Allena M, Tassorelli C, Sances G. Real life experience of one year treatment with Galcanezumab in chronic migraine with and without medication overuse headache. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.119292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Tassorelli C, De Icco R, Martinelli D, Putortì A, Allena M, Sances G. Migraine treatment update. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.117900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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22
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Bottiroli S, Ada G, Federica G, Castelli L, Sances G, Ahmad L, Guaschino E, Allena M, Tassorelli C. Psychological distress and alexithymia in chronic migraine and fibromyalgia: A comparative study. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.119247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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De Icco R, Greco R, Demartini C, Zanaboni AM, Reggiani A, Realini N, Allena M, Martinelli D, Putortì A, Ahmad L, Corrado M, Grillo V, Sances G, Tassorelli C. Spinal nociceptive sensitization and plasma palmitoylethanolamide levels during experimentally-induced migraine attacks. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.117721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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24
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Bottiroli S, Galli F, Ballante E, Pazzi S, Sances G, Guaschino E, Allena M, Tassorelli C. Validity of the Severity of Dependence Scale for detecting dependence behaviours in chronic migraine with medication overuse. Cephalalgia 2021; 42:209-217. [PMID: 34541932 DOI: 10.1177/03331024211039817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS In this study, we tested the validity of the Severity of Dependence Scale in detecting dependence behaviours in patients with chronic migraine and medication overuse (CM + MO) using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and the Leeds Dependence Questionnaire as gold standard measures. METHODS Four hundred and fifty-four patients with CM + MO filled in the Severity of Dependence Scale and the Leeds Dependence Questionnaire and underwent a psychological evaluation for the diagnosis of substance dependence according to the DSM-IV criteria. RESULTS Sixty-nine percent of subjects (n = 313) presented substance dependence according to the DSM-IV criteria. These patients scored significantly higher than those without substance dependence in Severity of Dependence Scale total score (Z = -3.29, p = 0.001), and in items 1 (Z = -2.44, p = 0.015), 2 (Z = -2.50, p = 0.012), 4 (Z = -2.05, p = 0.04), and 5 (Z = -3.39, p = 0.001). Severity of Dependence Scale total score (β = 0.13, SE = 0.04, z = 3.49, p < 0.001) was a significant predictor for substance dependence. Receiver Operating Characteristic (ROC) curves showed that Severity of Dependence Scale discriminated patients with or without substance dependence. CONCLUSION Severity of Dependence Scale could represent an interesting screening tool for dependency-like behaviors in CM + MO patients.
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Affiliation(s)
- Sara Bottiroli
- Giustino Fortunato University, Benevento, Italy.,Headache Science and Neurorehabilitation Centre, IRCCS C. Mondino Foundation, Pavia, Italy
| | - Federica Galli
- Department of Dynamic and Clinical Psychology, and Health Studies-Faculty of Medicine and Psychology, 9311Sapienza University of Rome, Sapienza University of Rome, Rome, Italy
| | - Elena Ballante
- BioData Science Unit, IRCCS C. Mondino Foundation, Pavia, Italy.,Department of Mathematics, 19001University of Pavia, University of Pavia, Italy
| | - Stefania Pazzi
- Headache Science and Neurorehabilitation Centre, IRCCS C. Mondino Foundation, Pavia, Italy
| | - Grazia Sances
- Headache Science and Neurorehabilitation Centre, IRCCS C. Mondino Foundation, Pavia, Italy
| | - Elena Guaschino
- Headache Science and Neurorehabilitation Centre, IRCCS C. Mondino Foundation, Pavia, Italy
| | - Marta Allena
- Headache Science and Neurorehabilitation Centre, IRCCS C. Mondino Foundation, Pavia, Italy
| | - Cristina Tassorelli
- Headache Science and Neurorehabilitation Centre, IRCCS C. Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Italy
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25
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De Icco R, Greco R, Demartini C, Vergobbi P, Zanaboni A, Tumelero E, Reggiani A, Realini N, Sances G, Grillo V, Allena M, Tassorelli C. Spinal nociceptive sensitization and plasma palmitoylethanolamide levels during experimentally induced migraine attacks. Pain 2021; 162:2376-2385. [PMID: 33587406 PMCID: PMC8374714 DOI: 10.1097/j.pain.0000000000002223] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/04/2021] [Accepted: 01/22/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Migraine pathophysiology has been suggested to include dysregulation of the endocannabinoid system (ES). We simultaneously evaluated plasma anandamide (AEA) and palmitoylethanolamide (PEA) levels and spinal sensitization in a validated human model of migraine based on systemic nitroglycerin (NTG) administration. Twenty-four subjects with episodic migraine (MIG) and 19 healthy controls (HC) underwent blood sampling and investigation of nociceptive withdrawal reflex thresholds (RTh: single-stimulus threshold; TST: temporal summation threshold) before and 30 (T30), 60 (T60), and 120 (T120) minutes after sublingual NTG administration (0.9 mg). At baseline, the MIG and HC groups were comparable for plasma AEA (P = 0.822) and PEA (P = 0.182) levels, and for RTh (P = 0.142) and TST values (P = 0.150). Anandamide levels increased after NTG administration (P = 0.022) in both groups, without differences between them (P = 0.779). By contrast, after NTG administration, PEA levels increased in the MIG group at T120 (P = 0.004), while remaining stable in the HC group. Nitroglycerin administration induced central sensitization in the MIG group, which was recorded as reductions in RTh (P = 0.046) at T30 and T120, and in TST (P = 0.001) at all time points. In the HC group, we observed increases in RTh (P = 0.001) and TST (P = 0.008), which suggest the occurrence of habituation. We found no significant correlations between the ES and neurophysiological parameters. Our findings suggest a role for PEA in the ictal phase of episodic migraine. The ES does not seem to be directly involved in the modulation of NTG-induced central sensitization, which suggests that the observed PEA increase and spinal sensitization are parallel, probably unrelated, phenomena.
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Affiliation(s)
- Roberto De Icco
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Rosaria Greco
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Chiara Demartini
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Pietro Vergobbi
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Annamaria Zanaboni
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Elena Tumelero
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Angelo Reggiani
- Department of Drug Discovery and Development, Istituto Italiano di Tecnologia, Genova, Italy
| | - Natalia Realini
- Department of Drug Discovery and Development, Istituto Italiano di Tecnologia, Genova, Italy
| | - Grazia Sances
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Valentina Grillo
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Marta Allena
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Cristina Tassorelli
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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26
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Martinelli D, Arceri S, De Icco R, Allena M, Guaschino E, Ghiotto N, Bitetto V, Castellazzi G, Cosentino G, Sances G, Tassorelli C. BoNT-A efficacy in high frequency migraine: an open label, single arm, exploratory study applying the PREEMPT paradigm. Cephalalgia 2021; 42:170-175. [PMID: 34404257 DOI: 10.1177/03331024211034508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION In this open label, single-arm trial we evaluated the efficacy of onabotulinum toxin-A in the prevention of high-frequency episodic migraine (8-14 migraine days/month). METHODS We enrolled 32 high-frequency episodic migraine subjects (age 44.8 ± 11.9 years, 11.0 ± 2.2 migraine days, 11.5 ± 2.1 headache days, 7 females). After a 28-day baseline period, subjects underwent 4 subsequent onabotulinum toxin-A treatments according to the phase III research evaluating migraine prophylaxis therapy (PREEMPT) paradigm, 12-weeks apart. The primary outcome was the reduction of monthly migraine days from baseline in the 12-week period following the last onabotulinum toxin-A treatment. RESULTS Onabotulinum toxin-A reduced monthly migraine days by 3.68 days (-33.1%, p < 0.01). Thirty-nine percent of the patients experienced a ≥50% reduction in monthly migraine days. Onabotulinum toxin-A also reduced the number of headache days (-33.9%, p < 0.01) and the intake of acute medications (-22.9%, p = 0.03). Disability and quality of life (QoL) scores improved markedly (migraine disability assessment (MIDAS) -41.7%; migraine specific questionnaire (MSQ) -31.7%, p < 0.01). CONCLUSIONS The findings suggest that, when administered according to the PREEMPT paradigm, onabotulinum toxin-A is effective in the prevention of high-frequency episodic migraine.Trial Registration: NCT04578782.
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Affiliation(s)
- Daniele Martinelli
- Deptartment of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.,Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Sebastiano Arceri
- Deptartment of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.,Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Roberto De Icco
- Deptartment of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.,Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Marta Allena
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Elena Guaschino
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Natascia Ghiotto
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Vito Bitetto
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Gloria Castellazzi
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy.,NMR Research Unit, Department of Neuroinflammation, 61554UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, Queen Square MS Centre, UCL Queen Square Institute of Neurology, London, United Kingdom.,Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Giuseppe Cosentino
- Deptartment of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.,Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Grazia Sances
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Cristina Tassorelli
- Deptartment of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.,Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
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Cargnin S, Sances G, Shin JI, Tassorelli C, Terrazzino S. Gene polymorphism association studies in cluster headache: A field synopsis and systematic meta-analyses. Headache 2021; 61:1060-1076. [PMID: 34309832 DOI: 10.1111/head.14168] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/13/2021] [Accepted: 04/29/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND A plethora of studies have attempted to identify genetic determinants of disease susceptibility and treatment response of patients with cluster headache (CH), but results are often conflicting, and no comprehensive overview with a quantitative summary of the evidence in this field is available. METHODS A systematic search of relevant publications was performed without any language restrictions on PubMed, Web of Knowledge, Cochrane Library, and OpenGrey, up to December 2020. A standardized data extraction form was used to collect relevant data from each included study. Meta-analyses were conducted for gene polymorphisms investigated in at least two studies and the Bayesian false discovery probability (BFDP) test was applied to the pooled odds ratios (ORs) to assess the credibility of the observed associations. RESULTS Among the 27 articles identified by the systematic review, 17 studies evaluating 12 single nucleotide polymorphisms (SNPs) were included in the quantitative data analysis. The pooled results showed no significant association with CH risk of 10 SNPs, including five SNPs of HCRTR2 (rs2653349, rs2653342, rs3122156, rs10498801, and rs3800539), two SNPs of ADH4 (rs1800759 and rs1126671), CLOCK rs1801260, and two SNPs (rs1006417 and ADCYAP1R1 rs12668955) previously identified by a genome-wide association study (GWAS). Conversely, the pooled results revealed the association of the HCRTR2 rs9357855 A allele with a higher risk of CH (A vs. G, OR: 1.33, 95% CI: 1.04-1.72, p = 0.026), and of GNB3 rs5443 with a higher response rate of patients with CH to triptan drugs (CT+TT vs. CC, OR: 1.96, 95% CI: 1.04-3.72, p = 0.038). However, assuming a prior probability of 0.001, the respective BFDP values being higher than 0.8 (BFDPrs9357855 = 0.998; BFDPrs5443 = 0.998) revealed lack of noteworthy results. CONCLUSIONS Well-designed GWASs and large replication studies are still needed to identify reliable genetic variants of disease susceptibility and treatment response of patients with CH.
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Affiliation(s)
- Sarah Cargnin
- Department of Pharmaceutical Sciences and Interdepartmental Research Center of Pharmacogenetics and Pharmacogenomics (CRIFF), University of Piemonte Orientale "A. Avogadro", Novara, Italy
| | - Grazia Sances
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Cristina Tassorelli
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Salvatore Terrazzino
- Department of Pharmaceutical Sciences and Interdepartmental Research Center of Pharmacogenetics and Pharmacogenomics (CRIFF), University of Piemonte Orientale "A. Avogadro", Novara, Italy
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Martinelli D, Castellazzi G, De Icco R, Bacila A, Allena M, Faggioli A, Sances G, Pichiecchio A, Borsook D, Gandini Wheeler-Kingshott CAM, Tassorelli C. Thalamocortical Connectivity in Experimentally-Induced Migraine Attacks: A Pilot Study. Brain Sci 2021; 11:165. [PMID: 33514029 PMCID: PMC7911420 DOI: 10.3390/brainsci11020165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 11/17/2022] Open
Abstract
In this study we used nitroglycerin (NTG)-induced migraine attacks as a translational human disease model. Static and dynamic functional connectivity (FC) analyses were applied to study the associated functional brain changes. A spontaneous migraine-like attack was induced in five episodic migraine (EM) patients using a NTG challenge. Four task-free functional magnetic resonance imaging (fMRI) scans were acquired over the study: baseline, prodromal, full-blown, and recovery. Seed-based correlation analysis (SCA) was applied to fMRI data to assess static FC changes between the thalamus and the rest of the brain. Wavelet coherence analysis (WCA) was applied to test time-varying phase-coherence changes between the thalamus and salience networks (SNs). SCA results showed significantly FC changes between the right thalamus and areas involved in the pain circuits (insula, pons, cerebellum) during the prodromal phase, reaching its maximal alteration during the full-blown phase. WCA showed instead a loss of synchronisation between thalami and SN, mainly occurring during the prodrome and full-blown phases. These findings further support the idea that a temporal change in thalamic function occurs over the experimentally induced phases of NTG-induced headache in migraine patients. Correlation of FC changes with true clinical phases in spontaneous migraine would validate the utility of this model.
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Affiliation(s)
- Daniele Martinelli
- Headache Science Center, IRCCS Mondino Foundation, 27100 Pavia, Italy; (R.D.I.); (M.A.); (G.S.); (C.T.)
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (A.P.); (C.A.M.G.W.-K.)
| | - Gloria Castellazzi
- NMR Research Unit Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, London WC1N3BG, UK;
- Department of Electrical Computer and Biomedical Engineering, University of Pavia, 27100 Pavia, Italy
- IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Roberto De Icco
- Headache Science Center, IRCCS Mondino Foundation, 27100 Pavia, Italy; (R.D.I.); (M.A.); (G.S.); (C.T.)
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (A.P.); (C.A.M.G.W.-K.)
| | - Ana Bacila
- Center of Advance Imaging and Radiomics, IRCCS Mondino Foundation, 27100 Pavia, Italy; (A.B.); (A.F.)
| | - Marta Allena
- Headache Science Center, IRCCS Mondino Foundation, 27100 Pavia, Italy; (R.D.I.); (M.A.); (G.S.); (C.T.)
| | - Arianna Faggioli
- Center of Advance Imaging and Radiomics, IRCCS Mondino Foundation, 27100 Pavia, Italy; (A.B.); (A.F.)
| | - Grazia Sances
- Headache Science Center, IRCCS Mondino Foundation, 27100 Pavia, Italy; (R.D.I.); (M.A.); (G.S.); (C.T.)
| | - Anna Pichiecchio
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (A.P.); (C.A.M.G.W.-K.)
- Center of Advance Imaging and Radiomics, IRCCS Mondino Foundation, 27100 Pavia, Italy; (A.B.); (A.F.)
| | - David Borsook
- Centre for Pain and The Brain Boston Children’s Hospital and Massachussetts General Hospital (MGH) Harvard Medical School, Boston, MA 02115, USA;
| | - Claudia A. M. Gandini Wheeler-Kingshott
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (A.P.); (C.A.M.G.W.-K.)
- NMR Research Unit Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, London WC1N3BG, UK;
| | - Cristina Tassorelli
- Headache Science Center, IRCCS Mondino Foundation, 27100 Pavia, Italy; (R.D.I.); (M.A.); (G.S.); (C.T.)
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (A.P.); (C.A.M.G.W.-K.)
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29
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Martinelli D, Arceri S, De Icco R, Allena M, Guaschino E, Ghiotto N, Castellazzi G, Cosentino G, Sances G, Tassorelli C. BoNT-A efficacy in high-frequency migraine: An open-label, single-arm, exploratory study applying the PREEMPT paradigm. Toxicon 2021. [DOI: 10.1016/j.toxicon.2020.11.438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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30
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De Icco R, Putortì A, De Paoli I, Ferrara E, Cremascoli R, Terzaghi M, Toscano G, Allena M, Martinelli D, Cosentino G, Grillo V, Colagiorgio P, Versino M, Manni R, Sances G, Sandrini G, Tassorelli C. Anodal transcranial direct current stimulation in chronic migraine and medication overuse headache: A pilot double-blind randomized sham-controlled trial. Clin Neurophysiol 2020; 132:126-136. [PMID: 33271482 DOI: 10.1016/j.clinph.2020.10.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/14/2020] [Accepted: 10/01/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Little evidence is available on the role of transcranial direct current stimulation (tDCS) in patients affected by chronic migraine (CM) and medication overuse headache (MOH). We aim to investigate the effects of tDCS in patients with CM and MOH as well as its role on brain activity. METHODS Twenty patients with CM and MOH were hospitalized for a 7-day detoxification treatment. Upon admission, patients were randomly assigned to anodal tDCS or sham stimulation delivered over the primary motor cortex contralateral to the prevalent migraine pain side every day for 5 days. Clinical data were recorded at baseline (T0), after 1 month (T2) and 6 months (T3). EEG recording was performed at T0, at the end of the tDCS/Sham treatment, and at T2. RESULTS At T2 and T3, we found a significant reduction in monthly migraine days (p = 0.001), which were more pronounced in the tDCS group when compared to the sham group (p = 0.016). At T2, we found a significant increase of alpha rhythm in occipital leads, which was significantly higher in tDCS group when compared to sham group. CONCLUSIONS tDCS showed adjuvant effects to detoxification in the management of patients with CM and MOH. The EEG recording showed a significant potentiation of alpha rhythm, which may represent a correlate of the underlying changes in cortico-thalamic connections. SIGNIFICANCE This study suggests a possible role for tDCS in the treatment of CM and MOH. The observed clinical improvement is coupled with a potentiation of EEG alpha rhythm.
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Affiliation(s)
- R De Icco
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | - A Putortì
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - I De Paoli
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - E Ferrara
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - R Cremascoli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
| | - M Terzaghi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
| | - G Toscano
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Stroke Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - M Allena
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - D Martinelli
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - G Cosentino
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - V Grillo
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - P Colagiorgio
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - M Versino
- Neurology and Stroke Unit, Circolo Hospital and Macchi Foundation, Varese, Italy; DMC Department, Insubria University, Varese, Italy
| | - R Manni
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
| | - G Sances
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - G Sandrini
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - C Tassorelli
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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31
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Delussi M, Gentile E, Coppola G, Prudenzano AMP, Rainero I, Sances G, Abagnale C, Caponnetto V, De Cesaris F, Frattale I, Guaschino E, Marcinnò A, Ornello R, Pistoia F, Putortì A, Roca ME, Roveta F, Lupi C, Trojano M, Pierelli F, Geppetti P, Sacco S, de Tommaso M. Investigating the Effects of COVID-19 Quarantine in Migraine: An Observational Cross-Sectional Study From the Italian National Headache Registry (RICe). Front Neurol 2020; 11:597881. [PMID: 33240213 PMCID: PMC7683429 DOI: 10.3389/fneur.2020.597881] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 10/05/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Previous studies during SARS and Ebola pandemics have shown that quarantine is associated with several negative psychological effects, such as post-traumatic stress symptoms, confusion, and anger. These conditions may affect the course of many diseases, including migraine. Although it is possible that the quarantine measures for the current COVID-19 pandemic affect migraine burden, no information is currently available on this issue. Aim: In this study, we aimed to: (1) explore the possible changes in migraine frequency, severity, and days with acute medication intake during quarantine period; (2) evaluate possible differences in migraine outcomes in consideration of lifestyle changes, emotions, pandemic diffusion, and COVID-19 infection. Methods: We interviewed patients who were included in the observational Italian Headache Registry (Registro Italiano Cefalee, RICE), retrospectively collecting information on main headache features, lifestyle factors, emotions, individual infection status, and perception of COVID-19 for 2 months before (pre-quarantine) and after the beginning of the quarantine (quarantine). Inclusion criteria were: age > 18, diagnosis of migraine without aura, migraine with aura and chronic migraine, last in-person visit more than 3 months preceding the beginning of quarantine. Results: A total of 433 migraine subjects agreed to be interviewed. We found an overall reduction in headache frequency (9.42 ± 0.43 days with headache vs. 8.28 ± 0.41) and intensity (6.57 ± 0.19 vs. 6.59 ± 0.21) during the quarantine, compared to pre-quarantine. There was a correlation between improvement and number of days of stay-at-home. When results were stratified for geographic area, we found a tendency toward worsening of headache frequency in northern Italy. Disgust regarding viral infection corresponded to a minor improvement in migraine. Conclusions: Migraine patients showed a mild improvement of migraine features, probably attributable to resilient behavior toward pandemic distress. Disgust regarding the contagion whereas potentially favoring defensive behavior, could potentially worsen migraine. The spontaneous limitation of migraine burden during quarantine could favor patient follow-up via the use of telemedicine visits, reliable diaries, and frequent remote contacts.
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Affiliation(s)
- Marianna Delussi
- Applied Neurophysiology and Pain Unit, Scienze Mediche di Base, Neuroscienze e Organi di Senso Department, Bari Aldo Moro University, Bari, Italy
| | - Eleonora Gentile
- Applied Neurophysiology and Pain Unit, Scienze Mediche di Base, Neuroscienze e Organi di Senso Department, Bari Aldo Moro University, Bari, Italy
| | | | | | - Innocenzo Rainero
- Department of Neuroscience “Rita Levi Montalcini,” Headache Center, University of Torino, Turin, Italy
| | - Grazia Sances
- Headache Science Centre, Istituto di Ricerca a Carattere Scientifico Mondino Foundation, Pavia, Italy
| | | | - Valeria Caponnetto
- Headache Regional Referral Center, Azienda Sanitaria Locale 1 Abruzzo, L'Aquila University, L'Aquila, Italy
| | | | - Ilaria Frattale
- Headache Regional Referral Center, Azienda Sanitaria Locale 1 Abruzzo, L'Aquila University, L'Aquila, Italy
| | - Elena Guaschino
- Headache Science Centre, Istituto di Ricerca a Carattere Scientifico Mondino Foundation, Pavia, Italy
| | - Andrea Marcinnò
- Department of Neuroscience “Rita Levi Montalcini,” Headache Center, University of Torino, Turin, Italy
| | - Raffaele Ornello
- Headache Regional Referral Center, Azienda Sanitaria Locale 1 Abruzzo, L'Aquila University, L'Aquila, Italy
| | - Francesca Pistoia
- Headache Regional Referral Center, Azienda Sanitaria Locale 1 Abruzzo, L'Aquila University, L'Aquila, Italy
| | - Alessia Putortì
- Headache Science Centre, Istituto di Ricerca a Carattere Scientifico Mondino Foundation, Pavia, Italy
| | - Maria Elena Roca
- Headache Center, Amaducci Neurological Clinic, Policlinico General Hospital, Bari, Italy
| | - Fausto Roveta
- Department of Neuroscience “Rita Levi Montalcini,” Headache Center, University of Torino, Turin, Italy
| | | | - Maria Trojano
- Headache Center, Amaducci Neurological Clinic, Policlinico General Hospital, Bari, Italy
| | - Francesco Pierelli
- Sapienza University of Rome Polo Pontino, Latina, IRCCS - Neuromed, Pozzilli, Italy
| | | | - Simona Sacco
- Headache Regional Referral Center, Azienda Sanitaria Locale 1 Abruzzo, L'Aquila University, L'Aquila, Italy
| | - Marina de Tommaso
- Applied Neurophysiology and Pain Unit, Scienze Mediche di Base, Neuroscienze e Organi di Senso Department, Bari Aldo Moro University, Bari, Italy
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32
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Greco R, Demartini C, Zanaboni AM, Tumelero E, Icco RD, Sances G, Allena M, Tassorelli C. Peripheral changes of endocannabinoid system components in episodic and chronic migraine patients: A pilot study. Cephalalgia 2020; 41:185-196. [PMID: 32967434 DOI: 10.1177/0333102420949201] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Preclinical and clinical evidence suggests a role for the dysregulation of the endocannabinoid system in migraine pain, particularly in subjects with chronic migraine. METHODS The gene expression of endocannabinoid system components was assayed in peripheral blood mononuclear cells of 25 subjects with episodic migraine, 26 subjects with chronic migraine with medication overuse (CM-MO) and 24 age-matched healthy controls. We also evaluated the protein expression of cannabinoid receptors 1 and 2 as well as DNA methylation changes in genes involved in endocannabinoid system components. RESULTS Both episodic migraine and CM-MO subjects showed higher cannabinoid receptor 1 and cannabinoid receptor 2 gene and protein expression compared to controls. Fatty acid amide hydrolase gene expression, involved in anandamide degradation, was lower in migraine groups compared to healthy control subjects. N-arachidonoyl phosphatidylethanolamine phospholipase D gene expression was significantly higher in all migraineurs, as were monoacylglycerol lipase and diacylglycerol lipase gene expressions. The above markers significantly correlated with the number of migraine days and with the days of acute drug intake. CONCLUSION The findings point to transcriptional changes in endocannabinoid system components occurring in migraineurs. These changes were detected peripherally, which make them amenable for a wider adoption to further investigate their role and applicability in the clinical field.clinicaltrials.gov NTC04324710.
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Affiliation(s)
- Rosaria Greco
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Anna Maria Zanaboni
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Elena Tumelero
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Roberto De Icco
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Grazia Sances
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Marta Allena
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Cristina Tassorelli
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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Viana M, Sances G, Terrazzino S, Zecca C, Goadsby PJ, Tassorelli C. Predicting the response to a triptan in migraine using deep attack phenotyping: A feasibility study. Cephalalgia 2020; 41:197-202. [PMID: 32955929 PMCID: PMC7859670 DOI: 10.1177/0333102420959786] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Triptans, specific symptomatic medications for migraine, are not effective in
a proportion of patients, or in all attacks, hence the importance of
identifying predictors of response. Our aim was to investigate the
association between the efficacy of oral frovatriptan 2.5 mg and clinical
characteristics of migraine attacks. Methods We enrolled 29 consecutive patients affected by migraine without aura at the
Headache Center of “Mondino” Institute of Pavia. Each patient was given a
diary and asked to record prospectively the features of three consecutive
migraine attacks while using frovatriptan. A generalized estimating
equations approach was used to determine phenotypic features associated with
the pain free response at 2 hours. Results Participants provided complete data for 85 attacks. Thirty of these (34%)
patients reported being pain free 2 hours after taking frovatriptan 2.5 mg
intake. Unilateral pain, presence of phonophobia, presence of one or more
cranial autonomic symptoms and presence of one or more premonitory symptom
were each associated with being pain free at 2 hours. Conclusions The response to frovatriptan was associated with particular features of the
migraine attack, either before or during the pain phase of attacks. The data
support larger studies to explore detailed attack phenotyping, with
particular attention to early signs, to enable individualized treatment in
migraine.
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Affiliation(s)
- Michele Viana
- Headache Group, Department of Basic and Clinical Neurosciences, King's College London, London, UK.,Neurocenter of Southern Switzerland, Neurology clinic, Headache Center, Lugano, Switzerland.,Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Grazia Sances
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Salvatore Terrazzino
- Department of Pharmaceutical Sciences, University of Piemonte Orientale, Novara, Italy
| | - Chiara Zecca
- Neurocenter of Southern Switzerland, Neurology clinic, Headache Center, Lugano, Switzerland.,Faculty of biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Peter J Goadsby
- Headache Group, Department of Basic and Clinical Neurosciences, King's College London, London, UK.,NIHR-Wellcome Trust Clinical Research Facility, King's College Hospital, London, UK
| | - Cristina Tassorelli
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
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De Icco R, Fiamingo G, Greco R, Bottiroli S, Demartini C, Zanaboni AM, Allena M, Guaschino E, Martinelli D, Putortì A, Grillo V, Sances G, Tassorelli C. Neurophysiological and biomolecular effects of erenumab in chronic migraine: An open label study. Cephalalgia 2020; 40:1336-1345. [PMID: 32715736 DOI: 10.1177/0333102420942230] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Anti-calcitonin gene-related peptide antibodies proved effective in the preventive treatment of chronic migraine. In this open label study, we aim to assess the effects of erenumab administration on neurophysiological and biomolecular profiles in a representative cohort of chronic migraine patients. METHODS Forty patients with a history of chronic migraine for at least 12 months prior to enrollment, and previous failure of at least two different preventive therapies, were enrolled. After a 1-month observation period (T0), patients were treated with erenumab 70 mg s.c. (every 28 days) for a total of three administrations. At week 12, they returned for the end-of-protocol visit (T3). At T0 and T3, patients underwent recording of clinical features, recording of single stimulus (RTh), temporal summation (TST) thresholds of the nociceptive withdrawal reflex, venous blood sampling for miR-382-5p, and miR-34a-5p quantification. RESULTS At T3, 31 patients (77.5%) qualified as 30% Responders (reduction in monthly migraine days by at least 30% in the last 4-week observation period). RTh (T0: 15.4 ± 8.1 mA, T3: 19.7 ± 8.2 mA) as well as TST (T0: 11.2 ± 5.8 mA, T3: 13.4 ± 5.0 mA) significantly increased at T3 in 30% Responders (p = 0.001 for both), while we did not observe significant changes in NON-responder patients. MiR-382-5p and miR-34a-5p levels were significantly lower after erenumab administration in the overall study population (p = 0.015, and p = 0.001, respectively), without significant differences between 30% Responder and NON-responder groups. CONCLUSIONS Different migraine phenotypes, characterized by different treatment susceptibility, may exist as suggested by the divergent behavior between neurophysiological and biomolecular findings in 30% Responder vs. NON-responder patients.The study protocol was registered at clinicaltrials.gov (NCT04361721).
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Affiliation(s)
- Roberto De Icco
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Giuseppe Fiamingo
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Rosaria Greco
- Laboratory of Neurophysiology of Integrative Autonomic Systems, IRCCS Mondino Foundation Pavia, Italy
| | - Sara Bottiroli
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy.,Faculty of Law, Giustino Fortunato University, Benevento, Italy
| | - Chiara Demartini
- Laboratory of Neurophysiology of Integrative Autonomic Systems, IRCCS Mondino Foundation Pavia, Italy
| | - Anna Maria Zanaboni
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Laboratory of Neurophysiology of Integrative Autonomic Systems, IRCCS Mondino Foundation Pavia, Italy
| | - Marta Allena
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Elena Guaschino
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Daniele Martinelli
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Alessia Putortì
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | - Grazia Sances
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Cristina Tassorelli
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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Allena M, De Icco R, Sances G, Ahmad L, Putortì A, Pucci E, Greco R, Tassorelli C. Gender Differences in the Clinical Presentation of Cluster Headache: A Role for Sexual Hormones? Front Neurol 2019; 10:1220. [PMID: 31824403 PMCID: PMC6882735 DOI: 10.3389/fneur.2019.01220] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/01/2019] [Indexed: 12/26/2022] Open
Abstract
Introduction: Cluster Headache (CH) is a well-characterized primary headache that mostly affects men, although a progressive decrease in the male-to-female ratio has occurred over time. Available, but partly discordant, data on gender-related differences in CH suggest a more marked overlapping with migraine features in female subjects. The aim of this study is to carefully evaluate the female/male distribution of the typical migraine-associated symptoms and of other features of the disease in a large and well-characterized clinical population of CH subjects. Materials and Methods: We enrolled consecutive CH patients regularly followed at the tertiary Headache Science Center of the IRCCS Mondino Foundation of Pavia (Italy) who attended the Center for a CH bout between September 2016 and October 2018. The subjects were requested to fill in a semi-structured questionnaire focused on the presence of migraine-associated symptoms, familiarity for migraine and, for women, the relationship of CH onset with the reproductive events of their life. These data were compared and integrated with those recorded over time in our clinical database, including demographics and clinical characteristics. The primary outcome was the gender distribution of subjects who satisfied ICHD-III criterion D for migraine-associated symptoms. The secondary outcomes were represented by the gender distribution of individual migraine-associated symptoms and of other disease features included in the questionnaire and/or in the clinical database. Results: Data from 163 males (mean age 41.46 ± 10.37) and 87 females suffering of CH (mean age 42.24 ± 11.95) were analyzed. We did not find a different distribution between sexes as regards the primary outcome measure (F 73.6%, M 65.6%, p = 0.200). However, when we analyzed the occurrence of individual symptoms, nausea and osmophobia were reported more frequently by women (p = 0.048, p = 0.037, respectively). Ptosis and nasal congestion were predominant in females (p = 0.017 and p = 0.01, respectively), while enlarged temporal artery was more frequently reported by men (p = 0.001). Distribution of pain across the head tended to be larger in women, extending more frequently to the zygomatic (p = 0.050), parietal (p = 0.049), and frontal (p = 0.037) regions. Women had a longer mean attack duration (p = 0.004) than men. In CH women the onset of disease often corresponded with moments of important changes in the levels of sexual hormones (menarche, post-partum, menopause). Concomitant thyroid diseases and psychiatric disorders were observed more frequently in women than in men, while snoring and smoking habit was reported by a higher percentage of men than women. Conclusion: We confirmed the presence of distinct gender-related differences in CH and added some novel information that lends credibility to the hypothesis of a closer phenotypical similarity between CH and migraine in the female sex. These observations are relevant for advancing our knowledge on CH pathophysiology, as well as for a more refined diagnostic framing and improved management of the disease.
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Affiliation(s)
- Marta Allena
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Roberto De Icco
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Grazia Sances
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Lara Ahmad
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Alessia Putortì
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Ennio Pucci
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Rosaria Greco
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Cristina Tassorelli
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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Viana M, Khaliq F, Zecca C, Figuerola MDL, Sances G, Di Piero V, Petolicchio B, Alessiani M, Geppetti P, Lupi C, Benemei S, Iannacchero R, Maggioni F, Jurno ME, Odobescu S, Chiriac E, Marfil A, Brighina F, Barrientos Uribe N, Pérez Lago C, Bordini C, Lucchese F, Maffey V, Nappi G, Sandrini G, Tassorelli C. Poor patient awareness and frequent misdiagnosis of migraine: findings from a large transcontinental cohort. Eur J Neurol 2019; 27:536-541. [PMID: 31574197 DOI: 10.1111/ene.14098] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 09/27/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Although migraine is the second most disabling condition worldwide, there is poor awareness of it. The objective was to assess the awareness of migraine and previous diagnostic and therapeutic consultations and treatments in a large international population of migraineurs. METHODS This was a multicentre study conducted in 12 headache centres in seven countries. Each centre recruited up to 100 patients referred for a first visit and diagnosed with migraine. Subjects were given a structured clinical questionnaire-based interview about the perceptions of the type of headache they suffered from, its cause, previous diagnoses, investigations and treatments. RESULTS In all, 1161 patients completed the study. Twenty-eight per cent of participants were aware that they suffered from migraine. Sixty-four per cent called their migraine 'headache'; less commonly they used terms such as 'cervical pain' (4%), tension headache (3%) and sinusitis (1%). Eight per cent of general practitioners and 35% of specialists (of whom 51% were neurologists and/or headache specialists) consulted for migraine formulated the correct diagnosis. Before participating in the study, 50% of patients had undergone X-ray, computed tomography and/or magnetic resonance imaging of the cervical spine and 76% underwent brain and/or cervical spine imaging for migraine. Twenty-eight per cent of patients had received symptomatic migraine-specific medications and 29% at least one migraine preventive medication. CONCLUSIONS Although migraine is a very common disease, poor awareness of it amongst patients and physicians is still an issue in several countries. This highlights the importance of the promotion of migraine awareness to reduce its burden and limit direct and indirect costs and the risk of exposure to useless investigations.
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Affiliation(s)
- M Viana
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy.,Headache Center, Neurocenter of Southern Switzerland, Regional Hospital Lugano, Lugano, Switzerland.,Headache Group, Department of Basic and Clinical Neurosciences, King's College London, London, UK
| | - F Khaliq
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy.,Scunthorpe General Hospital, North Lincolnshire, UK
| | - C Zecca
- Headache Center, Neurocenter of Southern Switzerland, Regional Hospital Lugano, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - M D L Figuerola
- Hospital de Clínicas José San Martín, Buenos Aires, Argentina.,Hospital Alemán, Buenos Aires, Argentina
| | - G Sances
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - V Di Piero
- Sapienza University of Rome, Rome, Italy
| | | | | | - P Geppetti
- Headache Center, Careggi University Hospital, University of Florence, Florence, Italy
| | - C Lupi
- Headache Center, Careggi University Hospital, University of Florence, Florence, Italy
| | - S Benemei
- Headache Center, Careggi University Hospital, University of Florence, Florence, Italy
| | | | | | - M E Jurno
- FAME/FUNJOB and FHEMIG, Barbacena, Brazil
| | - S Odobescu
- National Headache Center, Institute of Neurology and Neurosurgery of Chisinau City, Chisinau, Moldova
| | - E Chiriac
- National Headache Center, Institute of Neurology and Neurosurgery of Chisinau City, Chisinau, Moldova
| | - A Marfil
- Hospital Universitario, Monterrey, Mexico
| | - F Brighina
- Headache Center, Department BIONEC, University of Palermo, Palermo, Italy
| | | | | | - C Bordini
- Clínica Neurológica Batatais, Batatais, Brazil
| | - F Lucchese
- Sapienza University of Rome, Rome, Italy
| | - V Maffey
- Sapienza University of Rome, Rome, Italy
| | - G Nappi
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - G Sandrini
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - C Tassorelli
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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37
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Viana M, De Icco R, Allena M, Sances G, Højland JR, Katsarava Z, Lainez MJA, Fadic R, Goicochea MT, Nappi G, Tassorelli C, Sandrini G, Guaschino E, Ghiotto N, Munksgaard SB, Rapsch M, Lopez B, Cerquetti D, Shand B, Osa M, Stoppini A. Clinical Subtypes of Medication Overuse Headache – Findings From a Large Cohort. Headache 2019; 59:1481-1491. [DOI: 10.1111/head.13641] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Michele Viana
- Headache Science Center IRCCS Mondino Foundation Pavia Italy
- Neurocenter of Southern Switzerland (NSI), Headache Center Regional Hospital Lugano Lugano Switzerland
- Headache Group, Department of Basic and Clinical Neurosciences King's College London London UK
| | - Roberto De Icco
- Headache Science Center IRCCS Mondino Foundation Pavia Italy
- Department of Brain and Behavioral Sciences University of Pavia Pavia Italy
| | - Marta Allena
- Headache Science Center IRCCS Mondino Foundation Pavia Italy
| | - Grazia Sances
- Headache Science Center IRCCS Mondino Foundation Pavia Italy
| | | | - Zaza Katsarava
- Department of Neurology University of Duisburg‐Essen Essen Germany
- Department of Neurology Evangelical Hospital Unna Unna Germany
- EVEX Medical Corporation Tbilisi GA USA
- Sechenov University Moscow Moscow Russian Federation
| | - Miguel J. A. Lainez
- Foundation of the Valencian Community University Clinical Hospital Valencia Spain
| | - Ricardo Fadic
- Department of Neurology Pontificia Universidad Católica de Chile Santiago Chile
| | | | - Giuseppe Nappi
- Headache Science Center IRCCS Mondino Foundation Pavia Italy
| | - Cristina Tassorelli
- Headache Science Center IRCCS Mondino Foundation Pavia Italy
- Department of Brain and Behavioral Sciences University of Pavia Pavia Italy
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De Icco R, Bitetto V, Martinelli D, Allena M, Guaschino E, Bottiroli S, Liebler E, Tassorelli C, Sances G. Noninvasive peripheral vagal nerve stimulation prevents migraine aura: A case report. Cephalalgia Reports 2019. [DOI: 10.1177/2515816319855607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
We describe a patient affected by migraine with visual and somatosensory aura, whose symptoms were consistently attenuated by noninvasive peripheral vagal nerve stimulation (nVNS) in multiple prospectively recorded attacks. When compared with the current standard of care, nVNS significantly reduced the duration of visual aura in all the attacks ( n = 5) and prevented the somatosensory aura in three of the five attacks. The overall duration of nVNS-treated auras was 19.0 ± 4.2 min, significantly shorter than the duration of aura in attacks treated with standard of care (103.8 ± 10.3 min). This single-case study requires confirmation in a larger sample size, but we believe that this first report is suggestive of likely efficacy given the relatively high number of treated attacks and the consistent effect of nVNS.
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Affiliation(s)
- Roberto De Icco
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Vito Bitetto
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Daniele Martinelli
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Marta Allena
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Elena Guaschino
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Sara Bottiroli
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
- Faculty of Law, Giustino Fortunato University, Benevento, Italy
| | | | - Cristina Tassorelli
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Grazia Sances
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
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39
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Demartini C, Greco R, Zanaboni AM, Sances G, De Icco R, Borsook D, Tassorelli C. Nitroglycerin as a comparative experimental model of migraine pain: From animal to human and back. Prog Neurobiol 2019; 177:15-32. [DOI: 10.1016/j.pneurobio.2019.02.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 01/19/2019] [Accepted: 02/10/2019] [Indexed: 12/13/2022]
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Mainardi F, Maggioni F, Volta GD, Trucco M, Sances G, Savi L, Zanchin G. Prevalence of headache attributed to aeroplane travel in headache outpatient populations: An Italian multicentric survey. Cephalalgia 2019; 39:1219-1225. [DOI: 10.1177/0333102419843676] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background To assess the prevalence of headache attributed to aeroplane travel (AH) in patients referred to Italian Headache Centres. Material and method 869 consecutive patients visiting six Italian headache centres during a 6 month-period (October 2013 to March 2014) were enrolled in the survey. Among them, 136 (15.6%) had never flown and therefore were excluded from the study. The remaining 733 patients (f = 586, m = 147; age 39.1 ± 17.3) were asked about the occurrence of headache attacks during flight; those who answered the question positively filled in a detailed questionnaire that allowed the features of the attacks to be defined. Results Headache attacks during the flight was reported by 34/733 subjects; four presented attacks fulfilling ICHD-3 beta (1) criteria for migraine without aura and therefore were not further considered. The features of the remaining 30 (4.0%; m = 18, f = 12, age 36.4 ± 7.3) completely fulfilled the ICHD-3 beta criteria for AH. In more detail, the pain was unilateral (fronto-orbital: n = 23; fronto-parietal: n = 7; without side-shift: n = 25, with side-shift: n = 5), lasting up to 30 min in 29 subjects. All the patients reported the pain as very severe or unbearable and landing as the phase of travel in which the attack appeared. In four cases, a postictal, milder, dull headache could last up to 24 hours. Accompanying symptoms were present in eight cases (restlessness: n = 5; conjunctival injection and tearing: n = 2; restlessness + ipsilateral conjunctival injection and tearing: n = 1). The fear of experiencing further attacks negatively affected the propensity for future flights in 90.0% of subjects (n = 27). In all the patients, AH onset did not coincide with the first flight experience. Concomitant migraine without aura was diagnosed in 24, tension-type headache in four, migraine without aura + tension-type headache in two cases; none suffered from cluster headache. Five subjects reported AH on each flight, 20 in > 50% of flights, five occasionally. Despite the severe intensity of the pain, only one third of this sample spontaneously reverted to a pharmacological treatment; the most useful strategy combines a decongestant nasal spray plus the intake of a simple analgesic 30 min before the estimated attack. Spontaneous manoeuvres were applied by 18 patients (Valsalva-like: n = 12; compression: n = 2; both manoeuvres: n = 4), more often without significant improvement. These data confirm our previous finding on the clinical features of AH. Conclusion AH was found in 4.0% of a multicentre, large sample of patients with flight experiences. Although limited to a sample of patients followed in six Italian headache centres, to the best of our knowledge these are the first epidemiological data on AH gathered by direct interview. If properly investigated, AH seems to be a not infrequent condition, which, when diagnosed, could probably be prevented in many cases.
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Affiliation(s)
- Federico Mainardi
- Headache Centre, Neurological Division, SS Giovanni e Paolo Hospital, Venice, Italy
| | - Ferdinando Maggioni
- Headache Centre, Department of Neurosciences, University of Padua, Padua, Italy
| | | | - Marco Trucco
- Headache Centre, Department of Neurology, Santa Corona Hospital, Pietra Ligure, Italy
| | - Grazia Sances
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Lidia Savi
- Headache Centre, University of Turin, Turin, Italy
| | - Giorgio Zanchin
- Headache Centre, Department of Neurosciences, University of Padua, Padua, Italy
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Bottiroli S, Galli F, Viana M, De Icco R, Bitetto V, Allena M, Pazzi S, Sances G, Tassorelli C. Negative Short-Term Outcome of Detoxification Therapy in Chronic Migraine With Medication Overuse Headache: Role for Early Life Traumatic Experiences and Recent Stressful Events. Front Neurol 2019; 10:173. [PMID: 30899242 PMCID: PMC6416203 DOI: 10.3389/fneur.2019.00173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/11/2019] [Indexed: 01/03/2023] Open
Abstract
Background: Early traumatic experiences and Stressful episodes appear to be associated to the development and perpetuation of chronic pain disorders and to dependence-related behaviors. Objective: The present study evaluated whether these factors can be predictors, together with psychiatric conditions, of the outcome of a detoxification treatment in patients suffering from chronic migraine and medication-overuse headache in a 2-month follow-up. Methods: Consecutive patients undergoing a detoxification program as therapy for treating chronic migraine and medication overuse headache at the Pavia Headache Center were analyzed. During this program, lasting about 1 week, all patients received the standard CARE in-patient withdrawal protocol, which consisted in discontinuing abruptly the overused drug(s) and receiving daily detoxification therapy. Data on childhood traumatic events and recent stressful ones were analyzed by means of the Childhood Trauma Questionnaire and Stressful life-events Questionnaire. Psychiatric conditions were evaluated using the Structured Clinical Interview for Diagnostic and Statistical Manual of mental disorders. Results: A total of 166 (80% females; mean age 44.7) patients completed the follow-up at 2 months after the detoxification program: of these 118 (71%) (78% females; mean age 44.7) stopped overuse and reverted to an episodic pattern of headache (Group A); 19 (11%) (89% females; mean age 41.3) kept overusing and maintained a chronic pattern of headache (Group B); and 29 (18%) (79% females; mean age 46.9) stopped overuse without any benefit on headache frequency (Group C). At the multivariate analyses, a higher number of early life emotional distress (Odds Ratio 11.096; p = 0.037) arose as a prognostic factor for the outcome in Group B, while major depression during life-time (Odds Ratio 3.703; p = 0.006) and higher number of severe stressful episodes in the past 10 years (Odds Ratio 1.679; p = 0.045) were prognostic factors for the outcome of Group C. Conclusions: Data suggest that early life traumas and stressful events have a negative impact on the outcome of the detoxification program in subjects overusing acute medication for headache. The history of emotional childhood traumas is associated to the failure to cease overuse, whereas recent very serious life events are associated to the persistence of headache chronicity.
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Affiliation(s)
- Sara Bottiroli
- Faculty of Law, Giustino Fortunato University, Benevento, Italy.,Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Federica Galli
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Michele Viana
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy.,Headache Group, Department of Basic and Clinical Neurosciences, King's College London, London, United Kingdom.,Headache Center, Institute of the Neurocenter of Southern Switzerland (NSI), Regional Hospital Lugano, Lugano, Switzerland
| | - Roberto De Icco
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Vito Bitetto
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Marta Allena
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Stefania Pazzi
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Grazia Sances
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Cristina Tassorelli
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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Sacco S, Benemei S, Cevoli S, Coppola G, Cortelli P, De Cesaris F, De Icco R, De Marco CM, Di Lorenzo C, Geppetti P, Manni A, Negro A, Ornello R, Pierangeli G, Pierelli F, Pellesi L, Pini LA, Pistoia F, Prudenzano MP, Russo A, Sances G, Taranta V, Tassorelli C, Tedeschi G, Trojano M, Martelletti P. Development and validation of the ID-EC - the ITALIAN version of the identify chronic migraine. J Headache Pain 2019; 20:15. [PMID: 30760199 PMCID: PMC6734365 DOI: 10.1186/s10194-019-0966-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 01/24/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Case-finding tools, such as the Identify Chronic Migraine (ID-CM) questionnaire, can improve detection of CM and alleviate its significant societal burden. We aimed to develop and validate the Italian version of the ID-CM (ID-EC) in paper and as a smart app version in a headache clinic-based setting. METHODS The study investigators translated and adapted to the Italian language the original ID-CM questionnaire (ID-EC) and further implemented it as a smart app. The ID-EC was tested in its paper and electronic version in consecutive patients referring to 9 Italian tertiary headache centers for their first in-person visit. The scoring algorithm of the ID-EC paper version was applied by the study investigators (case-finding) and by patients (self-diagnosis), while the smart app provided to patients automatically the diagnosis. Diagnostic accuracy of the ID-EC was assessed by matching the questionnaire results with the interview-based diagnoses performed by the headache specialists during the visit according to the criteria of International Classification of Headache Disorders, III edition, beta version. RESULTS We enrolled 531 patients in the test of the paper version of ID-EC and 427 in the validation study of the smart app. According to the clinical diagnosis 209 patients had CM in the paper version study and 202 had CM in the smart app study. 79.5% of patients returned valid paper questionnaires, while 100% of patients returned valid and complete smart app questionnaires. The paper questionnaire had a 81.5% sensitivity and a 81.1% specificity for case-finding and a 30.7% sensitivity and 90.7% specificity for self-diagnosis, while the smart app had a 64.9% sensitivity and 90.2% specificity. CONCLUSIONS Our data suggest that the ID-EC, developed and validated in tertiary headache centers, is a valid case-finding tool for CM, with sensitivity and specificity values above 80% in paper form, while the ID-EC smart app is more useful to exclude CM diagnosis in case of a negative result. Further studies are warranted to assess the diagnostic accuracy of the ID-EC in general practice and population-based settings.
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Affiliation(s)
- Simona Sacco
- Department of Applied Clinical Sciences and Biotechnology, Section of Neurology, University of L’Aquila, L’Aquila, Italy
| | - Silvia Benemei
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Florence, Italy
| | - Sabina Cevoli
- IRCCS Institute of Neurological Science of Bologna, Bologna, Italy
| | - Gianluca Coppola
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University Polo Pontino, Latina, Italy
| | - Pietro Cortelli
- IRCCS Institute of Neurological Science of Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Francesco De Cesaris
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Florence, Italy
| | - Roberto De Icco
- Headache Science Center, IRCCS C. Mondino Foundation, Pavia, Italy
| | - Cristiano Maria De Marco
- Department of Clinical and Molecular Medicine, Regional Referral Headache Centre, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Cherubino Di Lorenzo
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University Polo Pontino, Latina, Italy
| | - Pierangelo Geppetti
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Florence, Italy
| | - Alessia Manni
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Andrea Negro
- Department of Clinical and Molecular Medicine, Regional Referral Headache Centre, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Raffaele Ornello
- Department of Applied Clinical Sciences and Biotechnology, Section of Neurology, University of L’Aquila, L’Aquila, Italy
| | - Giulia Pierangeli
- IRCCS Institute of Neurological Science of Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | | | - Lanfranco Pellesi
- Headache and Drug Abuse Research Centre, Policlinico Hospital, University of Modena e Reggio Emilia, Modena, Italy
| | - Luigi Alberto Pini
- Headache and Drug Abuse Research Centre, Policlinico Hospital, University of Modena e Reggio Emilia, Modena, Italy
| | - Francesca Pistoia
- Department of Applied Clinical Sciences and Biotechnology, Section of Neurology, University of L’Aquila, L’Aquila, Italy
| | - Maria Pia Prudenzano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Antonio Russo
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - Grazia Sances
- Headache Science Center, IRCCS C. Mondino Foundation, Pavia, Italy
| | - Valentina Taranta
- Department of Applied Clinical Sciences and Biotechnology, Section of Neurology, University of L’Aquila, L’Aquila, Italy
| | - Cristina Tassorelli
- Headache Science Center, IRCCS C. Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Gioacchino Tedeschi
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Regional Referral Headache Centre, Sant’Andrea Hospital, Sapienza University, Rome, Italy
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Cargnin S, Viana M, Sances G, Cantello R, Tassorelli C, Terrazzino S. Using a Genetic Risk Score Approach to Predict Headache Response to Triptans in Migraine Without Aura. J Clin Pharmacol 2018; 59:288-294. [PMID: 30256423 DOI: 10.1002/jcph.1320] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/04/2018] [Indexed: 12/16/2022]
Abstract
A large meta-analysis of genome-wide association studies has recently identified a number of risk loci for migraine without aura (MwoA). In this study, we tested the hypothesis that a genetic risk score based on single-nucleotide polymorphisms (SNPs), previously reported to be associated with MwoA at genome-wide significance, may influence headache response to triptans in patients with migraine without aura. Genotyping of rs9349379, rs2078371, rs6478241, rs11172113, rs1024905, and rs6724624 was conducted with a real-time PCR allelic discrimination assay in 172 MwoA patients, of whom 36.6% were inconsistent responders to triptans. Each genetic risk score model was constructed as an unweighted score, calculated by adding the number of risk alleles for MwoA across each SNP at selected loci. The association with headache response to triptans was evaluated by logistic regression analysis adjusted for triptan, and the P values were corrected for the false discovery rate. The genetic risk score including susceptibility risk alleles at TRPM8 rs6724624 and FGF6 rs1024905 was found to be inversely associated with risk of inconsistent response to triptans (OR, 0.62; 95%CI, 0.43-0.89; false discovery rate q value, 0.045). In addition, adding this genetic risk score to the triptan-adjusted logistic regression model significantly improved (P = .037) the discrimination accuracy, from 0.57 (95%CI, 0.50-0.65) to 0.64 (95%CI, 0.57-0.72). A modest but significant effect on risk of inconsistent response to triptans was identified for a genetic risk score model composed of 2 known risk alleles for MwoA, suggesting its potential utility in predicting headache response to triptan therapy.
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Affiliation(s)
- Sarah Cargnin
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Novara, Italy
| | - Michele Viana
- Headache Science Centre, National Neurological Institute C. Mondino, Pavia, Italy
| | - Grazia Sances
- Headache Science Centre, National Neurological Institute C. Mondino, Pavia, Italy
| | - Roberto Cantello
- Department of Neurology, Oriental Piedmont University, Maggiore della Carità Hospital, Novara, Italy
| | - Cristina Tassorelli
- Headache Science Centre, National Neurological Institute C. Mondino, Pavia, Italy.,Department of Brain and Behaviour, University of Pavia, Pavia, Italy
| | - Salvatore Terrazzino
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Novara, Italy
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Viana M, Sances G, Linde M, Nappi G, Khaliq F, Goadsby PJ, Tassorelli C. Prolonged migraine aura: new insights from a prospective diary-aided study. J Headache Pain 2018; 19:77. [PMID: 30171359 PMCID: PMC6119171 DOI: 10.1186/s10194-018-0910-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is limited literature on prolonged aura (PA - defined as an aura including at least one symptom for > 1 h and < 7d), and there are no prospective studies. The aim of this study is to characterize prospectively the phenotype and prevalence of PA. FINDINGS Two hundred and twenty-four patients suffering from migraine with aura were recruited from the Headache Centers of Pavia and Trondheim. Patients prospectively described, on an ad hoc diary, each aura symptom (AS), the duration of AS and headache, and headache features. Seventy-two patients recorded three consecutive auras in their diaries. 19 (26.4%) of patients suffered at least one PA. Out of 216 recorded auras, 38 (17.6%) were PAs. We compared PAs with non-PAs with respect to 20 features; PAs were characterized by a higher number of non-visual symptoms (non-VS) (p < 0.001). No other differences were found. We obtained similar results when we compared auras with at least one symptom with a duration of > 2 h (n = 23) or > 4 h (n = 14) with the the others (n = 193 and n = 202 respectively). CONCLUSION PAs are quite common. They do not differ from the other auras (even when their duration extends to 2 and/or 4 h) with the exception of a higher number of non-VS.
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Affiliation(s)
- Michele Viana
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Grazia Sances
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Mattias Linde
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian Advisory Unit on Headaches, St. Olavs University Hospital, Trondheim, Norway
| | - Giuseppe Nappi
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Farihah Khaliq
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Peter J. Goadsby
- Headache Group - NIHR-Wellcome Trust King’s Clinical Research Facility, King’s College, London, UK
| | - Cristina Tassorelli
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy
- Dept of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
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Bottiroli S, Allena M, Sances G, De Icco R, Avenali M, Fadic R, Katsarava Z, Lainez MJA, Goicochea MT, Bendtsen L, Jensen RH, Nappi G, Tassorelli C. Psychological, clinical, and therapeutic predictors of the outcome of detoxification in a large clinical population of medication-overuse headache: A six-month follow-up of the COMOESTAS Project. Cephalalgia 2018; 39:135-147. [DOI: 10.1177/0333102418783317] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Aim To identify factors that may be predictors of the outcome of a detoxification treatment in medication-overuse headache. Methods Consecutive patients entering a detoxification program in six centres in Europe and Latin America were evaluated and followed up for 6 months. We evaluated anxious and depressive symptomatology (though patients with severe psychiatric comorbidity were excluded), quality of life, headache-related disability, headache characteristics, and prophylaxis upon discharge. Results Of the 492 patients who completed the six-month follow up, 407 ceased overuse following the detoxification (non overusers), another 23 ceased overuse following detoxification but relapsed during the follow-up. In the 407 non-overusers, headache acquired an episodic pattern in 287 subjects (responders). At the multivariate analyses, lower depression scores (odds ratio = 0.891; p = 0.001) predicted ceasing overuse. The primary headache diagnosis – migraine with respect to tension-type headache (odds ratio = 0.224; p = 0.001) or migraine plus tension-type headache (odds ratio = 0.467; p = 0.002) – and the preventive treatment with flunarizine (compared to no such treatment) (odds ratio = 0.891; p = 0.001) predicted being a responder. A longer duration of chronic headache (odds ratio = 1.053; p = 0.032) predicted relapse into overuse. Quality of life and disability were not associated with any of the outcomes. Conclusions Though exploratory in nature, these findings point to specific factors that are associated with a positive outcome of medication-overuse headache management, while identifying others that may be associated with a negative outcome. Evaluation of the presence/absence of these factors may help to optimize the management of this challenging groups of chronic headache sufferers.
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Affiliation(s)
- Sara Bottiroli
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Marta Allena
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Grazia Sances
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Roberto De Icco
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Micol Avenali
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Ricardo Fadic
- Department of Neurology, Pontificia Catolica University of Chile, Santiago, Chile
| | | | - Miguel JA Lainez
- Foundation of the Valencian Community, University Clinical Hospital, Spain
| | - Maria Teresa Goicochea
- Integral Pain Centre, Fundación para la Lucha contra las Enfermedades Neurológicas Infantiles (FLENI), Buenos Aires, Argentina
| | - Lars Bendtsen
- Danish Headache Centre, Department of Neurology, Glostrup Hospital, Glostrup, Denmark
| | - Rigmor Højland Jensen
- Danish Headache Centre, Department of Neurology, Glostrup Hospital, Glostrup, Denmark
| | - Giuseppe Nappi
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Cristina Tassorelli
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Italy
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Bottiroli S, Galli F, Viana M, Sances G, Tassorelli C. Traumatic Experiences, Stressful Events, and Alexithymia in Chronic Migraine With Medication Overuse. Front Psychol 2018; 9:704. [PMID: 29867669 PMCID: PMC5960722 DOI: 10.3389/fpsyg.2018.00704] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/23/2018] [Indexed: 01/08/2023] Open
Abstract
Background: Many factors are involved in the prognosis and outcome of Chronic Migraine and Medication Overuse Headache (CM+MOH), and their understanding is a topic of interest. It is well known that CM+MOH patients experience increased psychiatric comorbidity, such as anxiety, depression, or personality disorders. Other psychological factors still need to be explored. The present study is aimed to evaluate whether early life traumatic experiences, stressful life events, and alexithymia can be associated with CM+MOH. Methods: Three hundred and thirty-one individuals were recruited for this study. They belonged to one of the two following groups: CM+MOH (N = 179; 79% females, Age: 45.2 ± 9.8) and episodic migraine (EM) (N = 152; 81% females; Age: 40.7 ± 11.0). Diagnosis was operationally defined according to the International Classification of Headache Disorders 3rd edition (ICHD-IIIβ). Data on early life (physical and emotional) traumatic experiences, recent stressful events and alexithymia were collected by means of the Childhood Trauma Questionnaire, the Stressful life-events Questionnaire, and the Toronto Alexithymia Scale (TAS-20), respectively. Results: Data showed a higher prevalence of emotional (χ2 = 6.99; d.f. = 1; p = 0.006) and physical (χ2 = 6.18; d.f. = 1; p = 0.009) childhood trauma and of current stressful events of important impact (χ2 = 4.42; d.f. = 1; p = 0.025) in CM+MOH patients than in EM ones. CM+MOH patients were characterized by higher difficulties in a specific alexithymic trait (Factor 1 subscale of TAS-20) [F(1, 326) = 6.76, p = 0.01, ηp2 = 0.02] when compared to the EM group. The role of these factors was confirmed in a multivariate analysis, which showed an association of CM+MOH with emotional (OR 2.655; 95% CI 1.153–6.115, p = 0.022) or physical trauma (OR 2.763; 95% CI 1.322–5.771, p = 0.007), and a high score at the Factor 1 (OR 1.039; 95% CI 1.002–1.078, p = 0.040). Conclusions: Our findings demonstrated a clear relationship between CM+MOH and life traumas, stressful events, and alexithymia. These observations have a relevant role in multiple fields of related to chronic headache: from the management to the nosographic framing.
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Affiliation(s)
- Sara Bottiroli
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Federica Galli
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Michele Viana
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Grazia Sances
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Cristina Tassorelli
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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Viana M, Bottiroli S, Sances G, Ghiotto N, Allena M, Guaschino E, Nappi G, Tassorelli C. Factors associated to chronic migraine with medication overuse: A cross-sectional study. Cephalalgia 2018; 38:2045-2057. [PMID: 29635935 DOI: 10.1177/0333102418761047] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIM Factors implicated in the evolution of episodic migraine into chronic migraine are largely elusive. Medication overuse is considered to be one of the main determinants, but other possible clinical and psychological factors can play a role. The aim of this study is to identify factors that are associated with chronic migraine with medication overuse. METHOD We enrolled consecutive migraine patients, subdividing them in two groups: Subjects with a long history of episodic migraine and subjects with chronic migraine and medication overuse. We then compared their clinical and psychological variables in a cross-sectional study. RESULTS Three hundred and eighteen patients were enrolled, of which 156 were episodic migraine and 162 were chronic migraine and medication overuse patients. The mean age was 42.1 ± 10.3, 80.8% were female. The duration of migraine was 24.6 years in episodic migraine and 24.0 years in chronic migraine and medication overuse ( p = 0.57). After the multivariate analysis, the factors associated to chronic migraine and medication overuse were: Marital status (married vs. unmarried, OR 3.65, 95% CI 1.63-8.19, p = 0.002; separated/divorced/widowed vs. unmarried, OR 4.19, 95% CI 1.13-15.47, p = 0.031), physical activity (OR 0.42, 95% CI 0.19-0.91, p = 0.029), age at onset of migraine (OR 0.94, 95% CI 0.89-0.98, p = 0.016), use of at least one migraine preventive medication (OR 2.36, 95% CI 1.18-4.71, p = 0.014), history of depression (OR 2.91, 95% CI 1.25-6.73, p = 0.012), insomnia associated with the use of hypnotics (OR 5.59, 95% CI 1.65-18.93, p = 0.006), traumatic head injuries (OR 3.54, 95% CI 1.57-7.99, p = 0.002), snoring (OR 2.24, 95% CI 1.05-4.79, p = 0.036), previous and/or actual use of combined oral contraceptives (OR 3.38, 95% CI 1.10-10.3, p = 0.031) and higher scores in the Childhood Trauma questionnaire (OR 1.48, 95% CI 1.09-2.02, p = 0.012). CONCLUSION We considered several aspects that may be involved in the development of chronic migraine and medication overuse. A multivariate analysis identified 10 factors belonging to five different areas, to suggest that chronic migraine and medication overuse onset is likely influenced by a complex mixture of factors. This information is useful when planning strategies to prevent and manage chronic migraine and medication overuse.
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Affiliation(s)
- Michele Viana
- 1 Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Sara Bottiroli
- 1 Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Grazia Sances
- 1 Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Natascia Ghiotto
- 1 Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Marta Allena
- 1 Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Elena Guaschino
- 1 Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Giuseppe Nappi
- 1 Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Cristina Tassorelli
- 1 Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy.,2 Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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Tassorelli C, Sances G, Avenali M, De Icco R, Martinelli D, Bitetto V, Nappi G, Sandrini G. Botulinum toxin for chronic migraine: Clinical trials and technical aspects. Toxicon 2017; 147:111-115. [PMID: 28877509 DOI: 10.1016/j.toxicon.2017.08.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/25/2017] [Accepted: 08/30/2017] [Indexed: 01/03/2023]
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.
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Affiliation(s)
- Cristina Tassorelli
- Headache Science Center and Headache Unit, National Neurological Institute C. Mondino Foundation, Pavia, Italy; Dept of Brain and Behavioral Sciences, University of Pavia, Italy.
| | - Grazia Sances
- Headache Science Center and Headache Unit, National Neurological Institute C. Mondino Foundation, Pavia, Italy
| | - Micol Avenali
- Headache Science Center and Headache Unit, National Neurological Institute C. Mondino Foundation, Pavia, Italy; Dept of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Roberto De Icco
- Headache Science Center and Headache Unit, National Neurological Institute C. Mondino Foundation, Pavia, Italy; Dept of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Daniele Martinelli
- Headache Science Center and Headache Unit, National Neurological Institute C. Mondino Foundation, Pavia, Italy; Dept of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Vito Bitetto
- Headache Science Center and Headache Unit, National Neurological Institute C. Mondino Foundation, Pavia, Italy
| | - Giuseppe Nappi
- Headache Science Center and Headache Unit, National Neurological Institute C. Mondino Foundation, Pavia, Italy
| | - Giorgio Sandrini
- Headache Science Center and Headache Unit, National Neurological Institute C. Mondino Foundation, Pavia, Italy; Dept of Brain and Behavioral Sciences, University of Pavia, Italy
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Cargnin S, Viana M, Sances G, Tassorelli C, Terrazzino S. A systematic review and critical appraisal of gene polymorphism association studies in medication-overuse headache. Cephalalgia 2017; 38:1361-1373. [DOI: 10.1177/0333102417728244] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Purpose of review Medication-overuse headache is a secondary chronic headache disorder, evolving from an episodic primary headache type, caused by the frequent and excessive use of headache symptomatic drugs. While gene polymorphisms have been deeply investigated as susceptibility factors for migraine, little attention has been paid to medication-overuse headache genetics. In the present study we conducted a systematic review to identify, appraise and summarize the current findings of gene polymorphism association studies in medication-overuse headache. Methods A comprehensive literature search was conducted on PubMed and Web of Knowledge databases of primary studies that met the diagnostic criteria for medication-overuse headache according to the temporally-relevant Classification of Headache Disorder of the International Headache Society. Results A total of 17 candidate gene association studies focusing on medication-overuse headache were finally included in the qualitative review. Among these, 12 studies investigated the role of common gene polymorphisms as risk factors for medication-overuse headache susceptibility, six studies focused on the relationship with clinical features of medication-overuse headache patients, and four studies evaluated their role as determinants of clinical outcomes in medication-overuse headache patients. Conclusion Results of single studies show a potential role of polymorphic variants of the dopaminergic gene system or of other genes related to drug-dependence pathways as susceptibility factors for disease or as determinants of monthly drug consumption, respectively. In this systematic review, we summarize the findings of gene polymorphism association studies in medication-overuse headache and discuss the methodological issues that need to be addressed in the design of future studies.
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Affiliation(s)
- Sarah Cargnin
- Department of Pharmaceutical Sciences and Interdepartmental Research Center of Pharmacogenetics and Pharmacogenomics (CRIFF), University of Piemonte Orientale “A. Avogadro”, Novara, Italy
| | - Michele Viana
- Headache Science Center, C. Mondino National Neurological Institute, Pavia, Italy
| | - Grazia Sances
- Headache Science Center, C. Mondino National Neurological Institute, Pavia, Italy
| | - Cristina Tassorelli
- Headache Science Center, C. Mondino National Neurological Institute, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Salvatore Terrazzino
- Department of Pharmaceutical Sciences and Interdepartmental Research Center of Pharmacogenetics and Pharmacogenomics (CRIFF), University of Piemonte Orientale “A. Avogadro”, Novara, Italy
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Terrazzino S, Cargnin S, Viana M, Sances G, Tassorelli C. Brain-Derived Neurotrophic Factor Val66Met Gene Polymorphism Impacts on Migraine Susceptibility: A Meta-analysis of Case-Control Studies. Front Neurol 2017; 8:159. [PMID: 28507530 PMCID: PMC5410590 DOI: 10.3389/fneur.2017.00159] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 04/04/2017] [Indexed: 01/03/2023] Open
Abstract
Inconclusive results have been reported in studies investigating the association between the brain-derived neurotrophic factor (BDNF) rs6265 polymorphism and migraine. In the present study, we conducted a systematic review and meta-analysis on the published data in order to quantitatively estimate the relationship between rs6265 and migraine susceptibility. A comprehensive search was performed through PubMed, Web of Knowledge, and Cochrane databases up to October 2016. The pooled odds ratio (OR) with the corresponding 95% confidence interval (CI) was calculated to estimate the strength of the association with rs6265 under an additive, dominant, or recessive model of inheritance. A total of five studies including 1,442 cases and 1,880 controls were identified for the meta-analysis. The pooled data showed an increased risk of migraine for the allelic (OR: 1.17, 95% CI: 1.03–1.34, p = 0.014) or the dominant model of rs6265 (OR: 1.22, 95% CI: 1.05–1.41, p = 0.011). Statistical significance of rs6265 was lost when one single study was excluded from the analysis (dominant OR: 1.17, 95% CI: 1.00–1.38, p = 0.054; allelic OR: 1.14, 95% CI: 0.99–1.31, p = 0.067), suggesting lack of robustness of pooled estimates. When stratified by migraine type, a similar trend of association was detected with both MA and MO, but a statistically significant association of rs6265 was reached only with the MA subtype in the dominant model (OR: 1.22, 95% CI: 1.00–1.47, p = 0.047). The present meta-analysis supports that BDNF rs6265 may act as a genetic susceptibility factor for migraine. Nevertheless, large-scale studies are required to confirm our findings and to assess potential modifiers of the relationship between rs6265 and migraine.
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Affiliation(s)
- Salvatore Terrazzino
- Department of Pharmaceutical Sciences and Interdepartmental Research Center of Pharmacogenetics and Pharmacogenomics (CRIFF), University of Piemonte Orientale "A. Avogadro", Novara, Italy
| | - Sarah Cargnin
- Department of Pharmaceutical Sciences and Interdepartmental Research Center of Pharmacogenetics and Pharmacogenomics (CRIFF), University of Piemonte Orientale "A. Avogadro", Novara, Italy
| | - Michele Viana
- Headache Science Center, C. Mondino National Neurological Institute, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Grazia Sances
- Headache Science Center, C. Mondino National Neurological Institute, Pavia, Italy
| | - Cristina Tassorelli
- Headache Science Center, C. Mondino National Neurological Institute, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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