Underdiagnosis and undertreatment of migraine in Italy: a survey of patients attending for the first time 10 headache centres.

The aim of this study was to asses the clinical features, pattern of healthcare and drug utilization of migraine patients attending 10 Italian headache centres (HC). Migraine is underdiagnosed and undertreated everywhere throughout the world, despite its considerable burden. Migraine sufferers often deal with their problem alone using self-prescribing drugs, whereas triptans are used by a small proportion of patients. All patients attending for the first time 10 Italian HCs over a 3-month period were screened for migraine. Migraine patients underwent a structured direct interview about previous migraine diagnosis, comorbidity, headache treatments and their side-effects and healthcare utilization for migraine. Patient satisfaction with their usual therapy for the migraine attack was evaluated with the Migraine-Assessment of Current Therapy (ACT) questionnaire. The quality of life of migraine patients was assessed by mean of Short Form (SF)-12 and Migraine-Specific Quality of life (MSQ) version 2.1 questionnaires. Of the 2675 patients who attended HCs for the first time during the study period, 71% received a diagnosis of migraine and the first 953 subjects completed the study out of 1025 patients enrolled. Only 26.8% of migraine patients had a previous diagnosis of migraine; 62.4% of them visited their general practitioner (GP) in the last year, 38.2% saw a specialist for headache, 23% attended an Emergency Department and 4.5% were admitted to hospital for migraine; 82.8% of patients used non-specific drugs for migraine attacks, whereas 17.2% used triptans and only 4.8% used a preventive migraine medication. Triptans were used by 46.4% of patients with a previous diagnosis of migraine. About 80% of migraine patients took over-the-counter medications. The Migraine-ACT revealed that 60% of patients needed a change in their treatment of migraine attacks, 85% of whom took non-specific drugs. Both the MSQ version 2.1 and the SF-12 questionnaires indicated a poor quality of life of most patients. Migraine represents the prevalent headache diagnosis in Italian HCs. Migraine is still underdiagnosed in Italy and migraine patients receive a suboptimal medical approach in our country, despite the healthcare utilization of migraine subjects being noteworthy. A cooperative network involving GPs, neurologists and headache specialists is strongly desirable in order to improve long-term migraine management in Italy.

Efficacy of dosing and re-dosing of two oral fixed combinations of indomethacin, prochlorperazine and caffeine compared with oral sumatriptan in the acute treatment of multiple migraine attacks: a double-blind, double-dummy, randomised, parallel group, multicentre study.

AIMS AND METHODS: In this double-blind, double-dummy, randomised, parallel group, multicentre study, the efficacy of dosing and re-dosing of a fixed combination of indomethacin, prochlorperazine and caffeine (Indoprocaf) was compared with encapsulated sumatriptan in the acute treatment of two migraine attacks. Additionally, in the group taking Indoprocaf, two different oral formulations were tested: effervescent tablets and encapsulated coated tablets. RESULTS: Of 297 patients randomised (150 assigned to Indoprocaf and 147 to sumatriptan), 281 were included in the intention-to-treat efficacy analysis. The initial dosing of Indoprocaf and sumatriptan was similarly effective with pain-free rates higher than 30% (95% CI of odds-ratio: 0.57-1.28) and headache relief rates of about 60% (95% CI of odds-ratio: 0.82-1.84) with both the drugs. The efficacy of re-dosing of Indoprocaf as rescue medication was more effective than that of sumatriptan with pain-free values of 47% vs. 27% in the total attacks with a statistically significant difference in the first migraine attack in favour of Indoprocaf. The efficacy of re-dosing to treat a recurrence/relapse was very high without differences between the drugs (pain-free: 60% with Indoprocaf and 50% with sumatriptan in the total attacks). Indoprocaf and sumatriptan were well-tolerated. CONCLUSION: The study demonstrated that the efficacy of the initial dosing of Indoprocaf was not higher than that of sumatriptan, but that the strategy to use the lowest effective dose as soon as the headache occurred, followed by a second dose if the headache has not relieved or to treat a relapse, was very effective, especially with Indoprocaf.

N-state adiabatic-to-diabatic transformation angle: theory and application.

In this article is discussed a new diabatization procedure which is expected to be reliable and, also, relatively easy to implement. This procedure takes into account the two main ingredients related to diabatization: (1) The size N of the smallest (relevant) group of states that forms a Hilbert subspace (this fact enforces the dimension of the adiabatic-to-diabatic transformation matrix to be N). (2) The total energy E which determines the number of open states, p, within this group of N states. The main emphasis in this manuscript is on the case that N is arbitrary but p is equal to 2. The various derivations as well as the final results are accompanied by numerical examples extracted from three- to five-state ab initio calculations for the H + H2 system.

Elevated levels of synovial fluid antibodies reactive with the small proteoglycans biglycan and decorin in patients with rheumatoid arthritis or other joint diseases.

OBJECTIVES: To determine whether patients with rheumatoid arthritis (RA) express humoral immunity to the small proteoglycans biglycan and decorin and to compare the response to that of patients suffering from other joint diseases. METHODS: Serum and synovial fluid IgG and IgM antibody levels were determined by enzyme-linked immunosorbent assay. Antibodies to biglycan and decorin as well as to other known and extensively investigated cartilage matrix components such as type II collagen, aggrecan and fibronectin were investigated. Patients suffering from RA, osteoarthritis (OA), psoriatic arthritis and other seronegative spondylarthropathies were included in the study. Correlation between antibody levels and clinical/laboratory parameters was determined. RESULTS: Patients with RA expressed an increased humoral immunity to biglycan, while patients with seronegative spondylarthropathies displayed elevated decorin-specific synovial antibody levels compared with OA patients. CONCLUSION: These results indicate a significantly higher immunity to small proteoglycans in RA and seronegative spondylarthropathies than in OA suggesting a possible involvement in the pathogenesis of inflammatory rheumatic diseases.

A reduced functionality of Gi proteins as a possible cause of fibromyalgia.

OBJECTIVE: The etiopathogenesis of fibromyalgia (FM), a syndrome characterized by widespread pain and hyperalgesia, is still unknown. Since the involvement of Gi proteins in the modulation of pain perception has been widely established, the aim of the present study was to determine whether an altered functionality of the Gi proteins occurred in patients with FM. METHODS: Patients with FM and other painful diseases such as neuropathic pain, rheumatoid arthritis (RA), and osteoarthritis, used as reference painful pathologies, were included in the study. The functionality, evaluated as capability to inhibit forskolin-stimulated adenylyl cyclase activity, and the level of expression of Gi proteins were investigated in peripheral blood lymphocytes. RESULTS: Patients with FM showed a hypofunctionality of the Gi protein system. In contrast, unaltered Gi protein functionality was observed in patients with neuropathic pain, RA, and osteoarthritis. Patients with FM also showed basal cAMP levels higher than controls. The reduced activity of Gi proteins seems to be unrelated to a reduction of protein levels since only a slight reduction (about 20-30%) of the Gi3alpha subunit was observed. CONCLUSIONS: Gi protein hypofunctionality is the first biochemical alteration observed in FM that could be involved in the pathogenesis of this syndrome. In the complete absence of laboratory diagnostic tests, the determination of an increase in cAMP basal levels in lymphocytes, together with the assessment of a Gi protein hypofunctionality after adenylyl cyclase stimulation, may lead to the biochemical identification of patients with FM.

Hypofunctionality of Gi proteins as aetiopathogenic mechanism for migraine and cluster headache.

The involvement of Gi proteins in the modulation of pain perception has been widely established, and mutations in G-proteins have already been identified as the aetiopathological cause of human diseases. The aim of the present study was to determine whether a deficiency or a hypofunctionality of the Gi proteins occurred in primary headache. The functionality and the level of expression of Gi proteins were investigated in lymphocytes from migraine without aura, migraine with aura and cluster headache sufferers. A reduced capability to inhibit forskolin-stimulated adenylyl cyclase activity in headache patients was observed. Migraine patients also showed basal adenosine cAMP levels about four times higher than controls. The reduced activity of Gi proteins seems not to be related to a reduction of protein levels since no significant reduction of the Gialpha subunits was observed. These results indicate Gi protein hypofunctionality as an aetiopathogenic mechanism in migraine and cluster headache.

Profil nutritionnel des enfants de 6 a 59 mois dans la sous-prefecture de Danane

Nous rapportons dans ce document les resultats d'une etude transversale descriptive ayant porte sur 337 enfants dans la zone d'accueil de reference des refugies liberiens en Cote d'Ivoire. L'objectif de ce travail etait d'apprecier l'impact de la presence des refugies sur l'etat nutritionnel de la population infantile de Danane. Analyses faites; il en ressort les conclusions suivantes: parmi les facteurs communement associes a la survenue d'une MPE; la pauvrete et la mauvaise observance de la prevention contre les affections qui disposent de vaccins sont les plus incrimines dans notre etude ; les taux de MPE dans la sous-prefecture de Danane sont de 13;95 pour cent pour l'emaciation; de 19;29 pour cent pour le retard de croissance et de 27 pour cent pour l'insuffisance ponderale. Ces chiffres sont largement au dessus des moyennes nationales; etablissant ainsi une correlation entre la situation de region hote et la prevalence de la MPE ; l'aide apportee aux refugies vulnerables est d'un role indeniable car les populations non assistees font plus de MPE rejetant l'hypothese de la correlation entre la MPE et la situation de refugie. Nous proposons au vu de ces resultats que : la zone d'accueil des refugies liberiens soit l'objet d'une attention medicale curative et preventive speciale ; les populations locales soient soutenues dans leur effort d'hebergement pour une facilitation de l'integration des immigres

Decentralization monoamine super-sensitivity of migraine and opiate abstinence: common features and different target mechanisms?

The similarity between opiate withdrawal and migraine (M) has been confirmed regarding increased monoamine sensitivity at the neuromuscular junction of the hand's dorsal vein as well as at the neuraxis where dopamine (DA) supersensitivity was observed. Similarities also included an increase in cAMP levels as a precocious sign in both M and opiate withdrawal. Particular attention has been devoted to the time-course of monoamine supersensitivity in M and in abstinence. It has been found that the maximum level of super-sensitivity occurs in M at the end of the M attack, whereas the maximum super-sensitivity is present at the very beginning of opiate abstinence. The inverse time-course of this phenomenon suggests that it could play some pathophysiological role in inducing the end of the M attack. Conversely, it can represent the expected transient result of a pharmacological denervation which ought to result in a supersensitivity of opioid-dependent neuron during withdrawal. In M, the super-sensitivity is wider, indeed, it involves more receptor types. This could be an indirect proof of the involvement of inhibitory pathways other than the opioidergic one.

Video assessment of yawning induced by sublingual apomorphine in migraine.

A double-blind, placebo-controlled study was carried out in 14 migraineous outpatients and 8 control subjects to assess yawning response to 0.25 mg of sublingual apomorphine, a dopamine receptor agonist, by means of an audiovisual technique. Apomorphine induced a significantly higher number of yawns than placebo in both groups of subjects, but the effect was significantly greater in migraine sufferers than in controls. The result seems to confirm the previous reported hyper-responsiveness to pharmacological dopaminergic stimulation in migraine sufferers. Moreover, the audiovisual technique seems to be an appropriate tool to study yawning response in man.

[The weight-bath and its biomechanics]. / A súlyfürdö alkalmazása és annak biomechanikája.

Authors report about build-up, the biomechanics, the indication, the contraindication and the method of appliance of traction bath. They were the first who made biomechanical calculations so that they could assess the extension power on the different parts of the spinal column as well as on the big joints of the lower limbs during traction bath treatment. The extension power in the traction bath depends on the way of the suspension, the weight of the human body in water, its relative density and the place and size of the weights. Supported by calculations extension power was defined in the suspension point and at any distance from it in unloaded conditions and in loading with various weights. The extension power of the net weight of the body was 2-4 kgs in the suspension point and at the neck (cervical vertebrae) while on the lumbar vertebrae it was the half of that value. The change in the power on the vertebrae (spinal column) was plotted against the body weight, the relative density and the applied weights.

Promoting women's health needs through women organising

Addresses the problems women face as a group

Promoting women's health needs through women organising

Addresses the problems women face as a group

Intramuscular treatment of migraine attacks using diclofenac sodium: a crossover clinical trial.

This was a double-blind clinical trial, with a crossover design, to compare the efficacy of a non-steroidal anti-inflammatory drug, diclofenac sodium, intramuscularly administered, and placebo in the treatment of migraine attacks. The drug was administered to 40 patients once a day in three consecutive migraine attacks. If pain still remained after 6 h following administration the patient was given a 100 mg diclofenac sodium suppository, in open condition. Evaluation was by a complete medical examination performed by the physician and by the patient completing a specially designed self-assessment card. A total of eight patients dropped out of the trial (all during placebo administration): three due to poor compliance, four for refusal to continue and one because no further migraine attacks developed. Results were analysed after having checked the absence of both period and carry-over effects. In all cases diclofenac sodium was more effective than placebo (P less than 0.01). This was also confirmed by data obtained from the patient self-assessment cards (P less than 0.001) and by preferences expressed by patients at the end of the trial (P less than 0.001). Tolerance to the drug was similar to that of placebo.

[Results of clinical and radiologic mass-screening tests of the locomotor system of miners in Hungary]. / Ergebnisse einer klinischen und radiologischen Reihenuntersuchung der Bewegungsorgane bei Bergleuten in Ungarn.

Clinical and radiological screening tests on the locomotor system of 250 workers being active in mines were accomplished by the authors. The test results of 125 miners working underground were compared with those of a control group consisting of equally 125 workers of the same age category, but engaged in open mining. As a result of the investigation it could be stated that miners working in underground mines were affected by diseases of the organs of motion at a very early stage, and in a greater proportion. The most serious deformations were observed with development irregularities and development variations. The development of degenerative locomotor diseases is promoted in Hungary by the working conditions prevailing underground. The completion of the examination procedure of fitness for work by clinical and radiological examinations of the locomotor system is important and highly recommended. The investigation carried out by the authors may serve as a model for the screening tests to be made on the locomotor system of industrial workers.

Personality patterns of headache sufferers.

One hundred and sixty-seven subjects (91 females and 76 males) aged 18 to 55 and suffering from recurrent headache, daily headache, and cluster headache, were studied. In order to collect detailed information about their clinical as well as social and environmental conditions, a multi-page card was used which had been specially prepared for this purpose. The patients' personality patterns were assessed by the following methods: MMPI (the Hs, Hy, D, and Ma scales, in particular); EPQ (Eysenck Personality Questionnaire); and AS IPAT (Cattel's Anxiety Scale). The statistical analysis of the data obtained made it possible to define the personality patterns of both male and female subjects and then to differentiate between them in relation to the various types of headache. Furthermore, possible relationships between personality traits and headache suffering were investigated. If the personality patterns of females seem to have existed prior to the disease, those of males raise some questions. In cluster patients, in particular, the age of onset seems to be related to certain personality traits; in patients with daily headache, by contrast the association between the duration and severity of the disorder appears to play a major trigger role. Some of these correlations do not have a linear character and suggest new working hypotheses that go beyond the limits of standard correlations.