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1.
Cephalalgia ; 36(14): 1356-1365, 2016 Dec.
Article in English | MEDLINE | ID: mdl-26879321

ABSTRACT

AIM: The aim of this study was to evaluate the psychological factors associated with a negative outcome following detoxification in a 2-month follow-up in medication-overuse headache. METHODS: All consecutive patients entering the detoxification program were analysed in a prospective, non-randomised fashion. Psychiatric conditions and personality characteristics were assessed using the Structured Clinical Interview for DSM-IV Disorders (SCID-I) and the Minnesota Multiphasic Personality Inventory (MMPI)-2. χ2 tests, one-way analyses of variance, and odds ratios (ORs) were used. RESULTS: A total of 248 patients completed the follow-up: 156 stopped overuse and their headaches reverted to an episodic pattern (Group A); 23 kept overusing without any benefit on headache frequency (Group B); and 51 stopped overuse without any benefit on headache frequency (Group C). The prognostic factors for the outcome of Group B were higher scores on the correction (OR 1.128; p = 0.036), depression (OR 1.071; p = 0.05), hysteria (OR 1.106; p = 0.023), and overcontrolled hostility (OR 1.182; p = 0.04) MMPI-2 scales, whereas those for Group C were psychiatric comorbidities (OR 1.502; p = 0.021) and higher scores on the hysteria scale (OR 1.125; p = 0.004). CONCLUSIONS: The outcome of detoxification is influenced by psychological factors that should be considered when considering treatment strategies.


Subject(s)
Headache Disorders, Secondary/psychology , Headache Disorders, Secondary/therapy , Headache Disorders/psychology , Headache Disorders/therapy , Prescription Drug Overuse/psychology , Adult , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prospective Studies , Treatment Failure , Treatment Outcome
2.
Cephalalgia ; 36(9): 825-30, 2016 Aug.
Article in English | MEDLINE | ID: mdl-26498348

ABSTRACT

BACKGROUND: Migraine attacks may present different features in different patients and also within the same patient. The percentage of patients reporting stereotyped attacks and those reporting attacks with different phenotypes has not been the object of specific investigations. OBJECTIVE: The objective of this article is to evaluate the percentage of migraine patients reporting the same characteristics, in terms of phenotype and response to symptomatic medications on three consecutive migraine attacks. METHODS: Thirty patients with migraine without aura prospectively recorded the features of three consecutive attacks in a headache diary. Characteristics recorded were: pain intensity, presence of nausea, vomiting, photophobia, phonophophia, osmophobia, allodynia, cranial autonomic symptoms (at least one), and premonitory symptoms. Patients were allowed to take frovatriptan as symptomatic medication, whose efficacy was evaluated as the two hours pain-free status. RESULTS: None of the patients presented identical characteristics on the three studied attacks. This was still the case if we reduced the number of variables evaluated from 11 to seven of the eight core features indicated by the ICHD. Considering just six variables: unilaterality and quality of pain, presence/absence of nausea, vomiting, photophobia and phonophobia, only two patients (6%) had identical features on three consecutive attacks.With respect to the response to frovatriptan, 39% of patients had the same response, either positive (i.e. pain free after two hours) or negative (i.e. not pain free after two hours) on three consecutive attacks. CONCLUSION: Migraine attacks show a high variability not just among patients, but also within the same patient. Our data indicate that stereotypy of attacks is uncommon, and reinforces the underlying logic of the current operational classification system.


Subject(s)
Migraine Disorders , Adult , Carbazoles/therapeutic use , Female , Humans , Hyperacusis/etiology , Hyperalgesia/etiology , Male , Medical Records , Middle Aged , Migraine Disorders/complications , Migraine Disorders/drug therapy , Phenotype , Photophobia/etiology , Serotonin Receptor Agonists/therapeutic use , Treatment Outcome , Tryptamines/therapeutic use , Vomiting/etiology , Young Adult
3.
J Headache Pain ; 16: 532, 2015.
Article in English | MEDLINE | ID: mdl-26018292

ABSTRACT

BACKGROUND: Chronic migraine (CM) has a high impact on functional performance and quality of life (QoL). CM also has a relevant burden on the National Health Service (NHS), however precise figures are lacking. In this pilot study we compared the impact in terms of costs of CM and episodic migraine (EM) on the individual and on the National Health System (NHS). Furthermore, we comparatively evaluated the impact of CM and EM on functional capability and on QoL of sufferers. METHODS: We enrolled 92 consecutive patients attending the Pavia headache centre: 51 subjects with CM and 41 with episodic migraine (EM). Patients were tested with disability scales (MIDAS, HIT-6, SF-36) and with an ad hoc semi-structured questionnaire. RESULTS: The direct mean annual cost (in euro) per patient suffering from CM was €2250.0 ± 1796.1, against €523.6 ± 825.8 per patient with EM. The cost loaded on NHS was €2110.4 ± 1756.9 for CM, €468.3 ± 801.8 for EM. The total economic load and the different sub-items were significantly different between groups (CM vs. EM p = 0.001 for each value). CM subjects had higher scores than EM for MIDAS (98.4 ± 72,3 vs 15.5 ± 17.7, p = 0.001) and for HIT-6 (66.1 ± 8.4 vs 58.7 ± 10.1, p = 0.001). The SF-36 score was 39.9 ± 14,74 for CM and 66.2 ± 18.2 for EM (p = 0.001). CONCLUSIONS: CM is a disabling condition with a huge impact on the QoL of sufferers and a significant economic impact on the NHS. The adequate management of CM, reverting it back to EM, will provide a dual benefit: on the individual and on the society.


Subject(s)
Cost of Illness , Health Care Costs , Migraine Disorders/economics , Tertiary Care Centers/economics , Adult , Female , Humans , Italy , Male , Middle Aged
4.
Cephalalgia ; 30(3): 329-36, 2010 Mar.
Article in English | MEDLINE | ID: mdl-19614697

ABSTRACT

To investigate factors influencing prognosis in medication-overuse headache (MOH), we conducted a 12-month follow-up of patients with probable MOH. We recruited 215 patients consecutively admitted to our headache centre for an inpatient detoxification treatment. We analysed likely predictor factors for headache resolution (sex, age, primary headache, psychiatric comorbidity, type and timing of overuse). Mann-Whitney U-test and chi-squared test were used. One year after withdrawal, we had complete data on 172 patients (80%): 38 of these patients (22%) had relapsed into overuse and 134 (78%) had not. The negative prognostic factors for relapse were: intake of more than 30 doses/month (P = 0.004), smoking (P = 0.012), alcohol consumption (P = 0.037), non-confirmation of MOH diagnosis 2 months after detoxification (P = 0.000), and return to overused drug(s) (P = 0.000). The 1-year relapse rate was 22%. The existence of sub-groups of MOH patients with such risk factors could influence treatment strategies.


Subject(s)
Analgesics/adverse effects , Analgesics/pharmacokinetics , Headache Disorders, Secondary/epidemiology , Headache Disorders, Secondary/therapy , Inactivation, Metabolic , Aged , Female , Follow-Up Studies , Humans , Logistic Models , Male , Middle Aged , Prognosis , Recurrence , Risk Factors
5.
Cephalalgia ; 29(2): 233-43, 2009 Feb.
Article in English | MEDLINE | ID: mdl-19025549

ABSTRACT

Medication overuse headache (MOH) is a growing problem worldwide and a challenge for clinicians and investigators. This study aims to contribute to the ongoing debate surrounding the classification of MOH. Applying the revised diagnostic criteria for MOH contained in the updated International Classification of Headache Disorders (ICHD-II), we enrolled 140 probable MOH (p-MOH) patients. They were submitted to an in-patient detoxification protocol and re-examined 2, 6 and 12 months later to confirm, or otherwise, the diagnosis of MOH and to observe the evolution of their headache. MOH diagnosis was confirmed 2 months after detoxification in 71% of patients, who reverted to an episodic headache pattern and stopped their drug overuse The overall clinical situation at 2 months closely reflected the 1-year trend. The 2-month period after drug withdrawal should be retained as a diagnostic criterion in the ICHD-II because it is useful not only as a diagnostic parameter, but also as predictor of a good outcome of 1-year drug withdrawal. In addition, the present findings point to the need for a more objective criterion to quantify headache frequency after drug withdrawal.


Subject(s)
Headache Disorders, Secondary/diagnosis , Headache Disorders, Secondary/therapy , Adult , Aged , Analgesics/adverse effects , Ergotamine/adverse effects , Female , Follow-Up Studies , Headache Disorders, Secondary/chemically induced , Humans , Male , Middle Aged , Treatment Outcome , Tryptamines/adverse effects , Young Adult
6.
Neurosci Lett ; 424(3): 179-84, 2007 Sep 13.
Article in English | MEDLINE | ID: mdl-17719176

ABSTRACT

Homozygosis for wolframin (WFS1) mutations determines Wolfram syndrome (WS), and common polymorphisms of WFS1 are associated with psychiatric illnesses and dependence behaviour. To test the influence of WFS1 polymorphisms on medication overuse headache (MOH), a chronic headache condition related to symptomatic drugs overuse, we analyzed 82 MOH patients for the WFS1 His611Arg polymorphism, and performed a comparison between clinical features of Arg/Arg (R/R) and non-R/R individuals. Individuals harbouring the R/R genotype showed significantly higher monthly drug consumption (t=-3.504; p=0.00075) and more severe depressive symptoms on the BDI questionnaire (t=-3.048; p=0.003) than non-R/R. WFS1 polymorphism emerged as the only significant predictor of drug consumption, at the multivariate regression analysis (F=12.277; d.f.=1,80; p=0.00075, adjusted R2=0.122). These results implicate WFS1 in the clinical picture of MOH, may be through an influence on need for drugs as in other conditions of abuse behaviour.


Subject(s)
Arginine/genetics , Genetic Predisposition to Disease , Headache/genetics , Histidine/genetics , Membrane Proteins/genetics , Polymorphism, Genetic , Adult , Case-Control Studies , DNA Mutational Analysis/methods , Drug-Related Side Effects and Adverse Reactions , Female , Headache/chemically induced , Humans , Male , Middle Aged , Multivariate Analysis
7.
Neurol Sci ; 27 Suppl 1: S59-61, 2006 Mar.
Article in English | MEDLINE | ID: mdl-16708189

ABSTRACT

Typical cases of the most common kinds of headache can be diagnosed and treated by general practitioners (GPs). Non-traumatic patients with de novo acute sudden-onset disabling headaches as well as significant worsening of pre-existing headaches seek care at emergency departments (EDs) and represent a diagnostic challenge for the consultant neurologist, who is the specialist of reference for the entire diagnostic process. Explicit diagnostic criteria for the classification of headache disorders (ICHD-II) are fundamental for verifying the final diagnosis, but in the emergency setting diagnostic and therapeutic guidelines and recommendations, coupled with lists of diagnostic alarms and warnings, may further contribute to the preliminary identification of secondary headaches.


Subject(s)
Emergency Service, Hospital , Headache/therapy , Headache/diagnosis , Humans
8.
J Headache Pain ; 6(6): 471-2, 2005 Dec.
Article in English | MEDLINE | ID: mdl-16388344

ABSTRACT

We describe a woman with a long history of relapsing-remitting painful ophthalmoplegia in a seasonal pattern, due to an isolated orbital myositis that was--at our observation--classified in the context of the so-called SAPHO syndrome. She had been previously treated with corticosteroid therapy, but the association with immunosuppressive drugs produced a more prompt resolution of both the headache and ophthalmoplegia, and of the magnetic resonance imaging pictures of isolated myositis as well.


Subject(s)
Ophthalmoplegia/etiology , Orbital Pseudotumor/complications , Adrenal Cortex Hormones/therapeutic use , Adult , Anti-Inflammatory Agents/therapeutic use , Female , Humans , Ophthalmoplegia/drug therapy , Orbital Pseudotumor/drug therapy , Recurrence
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