Arterial hypertension in the chronic evolution of migraine: bystander or risk factor? An overview.

BACKGROUND: Several risk factors are associated with the chronic evolution of migraine. Clinical and preclinical studies have provided data about the role of hypertension (HT) as one of the potential modifiable risk factors of chronic migraine (CM). This review is focused on the biological and clinical evidence supporting common mechanisms underlying HT and migraine and the potential role of HT in the transition from episodic to chronic migraine. METHODS: We conducted a narrative review from a literature search covering the available evidence from studies investigating: i) the role of HT in the transition to CM in clinical practice; ii) the biological mechanisms potentially underpinning the association between HT and evolution to CM; iii) the role of antihypertensive medications in migraine prophylaxis. RESULTS: HT proved to be at the base of multiple mechanisms underlying migraine and migraine chronicization. Endothelial dysfunction, blood-brain barrier alterations, calcitonin gene-related peptide signaling, and renin-angiotensin-aldosterone system dysregulation are involved in the worsening effect of HT on migraine frequency, and the role of HT in the transition to CM is supported by clinical observations. CONCLUSIONS: The observed evidence supports HT contribution to CM evolution due to shared pathophysiologic mechanisms. While a bidirectional influence appears to be ascertained, data are still lacking about the one-way role of HT as direct risk factor for CM transition. Further research is needed to confirm a causal role of HT in this process.

The Migraine Stigma Kaleidoscope View.

The stigma of migraine, despite an impressive body of data on the epidemiological of migraine and the associated disability, burden and cost of migraine to patients, has not been fully evaluated as an important factor in the chronicization of the disease and social isolation of the patient. In this commentary, we present three points of view. From the point of view of a European advocacy body active in the field of migraine medicine, actions to improve the perception of migraine within the community regarding the stigma for people with migraine are presented at the personal, relational and occupational levels. From the point of view of a clinician who is an expert on migraine, proposals are made for treatment and rehabilitation paths specifically dedicated to the reintegration of these individuals into social contexts.

Pharmacological rationale for tapentadol therapy: a review of new evidence.

Chronic pain could be considered as a neurological disorder. Therefore, appropriate selection of the therapy, which should consider the pathophysiological mechanisms of pain, can result in a successful analgesic outcome. Tapentadol is an analgesic drug which acts both as a µ-opioid receptor (MOR) agonist and as a noradrenaline reuptake inhibitor (NRI), thereby generating a synergistic action in terms of analgesic efficacy, but not for the burden of adverse effects. Therefore, tapentadol can be defined as the first "MOR-NRI" drug. This molecule holds the potential to address at least some of the current limitations of analgesic therapy due to its unique mechanism of action and has shown to be safe and effective in the treatment of chronic pain of cancer and noncancer etiologies including nociceptive, neuropathic and mixed pain. In particular, the MOR component of tapentadol activity predominantly allows for analgesia in nociceptive pain; on the other hand, the NRI component contributes, now in a predominant manner, for analgesic efficacy in cases of neuropathic pain states. This paper will discuss recent pieces of evidence on the pathophysiology of pain, the background on tapentadol and then present some new studies on how the unique mechanism of action of tapentadol provides a key role in its analgesic efficacy in a number of pain states and with a favorable safety profile.

Beneficial Effects of Regular Physical Activity on Exercise-Induced Analgesia in Adolescent Males.

PURPOSE: To evaluate exercise-induced analgesia (EIA) effectiveness in healthy adolescent males and to investigate possible associations between EIA and physiological/psychological variables. METHODS: Twenty-eight healthy adolescent males (14-17 y) participated in this study. EIA was evaluated by comparing perceptions of heat pain stimulations before and after an increasing maximal load test on a cycle ergometer (VO2max). RESULTS: Pain intensity for mild and strong heat pain stimulations significantly decreased following physical exercise (mild: EIA = 28.6%; 95% confidence interval, 0.9-1.9; P < .001 and strong: EIA = 11.3%; 95% confidence interval, 0.3-1.4; P = .002). The number of physical activity hours per week was positively correlated with the effectiveness of EIA for mild and strong pain intensity (r = .41, P = .03 and r = .43, P = .02, respectively). CONCLUSIONS: Intense physical exercise decreases perception of intensity of experimental heat pain in healthy adolescent males. The least physically active adolescents have reduced EIA effectiveness to experimental heat pain stimulations compared with physically active ones. Adolescents adopting an active lifestyle have more endogenous pain inhibition and could, therefore, potentially be less disposed to suffer from chronic pain later in life.

Freud e a Grécia antiga: uma leitura do processo de cronificação em saúde mental / Freud et l’antiquité grecque: une lecture du processus de chronicisation en santé mentale / Freud and ancient Greece: a reading of the chronification process in mental health

O presente artigo tem como objetivo examinar a discussão que se realiza no Brasil sobre uma nova forma de cronificação nos ambulatórios de saúde mental. Será destacada a tensão entre a ética do bem-estar com um saber institucional legitimado a respeito dos usuários, e a dimensão ética do bem-dizer na qual a psicanálise sustenta-se orientada pela via do desejo singular a cada sujeito. Neste percurso, será traçado um paralelo entre a tradição grega e a era moderna pelo modo como exploram a sexualidade. A psicanálise, em certa medida, retoma a antiguidade pelo valor que atribui à potência sexual, em detrimento dos objetos tomados pela pulsão.

Cet article vise à examiner la discussion qui a lieu au Brésil sur une nouvelle forme de chronicisation dans les ambulatoires de santé mentale. Il sera mis en évidence la tension entre l'éthique du bien-être avec un savoir institutionnel légitime sur les usagers, et la dimension éthique du bien-dire sur laquelle la psychanalyse se fonde orientée par le désir singulier à chaque sujet.Dans cette démarche, il va tracer un parallèle entre la tradition grecque et l'ère moderne par la façon dont elles explorent la sexualité. La psychanalyse, dans une certaine mesure, reprend l'Antiquité par la valeur qu'elle attache à la puissance sexuelle, au détriment des objets pris par la pulsion.

This article aims to examine the discussion that takes place in Brazil about a new form of chronification in mental health institutions. We will highlight the tension between the ethics of well-being with a legitimized institutional knowledge about the users, and the ethical dimension of well saying in which psychoanalysis is sustained, oriented by the singular desire in each subject. On the course of this exaination, a parallel will be drawn between the Greek and the modern tradition through the way in which sexuality is explored. Psychoanalysis, to some extent, reclaims antiquity for the value atributed to sexual potency, in detriment of objects taken by the drive.

Freud e a Grécia antiga: uma leitura do processo de cronificação em saúde mental / Freud et l’Antiquité grecque: une lecture du processus de chronicisation en santé mentale / Freud and ancient Greece: a reading of the chronification process in mental health

O presente artigo tem como objetivo examinar a discussão que se realiza no Brasil sobre uma nova forma de cronificação nos ambulatórios de saúde mental. Será destacada a tensão entre a ética do bem-estar com um saber institucional legitimado a respeito dos usuários, e a dimensão ética do bem-dizer na qual a psicanálise sustenta-se orientada pela via do desejo singular a cada sujeito. Neste percurso, será traçado um paralelo entre a tradição grega e a era moderna pelo modo como exploram a sexualidade. A psicanálise, em certa medida, retoma a antiguidade pelo valor que atribui à potência sexual, em detrimento dos objetos tomados pela pulsão(AU)

Cet article vise à examiner la discussion qui a lieu au Brésil sur une nouvelle forme de chronicisation dans les ambulatoires de santé mentale. Il sera mis en évidence la tension entre l'éthique du bien-être avec un savoir institutionnel légitime sur les usagers, et la dimension éthique du bien-dire sur laquelle la psychanalyse se fonde orientée par le désir singulier à chaque sujet.Dans cette démarche, il va tracer un parallèle entre la tradition grecque et l'ère moderne par la façon dont elles explorent la sexualité. La psychanalyse, dans une certaine mesure, reprend l'Antiquité par la valeur qu'elle attache à la puissance sexuelle, au détriment des objets pris par la pulsion(AU)

This article aims to examine the discussion that takes place in Brazil about a new form of chronification in mental health institutions. We will highlight the tension between the ethics of well-being with a legitimized institutional knowledge about the users, and the ethical dimension of well saying in which psychoanalysis is sustained, oriented by the singular desire in each subject. On the course of this exaination, a parallel will be drawn between the Greek and the modern tradition through the way in which sexuality is explored. Psychoanalysis, to some extent, reclaims antiquity for the value atributed to sexual potency, in detriment of objects taken by the drive(AU)