Migraine Awareness in Italy and the Myth of "Cervical Arthrosis".

OBJECTIVE: The primary aim of this study was to assess the degree of awareness migraine patients had of their condition. The secondary aims were to evaluate the frequency of an incorrect diagnosis of "cervical arthrosis" in patients unaware of having migraine and to compare the clinical features, diagnostic investigation, and treatment strategies between the 2 subgroups of migraineurs, that is, those with and without the incorrect diagnosis of "cervical arthrosis." METHODS: Patients, between 18 and 65 years, were consecutively referred to 5 Headache Centers in 2 Italian regions for a first visit. They fulfilled the diagnostic criteria for migraine (with/without aura, episodic/chronic) and were enrolled in this cross-sectional study. Each patient underwent a specific cranial/cervical musculoskeletal clinical examination. RESULTS: A total of 117/250 subjects (46.8%) were unaware that they suffered from migraine. In these unaware subjects, the most frequently reported diagnosis was "cervical arthrosis" in 34/117 (29.1%), followed by tension-type headache in 23/117 (19%). The cervical region was the most common site of pain onset in the so-called "cervical arthrosis" group (52.9%, P < .0001), where also more pericranial (58.8%; P = .041) and neck (70.6%; P = .009) muscle tenderness, restricted range of cervical vertical (47.1%; P < .001), and lateral (29.4%; P = .040) movements were reported. More "cervical arthrosis patients" had been referred to an Emergency Department (88.2%; P = .011) and had undergone more cervical spine radiography (23.5%; P = .003) and magnetic resonance imaging (20.6%; P = .044). While they had used fewer triptans (11.8%; P = .007) and received less pharmacological prophylaxis (2.9%; P = .004). CONCLUSIONS: In our sample, there were high misdiagnosis rates for migraine sufferers in Italy. The most common misdiagnosis, that is, "cervical arthrosis," led to misuse of healthcare facilities and had a negative impact on the migraine treatment.

Sodium valproate in migraine without aura and medication overuse headache: a randomized controlled trial.

OBJECTIVE: To assess the efficacy, safety and tolerability of sodium valproate (800mg/die) compared with placebo in medication-overuse headache patients with a history of migraine without aura. METHODS: This is a multicenter, randomized, double-blind, placebo-controlled study enrolled medication-overuse headache patients for a 3-month treatment period with sodium valproate (800mg/day) or placebo after a 6 day outpatient detoxification regimen, followed by a 3-month follow-up. Primary outcome was defined by the proportion of patients achieving ≥50% reduction in the number of days with headache per month (responders) from the baseline to the last 4 weeks of the 3-month treatment. Multivariate logistic regression models were used on the primary endpoint, adjusting for age, sex, disease duration, comorbidity and surgery. The last-observation-carried-forward method was used to adjust for missing values. RESULTS: Nine sites enrolled 130 patients and, after a 6-day detoxification phase, randomized 88 eligible patients. The 3-month responder rate was higher in the sodium valproate (45.0%) than in the placebo arm (23.8%) with an absolute difference of about 20% (p=0.0431). Sodium valproate had safety and tolerability profiles comparable to placebo. CONCLUSIONS: The present study supports the efficacy and safety of sodium valproate in the treatment of medication overuse headache with history of migraine after detoxification.

The antinociceptive effect of acetylsalicylic acid is differently affected by a CB1 agonist or antagonist and involves the serotonergic system in rats.

AIMS: Combinations of non-steroidal anti-inflammatory drugs (NSAIDs) and cannabinoids are promising because of their potential synergistic effects in analgesia, resulting in a reduction in dosage and minimizing adverse reactions. The analgesic effect of acetylsalicylic acid (ASA), probably due to a central mechanism, also implicates changes in the central monoaminergic system. Therefore, we decided to evaluate the antinociceptive interaction between the CB(1) receptor agonist, HU210, and ASA in tests involving central pain in rats as well as the implication of the central serotonergic system thereon. MAIN METHODS: The selective CB(1) antagonist SR141716A and the potent cannabinoid agonist HU210 were evaluated alone and in combination with ASA in both algesimetric tests (hot-plate and formalin tests) and for 5-HT activity and 5-HT(2) receptor density and affinity. KEY FINDINGS: ASA or HU210 alone showed a dose-dependent effect in both tests. HU210, at an inactive dose, significantly increased the antinociceptive effect of the sub-active dose of ASA. SR141716A (1.5mg/kgi.p.) was ineffective per se and failed to modify antinociception induced by the HU210 plus ASA combination in either test. HU210 plus ASA significantly decreased the 5-HIAA/5-HT ratio and the 5-HT(2) receptor density in the frontal cortex, changes not antagonized by SR141716A. SIGNIFICANCE: The present study provides evidence that mutual potentiation of the antinociceptive effects of HU210 and ASA may, at least partly, depend on serotonergic mechanisms, with an indirect participation of cannabinodiergic mechanism. In conclusion, combinations of low doses of cannabinoids and NSAIDs may be of interest from the therapeutic point of view.

Risk-benefit and cost-benefit ratio in headache treatment.

The cost-benefit and the risk-benefit ratios are two of the most relevant items in ongoing health organisation procedures. The choice of a new or an old therapeutic treatment depends on a number of factors and the evaluation of the cost, in terms of economics, but also in terms of quality of life and type of facilities necessary for one treatment are crucial criteria. Therefore, we have to consider in evaluating treatment strategies not only the activity of a drug in reaching the main end-points, (i.e., pain free or headache relief) but also the safety and perception of safety by patients, and the cost effectiveness, including indirect costs compared with personal and social benefits. Because it is reasonable that a subgroup of migraine patients may have a clinically progressive disorder, studies should be necessary to assess strategies for migraine treatments.

Topo-kinesthetic memory in chronic headaches. A new test for chronic patients: preliminary report.

The objective of this study was to establish if chronic headaches with medication overuse can modify a topo-kinesthetic memory test. Nineteen patients with medication overuse headache (MOH), 13 patients with chronic tension-type headache (CTTH) without medication use and a group of "normal" subjects underwent a topo-kinesthetic memory test at T0 and after one month (T1); a control group of healthy volunteers was also tested to establish the baseline in our experimental setting. After one month, in the MOH patients there was a reduction of medication overuse from 3.3+/-2.65 to 1.1+/-2.23 (p<0.01), but no significant reduction in headache frequency and severity index, quality of life, anxiety and depression scores. The navigation time at T0 was 14.3+/-4.97, 27.9+/-10.12, 34.3+/-15.38 and 7.5+/-2.33, 10.1+/-2.95, 11.4+/-3.21 for control, MOH and CTTH with closed and open eyes, respectively (p<0.02). At T1, the MOH patients reached performances with open eyes similar to the healthy controls, while with closed eyes the navigation test reached times similar to those of CTTH patients. The topo-kinesthetic memory test seems both able to discriminate MOH and CTTH from healthy volunteers and to be related to pain scores but is not influenced by the use of drugs.