Davide Moscato

Flunarizine and Migraine in Childhood: An Evaluation of Endocrine Function

Flunarizine was tested for prophylactic efficacy and for side effects in 10- to 13-year-old patients with severe migraine (> 2 attacks per month). The 13 preadolescents received a single 5-mg dose at night for 2 months. The attack frequency decreased significantly, and the effect was maintained over time. The endocrine status, investigated before and after treatment, showed no significant interference with pituitary, beta-pancreatic, or gonadal function.

Osmophobia as an early marker of migraine: a follow-up study in juvenile patients.

Background: Osmophobia is frequent in children with migraine (20–35%) but can also occur in up to 14% of cases with tension-type headache (TTH). So far, the prognostic role of this symptom in children with primary headaches has never been evaluated. Methods: A longitudinal prospective study was conducted on 90 young patients with TTH (37 with osmophobia, 53 without osmophobia). We evaluated whether osmophobia could predict the diagnosis transformation from TTH to migraine after a 3-year follow-up. Results and Discussion: In our cases the rate of diagnosis change was significantly greater in cases with osmophobia (62%) than in those without (23%). Osmophobia persisted at a 3-year follow-up in the majority of our cases (85%) and it was found to be one of the major predictors for the development of migraine; other predictors of evolution to migraine were phonophobia, a probable rather than certain diagnosis of TTH and olfactory triggers (p < 0.05). Conclusion: Our data confirm that osmophobia has an important diagnostic and prognostic role in children with primary headaches and should be systematically investigated at diagnosis and during follow-up.

Osmophobia in migraine classification: A multicentre study in juvenile patients

Aims: This study was planned to investigate the diagnostic utility of osmophobia as criterion for migraine without aura (MO) as proposed in the Appendix (A1.1) of the International Classification of Headache Disorders (ICHD-II, 2004). Methods: We analysed 1020 patients presenting at 10 Italian juvenile headache centres, 622 affected by migraine (M) and 328 by tension-type headache (TTH); 70 were affected by headache not elsewhere classified (NEC) in ICHD-II. By using a semi-structured questionnaire, the prevalence of osmophobia was 26.9%, significantly higher in M than TTH patients (34.6% vs 14.3%). Results: Osmophobia was correlated with: (i) family history of M and osmophobia; and (ii) other accompanying symptoms of M. By applying these ‘new’ criteria, we found an agreement with the current criteria for the diagnosis of migraine without aura (MO) in 96.2% of cases; 54.3% of previously unclassifiable patients received a ‘new’ diagnosis. Conclusions: In conclusion, this study demonstrates that this new approach, proposed in the Appendix (A1.1), appears easy to apply and should improve the diagnostic standard of ICHD-II in young patients too.

Post–traumatic headache from moderate head injury

The onset of post-traumatic headache occurs frequently in children, where it is often caused by severe head injuries, therefore, it is part of a post–traumatic syndrome, rather than of an independent headache and in this case no cause is clearly evident. The problem, conversely, arises in post–traumatic headache after a light trauma, since it is difficult to establish the cause–effect link. We have studied PTH incidence for one year in the patients of the emergency ward of the Saint Charles of Nancy Hospital, compared to the activity of 4 Italian headache centres. At the Saint Charles of Nancy Hospital of 98 patients with PTH after a moderate head trauma, 18 had acute and 26 chronic PTH, the majority ceased after six months. In the Italian headache centres 1,656 patients were examined, of these 3.2% suffered from PTH: 25 acute, 29 chronic. These data confirm the poor evidence of PTH after a light trauma and lead to doubt of the existence of this nosological entity.

Frovatriptan vs almotriptan for treatment of menstrual migraine: a double-blind, randomized, cross-over, multicenter Italian study

Results 67 of the 96 female patients of the intention-to-treat population of the main study had regular menstrual cycles and were thus included in this subgroup analysis. 77 migraine attacks classified as related to menses were treated with frovatriptan and 78 with almotriptan. Rate of pain relief at 2and 4-hrs was 36% and 53% for frovatriptan and 41% and 50% for almotriptan (p=NS between treatments). Rate of pain free at 2and 4-hrs was 19% and 47% with frovatriptan and 29% and 54% for almotriptan (p=NS). At 24-hrs, 62% of frovatriptanand 67% of almotriptan-treated patients had pain relief, while 60% vs. 67% were pain free (p=NS). Recurrence at 24-hrs was significantly (p<0.05) lower with frovatriptan (8% vs. 21% almotriptan). This was the case also at 48-hrs (9% vs. 24%, p<0.05).

Changes in lifestyle and therapeutic strategy

Since it is extremely important to fully evaluate the psychological characteristics of young headache sufferers and their family circle, we have implemented a diagnostic therapeutic protocol arranged in a number of day hospital (D. H.) sessions. These include a series of specialist examinations and dialogues with child and parent together, in addition to projective, drawing, Rorschach and psychometric tests. It has been found that the more frequent elements triggering headache in a child arise in the family: from competition between the child and the family figure (sibling, either parent, etc.), and the lack of the same. Once the causative link has been identified, a process must be initiated that gives rise to a doubt, without demonising the parents. A way must be found for parents and child to better communicate each other. We strongly trust the D. H. treatment and we have presented a paper at the HIS conference in Rome about this subject, in order to prove that it is successful in most cases. Several clinical cases have been included in our study, to show how the D. H. works and the successful results achieved. In synthesis, a young headache sufferer is a subject who is very sensitive to the external environment surrounding him/her, therefore, it is of paramount importance to deeply examine his behavior and find the causes that trigger headache, in order to help him/her to avoid them, through pharmacological treatment, behavioral therapy, biofeedback, relaxation and finally therapy with the assistance of animals.

Mothers and pain: the effect of a mother's pain experience on the child

Abstract How does the preceding experience of pain by the mother affect the childs response to the painful event? This work intends to be a preliminary answer to this problem. A questionnaire with 10 items was administered to 217 mothers aged 26/45 years, with 1 (44%) or 2 (47%) children, and from different regions of central and southern Italy. The majority of the mothers had a memory of a supporting response by her family to her experience of pain. 50% of the mothers recalled an episode of physical pain and 20% an episode of moral pain. The memory of moral pain was more widespread in the South (71% of all the mothers). The definition of pain was negative (62%): pain was experienced either as a threat to health or a limitation to ones freedom. The children, conversely, dealt with pain in 67% of the cases by looking for their parents and asking for help; 33% dealt with pain alone. 91% of the mothers who become upset when they have pain have children who, when they are ill, behave in the same manner.It is in the South that the relationships in the family remain mainly unchanged (68%) on the occasion of an illness of a child, while it is in central Italy that these improve more easily. For mothers, pain is a substantially negative experience. The study shows that a family experience of pain is passed, as far as the manner of dealing with it is concernec, from one generation to another.