Francesco Di Sabato

Hyperbaric oxygen therapy in cluster headache

Preliminary reports have shown that hyperbaric oxygen (HBO) interrupts cluster headache (CH) attacks. In the present study, 6 of 7 patients with episodic cluster headache who were treated with hyperbaric oxygen experienced an interruption of the attack. In 3 of 6 responders the florid period of the cluster headache was interrupted. The other 3 patients remained without pain attacks for a period lasting from 3 to 6 days. In 6 different patients, a placebo treatment had no effect. The present findings clearly indicate that hyperbaric oxygen has not only a symptomatic effect on a single attack of cluster headache, but it also could prevent the occurrence of subsequent attacks.

Effect of Hyperbaric Oxygen on the Immunoreactivity to Substance P in the Nasal Mucosa of Cluster Headache Patients

Exposure to hyperbaric oxygen has been shown to the effective in cluster headache, but the mechanism of the action is still not clear. Primary nociceptive neurons, containing neuropeptides such as substance P and particularly those innervating the nasal mucosa, could be involved in the pathogenesis of cluster headache. The present study evaluated the effect of an exposure to hyperbaric oxygen on the content of substance P in the nasal mucosa of patients affected by cluster headache. The results were compared with those observed in another group of cluster headache patients who underwent a placebo procedure. The samples of nasal mucosa were analyzed by immunocytochemical methods. A qualitative analysis of the slides was carried out by an operator under “blinded conditions.” A marked decrease in the content of immunoreactivity for substance P was found in the patients exposed to hyperbaric oxygen. The decrease was statistically significant when compared with the findings of the placebo procedure. The results of the present study indicate that an influence on the content of peripheral neuropeptides could be involved in the mechanism of action of the beneficial effect of hyperbaric oxygen in cluster headache.

Defective Expression of IL‐2 Receptors on Peripheral Blood Lymphocytes from Patients with Cluster Headache

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Impairment of 5HT binding to lymphocytes and monocytes from tension-type headache patients

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Analytic information processing style in migraineurs

Despite great advances in pathophysiological facets of migraine that have been made during recent years, as of today, migraine etiology is still not completely understood; moreover, to date the relationship between psychological factors and this primary headache must be further elucidated. However, abnormal information processing, as measured by evoked and event-related potentials, has been considered a key feature in migraine pathogenesis. The aim of this work was to study the relationships between analytic/global style of information processing and migraine, hypothesizing an analytic style, as highlighted by our previous study on cluster headache. This study applied three cognitive style tests never previously used in the context of migraine: “Sternberg–Wagner Self-Assessment Inventory”, the C. Cornoldi test series called AMOS, and Brain-Dominance Questionnaire. 280 migraneurs with and without aura were tested and matched with two control groups: healthy subjects and tension-type headache patients. Our results demonstrated a strong correlation between analytic information processing style and migraine, indicating a preference toward a visual sensory approach in migraine without aura, in line with known neuroelectrophysiological data. These findings may suggest a role for this specific cognitive behavior in migraine pathogenesis, leading us to further investigate the neuroelectrophysiological, neurobiological, and epigenetic correlates.

Analytic cognitive style in cluster headache

Previous reports on cluster headache have shown a hypothalamic dysfunction and a hitherto unrecognized defect in the information processing pathways measured by event-related potentials. As of today, the causes are still unknown; likewise, studies on the psychological factors involved in CH have not yielded relevant data. The aim of our study was to evaluate the presence of a possible correlation between CH and a specific manner of information processing, i.e., an analytic cognitive style. This study applies two cognitive style tests that have not previously been used in the context of cluster headache: “Sternberg–Wagner Self Assessment Inventory” and the C. Cornoldi AMOS test series. Twenty-three CH patients were involved in the study and were compared with two control groups: healthy subjects and tension type headache patients. Our findings clearly indicate a significant correlation between analytic cognitive style and CH, warranting further studies focusing on the underlying neurophysiological mechanisms.

Hyperresponsivity in migraine: a network dysfunction or an analytic cognitive style-connected feature?

Dear Editor, We read the interesting article by Ambrosini, recently published in Neurological Sciences [1], summarizing the main recognized mechanism underlying pathophysiology of migraine. As the author stressed, every effort in the last decades, aimed to unmask any consistent and permanent structural disturbance of the brain of migraine sufferers, was in vain, except for an interictal CNS dysfunction that normalizes ictally, identifiable as a lack of habituation to cortical repeated stimulations [1]. Lack of habituation, even if recently the subject of some criticism [2], has been indeed consistently reported and considered as a main feature of the migrainous brain, at the extent to be proposed as a diagnostic tool so far [1]. However, during the last years, we first provided evidence [3, 4] highlighting a specific, i.e., analytic, style of processing visual and auditory information in a large sample of migraineurs [3]; then, we showed a clear link between this cognitive behavior factor—per se—and lack of habituation through visually evoked potentials [4]. It should be noted that analytic style of processing visual stimuli has shown—per se—the following cortical responsiveness features, similarly to migraine [4]:

Lack of habituation of visual evoked potentials in migraine and healthy subjects: Correlated cognitive behavioral aspects

Dear Editor, We read Lisicki’s interesting paper, recently published in Cephalalgia, which focused on the influence of a positive familial history of migraine on visual evoked potential (VEP) amplitude and habituation (1). The authors showed significant reduced habituation in migraineurs and their healthy first-degree relatives, concluding that it may be a genetically determined endophenotypic trait associating both migraine and migraine susceptibility. Lisicki and co-authors correctly cited our recent report (2); however, we would like to add the following remarks concerning our findings: