Maria Carola Narbone

Underdiagnosis and undertreatment of migraine in Italy: a survey of patients attending for the first time 10 headache centres.

The aim of this study was to asses the clinical features, pattern of healthcare and drug utilization of migraine patients attending 10 Italian headache centres (HC). Migraine is underdiagnosed and undertreated everywhere throughout the world, despite its considerable burden. Migraine sufferers often deal with their problem alone using self-prescribing drugs, whereas triptans are used by a small proportion of patients. All patients attending for the first time 10 Italian HCs over a 3-month period were screened for migraine. Migraine patients underwent a structured direct interview about previous migraine diagnosis, comorbidity, headache treatments and their side-effects and healthcare utilization for migraine. Patient satisfaction with their usual therapy for the migraine attack was evaluated with the Migraine-Assessment of Current Therapy (ACT) questionnaire. The quality of life of migraine patients was assessed by mean of Short Form (SF)-12 and Migraine-Specific Quality of life (MSQ) version 2.1 questionnaires. Of the 2675 patients who attended HCs for the first time during the study period, 71% received a diagnosis of migraine and the first 953 subjects completed the study out of 1025 patients enrolled. Only 26.8% of migraine patients had a previous diagnosis of migraine; 62.4% of them visited their general practitioner (GP) in the last year, 38.2% saw a specialist for headache, 23% attended an Emergency Department and 4.5% were admitted to hospital for migraine; 82.8% of patients used non-specific drugs for migraine attacks, whereas 17.2% used triptans and only 4.8% used a preventive migraine medication. Triptans were used by 46.4% of patients with a previous diagnosis of migraine. About 80% of migraine patients took over-the-counter medications. The Migraine-ACT revealed that 60% of patients needed a change in their treatment of migraine attacks, 85% of whom took non-specific drugs. Both the MSQ version 2.1 and the SF-12 questionnaires indicated a poor quality of life of most patients. Migraine represents the prevalent headache diagnosis in Italian HCs. Migraine is still underdiagnosed in Italy and migraine patients receive a suboptimal medical approach in our country, despite the healthcare utilization of migraine subjects being noteworthy. A cooperative network involving GPs, neurologists and headache specialists is strongly desirable in order to improve long-term migraine management in Italy.

Prevalence of Atrial Septal Aneurysm in Patients With Migraine: An Echocardiographic Study

Objective.—To evaluate the prevalence of atrial septal aneurysm in patients with migraine.

A Case of SUNCT Syndrome Responsive to Verapamil

SUNCT is a rare headache disorder, first described by Sjaastad et al. in 1989 (1) and recently codified by the International Classification of Headache Disorders as a primary headache (2). The literature, however, discloses some cases of secondary SUNCT syndrome, particularly due to lesions in the posterior fossa or involving the pituitary gland (3–10). The pharmacological treatment of this syndrome is problematic. Some encouraging results have been recently suggested with lamotrigine (11–15), gabapentin (16, 17) and topiramate (18, 19); all previous attempts at treatment with drugs used for other short-lasting headaches were unsuccessful (20). It is noteworthy that two reports (21, 22) even reported a worsening effect of verapamil in patients affected by SUNCT. We describe a patient with SUNCT syndrome and an ischaemic lesion in the posterior fossa, who was successfully treated with verapamil.

Valproic acid-ethosuximide interaction: a pharmacokinetic study.

Summary: The present pharmacokinetic study was designed to investigate the possible interaction between valproic acid (VPA) and ethosuximide (ESM) in humans. Six drug‐free healthy volunteers, four men and two women, 18–42 years of age, received a single oral dose of 500 mg ESM before and during a treatment with VPA at 800‐ to 1,600‐mg daily doses. The second ESM dose was given 9 days after VPA administration was started. In this latter condition, a significant (p < 0.05) increase in ESM serum half‐life, from 44 to 54 h on average, and a significant (p < 0.05) decrease in total body clearance, from 11.2 to 9.5 ml/min on average, were observed. Other pharmacokinetic parameters were unchanged and showed values similar to those reported in the literature. Serum VPA levels ranged between 66.8 and 95 μg/ml. Two subjects showed no evidence of interaction. Although a great interindividual variability in the occurrence of VPA‐ESM interaction can be observed, the present study indicates that VPA is able to inhibit the metabolism of ESM. Possible factors affecting this interaction are hypothesized and discussed.

Migraine stroke: A possible complication of both migraine with and without aura

We describe four migraine patients who developed an ischemic stroke during their typical migraine attacks.

Effect of Viloxazine on Serum Carbamazepine Levels in Epileptic Patients

Summary: The present study describes the interaction between carbamazepine (CBZ) and viloxazine, a recently synthesized antidepressant agent. Seven epileptic patients on chronic anticonvulsant therapy showed a significant (p <0.005) increase in steady‐state serum CBZ levels (from 8.1 ± 2.5 SD to 12.1 ± 2.5 SD μg/ml) when viloxazine (300 mg/day) was added to the therapy. The effect was associated with the appearance of mild CBZ intoxication. The symptoms of this intoxication (i.e., dizziness, ataxia, fatigue, drowsiness) disappeared rapidly, and serum CBZ levels decreased to the basal values, when viloxazine administration was stopped.

A Late 'Migraine': The Only Symptom of an Intrasellar Aneurysm

The history of a 62‐year‐old woman affected by an intrasellar aneurysm is described. A migrainelike headache was, for many years, her only complaint.

Cluster-like headache and a median intracranial calcified lesion: case report.

SYNOPSIS

Classic Migraine and Intercalated Seizures in a Young Woman: Efficacy of Flunarizine

SYNOPSIS

Generalized EEG abnormalities in cluster headache

Sir, A strict temporal association between cluster headache (CH) attacks and sleep has been described [1], but very few polysomnographic studies of CH patients during their active period have been undertaken. For this reason, we performed polysomnography in thirteen unmedicated patients (9 males, 4 females; mean age 41.38 years) affected by episodic CH (IHS criteria, 2) and with ocular autonomic signs ipsilateral to the side of pain. Cluster attacks occurred during the night recording in only three patients (2 males, 1 female); three females, none of whom experienced attacks during the night, presented generalized EEG abnormalities. Of these latter patients, patient 1, aged 29 years, has suffered from photosensitive GM seizures, well controlled by phenobarbital, since the age of 22; her CH started when she was 24. Baseline EEG showed generalized photoparoxysmal discharges whereas, during NREM sleep, EEG activity was characterized by brief trains of generalized spike and polyspike and wave complexes (3 c/sec). Patient 2, aged 37 years, has a positive familial history of idiopathic epilepsy and suffered a head injury at the age of 24. Clinical, EEG and neuroradiological findings had always been normal. CH started at the age of 28. The nocturnal recording revealed frequent trains of generalized rapid spike and polyspike and wave complexes (3-4 c/sec), strongly activated by all NREM sleep stages. Patient 3, aged 41 years, with no familial or personal history of neurological disorders, has experienced CH since the age of 20. Her NREM sleep EEG showed dispersed generalized rapid (4-5 c/sec) polyspike and wave complexes bilaterally predominant on the anterior leads. In patient 1, the EEG findings may be explained by her known generalized epileptic seizures; an association between CH and epilepsy has recently been reported [3]. The ipsilateral association of pain attacks with head injur,