Marianna Nicodemo

Family History for Chronic Headache and Drug Overuse as a Risk Factor for Headache Chronification

Objectives.— To assess whether family history for chronic headache (CH) and drug overuse could represent a risk factor for headache chronification.

Increased Prevalence of Sleep Disorders in Chronic Headache: A Case–Control Study

Objectives.— The aim of our study was to investigate the prevalence of sleep disorders in chronic headache patients and to evaluate the role of psychiatric comorbidity in the association between chronic headache and sleep complaints.

Application of ICHD-II and revised diagnostic criteria to patients with chronic daily headache

The objective of this study was to evaluate how the criteria of the second edition of the International Classification of Headache Disorders (ICHD-II) and the revised criteria fit a sample of patients with chronic daily headache (CDH). One hundred and five patients with CDH in a tertiary headache centre were included. Headache was assessed using a semi-structured interview. Patients were classified according to the ICHD-II and to the new appendix criteria of the ICHD. Using the ICHDII, 91% of patients received a combination of diagnoses and 76% received only a probable diagnosis: 47% had probable chronic migraine (CM) with probable medication overuse headache (MOH), 28% had probable chronic tension-type headache (CTTH) with probable MOH, 20% had CTTH and 3.8% had CM. Using the new appendix criteria, 88.5% of patients required one diagnosis. Seventy-six percent of patients were classified as MOH, 17% had CTTH and 6.7% had CM. The classification of CDH remains controversial. Alternative criteria for CM with and without medication overuse are discussed.

Chronic daily headache: risk factors and pathogenetic considerations

Chronic daily headache (CDH) is a major clinical concern, although it is still plagued by difficulties with classification and definitions. CDH usually evolves from an episodic headache, mainly migraine. Drug overuse and other somatic or psychological traits are considered risk factors for CDH. The neurobiology underlying this clinical evolution is incompletely understood. There is evidence of a progressive dysfunction of central pain systems in some individuals probably genetically predisposed.

Cerebrospinal fluid hypocretin-1 levels during the active period of cluster headache.

Background: Hypocretins (orexins) are hypothalamic neuropeptides which are involved in a wide range of physiological processes in mammals including central pain processing. Genetic studies in humans evidenced a role for the hypocretinergic system in cluster headache (CH). Patients and methods: We tested cerebrospinal fluid (CSF) hypocretin-1 (orexin-A) levels in 10 CH patients during an active cluster period. CSF hypocretin-1 levels were measured by radioimmunoassay. Results: CSF hypocretin-1 levels were within the normal range (mean 457.3 ± 104.98 pg/ml, range 304–639) in our 10 patients, with a slight reduction in one case (304 pg/ml). There were no associations between CSF hypocretin-1 levels and the clinical features of CH. A trend towards higher hypocretin-1 levels was disclosed in patients with chronic CH compared to episodic CH. Conclusions: CSF hypocretin-1 levels seem not to influence the clinical course of CH, but our results cannot completely exclude a functional involvement of the hypothalamic hypocretinergic system in the pathogenesis of CH.

Self-help group and medication overuse headache: preliminary data

The objective of the study is to investigate the benefits of joining a self-help group for patients with medication overuse headache (MOH). A self-help group is a voluntary gathering of a small number of persons who share a common problem. Little is known about support groups for people with chronic non-malignant pain such as MOH. Eight patients with refractory MOH attended a self-help group twice a month. During the meetings, patients were asked to focus on their headache experiences. Our data showed an increase in resourcefulness in coping with pain and a reduction in cephalalgiophobia. All patients reported general benefits in sharing their headache-related problems. No differences were found for headache frequency or analgesic overuse. To our knowledge, this is the first report on a self-help group for patients with MOH. Joining a self-help group can help patients develop positive attitudes to managing pain.

Quality of life, eating and mood disorders in menstrual migraine : a case-control study

The aim of this study was to evaluate the prevalence of mood and eating disorders in patients with menstrual migraine. Quality of life and disability were also assessed. The study confirmed the presence of significant disability and poor quality of life due to migraine even in a selected subgroup of patients affected with menstrual migraine. In contrast with the previous literature we did not find any difference in the prevalence of mood and eating disorders.

A case of strictly unilateral migraine without aura transformed in an episodic hemicrania continua

According to the diagnostic criteria of International Headache Society classification, hemicrania continua is a strictly unilateral continuous headache of moderate intensity with painful exacerbations associated with ipsilateral autonomic signs without pain-free periods. We report a case of a 42-year-old woman suffered of a remitting form of hemicrania continua evolved from a strictly unilateral migraine without aura.

Chronotypes in menstrual migraine: a case–control study

Migraine attacks have a seasonal, menstrual and circadian periodicity, suggesting a role of chronobiological mechanisms probably related to a hypothalamic involvement. The aim of the study was to evaluate the chronotypes in patients with menstrual migraine, a migraine sub-type with a cyclical recurrence compared to normal female. Ninety-three patients with ICHD-II diagnosis of pure menstrual migraine and menstrually-related migraine were recruited and compared to 85 age-matched healthy women. The Italian version of Morningness–Eveningness Questionnaire was administered to identify circadian preference of our participants. No differences were found regarding the distribution of chronotypes in patients with menstrual migraine and healthy controls. The study did not confirm the presence of a morning and evening preference among migraineurs as previously reported.

Comorbidity in Perimenstrual Migraine

Comorbidity may be defined as the association of two or more diseases in individuals at a frequency greater than that expected statistically by chance. Studying the co-occurrence of two disorders requires a careful statistical analysis before any clear conclusion on causality is reached. Many studies have looked for an association between migraine and many diseases, reporting several sometimes controversial comorbidities in migraine subjects. Although migraine is more common in women than in men, very few studies have analyzed the comorbidity of perimenstrual migraine, a migraine sub-type characterized by attacks of migraine without aura related to menstruation. We review the studies on migraine comorbidities, particularly migraine without aura in women.