Paola Castellini

The PACE study: Past-year prevalence of migraine in Parma's adult general population

Background: In the literature there are few data about the prevalence of primary headaches, including migraine, in the Italian general population. The PACE study (PArma CEfalea, or ‘Headache in Parma’) is an observational study aimed at detecting the prevalence and clinical features of primary headaches in the city of Parma’s adult general population. Materials and methods: A total of 904 subjects representative of Parma’s adult general population were interviewed face-to-face by a physician from the Parma Headache Centre. They were given a specially designed and validated questionnaire for the diagnosis of primary headaches according to the ICHD-II criteria. Results: Past-year adjusted prevalence of definite migraine, including migraine with and without aura and chronic migraine, was 24.7% (95% CI 21.9 to 27.5); 13% (95% CI 9.7 to 16.4) were men and 32.9% (95% CI 28.8 to 37.0) were women. Past-year prevalence of probable migraine was 5.1% (95% CI 3.6 to 6.5): 5.2% (95% CI 3.0 to 7.4) in men and 5% (95% CI 3.1 to 6.9) in women. Conclusions: The high prevalence of definite migraine is the major difference between our results and the literature data. Such a difference in results may be due to the use of a different investigational approach compared with the other epidemiological studies. However, an actual higher frequency of migraine in the Italian general population cannot be excluded given the lack of studies on this topic.

Fasting Headache: A Review of the Literature and New Hypotheses

Headache is a common disorder in the general population. It is often highly debilitating for the people affected and highly costly to society. Although we know much about primary headaches, little is known about secondary headaches which, however, are a frequent occurrence in the general population. A study conducted on Denmarks general population found a lifetime prevalence rate of 22% for headache forms attributed to disorder of homeostasis, including fasting headache.

Human psyche and headache: tension-type headache

The role of psychological factors related to headache, particularly tension-type headache (TTH), has long been a focus of investigation. The subject at issue is a complex one, with some aspects that are still being debated by experts. In episodic TTH, it is possible to hypothesise that headache is not only a “primary” headache that causes gratuitous pain to sufferers. In fact, it might represent an improper mode of communicating the sufferers’ intimate discomfort, caused by an inadequate relationship between their personality profiles and events in their lives. As in migraine, in TTH, too, evidence has been found of comorbidity between headache and psychiatric disorders, including depression and anxiety disorder. Such evidence will have to be confirmed by further studies on the general population. As regards behaviour and personality traits, subjects with TTH had significantly higher scores than healthy controls on measures of automatic thoughts and alexithymia, and lower scores on assertiveness. Patients with chronic TTH had higher automatic thoughts scores than patients with episodic TTH. These findings suggest that people with TTH may have difficulty in expressing their emotions. Finally, psychological factors and emotional disturbances have been indicated as risk factors for TTH. Indeed, stress and mental tension are the most common factors that cause TTH.

Description and Validation of an Italian ICHD-II-Based Questionnaire for Use in Epidemiological Research

Background.— In the absence of biological markers, the diagnosis of primary headache in epidemiological studies rests on clinical findings, as reported through ad‐hoc interviews.

Hemicrania Continua Evolving From Cluster Headache Responsive to Valproic Acid

Hemicrania continua (HC) is a rare type of primary headache characterized by a prompt and enduring response to indomethacin. We describe a patient who suffered from cluster headache evolving into ipsilateral HC, who does not tolerate a long‐term indomethacin therapy. The case was complex in terms of diagnosis, associated comorbidity, and choice of treatment; after several trials with different therapeutic regimens, we started the patient on a therapy with valproic acid and obtained an improvement of her HC.

Mode of occurrence of traumatic head injuries in male patients with cluster headache or migraine: Is there a connection with lifestyle?

Introduction: Our study objective was to investigate the mode of occurrence of traumatic head injury in episodic cluster headache and migraine patients. Methods: We conducted a retrospective study on 400 male patients, 200 with cluster headache (cases) and 200 with migraine (controls). We investigated the frequency and mode of occurrence of traumatic head injury and some lifestyle habits. Results: The number of traumatic head injuries was significantly higher in cases than in controls (adjusted odds ratio [OR] = 2.0; 95% confidence interval [CI] = 1.5–2.8). Cases were more often responsible for the head traumas (adjusted OR = 2.6; 95% CI = 1.3–4.9) and reported a significantly higher proportion of injuries during scuffles or brawls (OR = 6.5; 95% CI = 2.9–14.8). Compared with other cluster headache patients, cases responsible for traumatic head injuries were more frequently heavy alcohol (p = .000), heavy tobacco (p = .03) and heavy coffee consumers (p = .003). Conclusions: Cluster headache patients (a) had traumatic head injuries more frequently than migraineurs; and (b) were more often responsible for them, perhaps due to particular behaviours related to their lifestyles.

Atrial septal defect closure and migraine with aura: is there a correlation?

Recently, some authors detected increased frequency or new onset of migraine with aura (MA) after atrial septal defect (ASD) closure. We report the effects of ASD closure on the occurrence of MA in three patients of Parma Headache Centre. Two of them developed MA after the procedure one had a worsening of pre-existing MA. The increased frequency or the de novo onset of MA after ASD closure may be related to the alteration of some physiological variables that play a central role in the physiopathogenetic mechanisms of MA and may trigger attacks in predisposed individuals. In previous literature reports, the new pattern of MA appeared self-limiting within a few weeks or months. In our cases, it seemed to last longer, but the natural history of this headache subtype suggests that this finding could be related to the extended duration of our follow-up and to the prospective nature of our study.

Post-traumatic cluster headache: from the periphery to the central nervous system?

A correlation between head trauma and cluster headache is believed to exist. We report a case of post‐traumatic episodic cluster headache that fulfills the criteria of the International Classification of Headache Disorders, 2nd edition. The distinctive features of this case are: a close temporal relation between head trauma and headache onset; pain ipsilateral to the side of trauma; mild severity of trauma; episodic course well‐responsive to low doses of verapamil. Given the close temporal relation between the 2 events, multiple hypotheses can be advanced about a possible role of head trauma in the pathogenesis of cluster headache.