Teresa Catarci

Amitriptyline Is Effective in Chronic But Not in Episodic Tension-Type Headache: Pathogenetic Implications

The tricyclic antidepressant amitriptyline, is an effective drug for the treatment of chronic tension‐type headache and for other chronic pain syndromes, but it is also effective in the prophylaxis of an episodic type of headache such as migraine. However, its efficacy in episodic tension‐type headache has not yet been clarified. We compared the efficacy of amitriptyline (25 mg/day) in 82 nondepressed patients with either chronic or episodic tension‐type headache in an open‐label study. Amitriptyline significantly reduced (P<0.05) frequency and duration of headache as well as analgesic consumption in chronic, but not in episodic, tension‐type headache. Further placebo‐controlled trials, possibly with higher doses of amitriptyline, might confirm if the different pattern of response to amitriptyline can be explained in terms of different involvement of central nociception and of peripheral myofascial factors in the chronic and in the episodic forms of tension‐type headache.

A CARE pathway in medication–overuse headache: the experience of the Headache Centre in Pavia

Medication–overuse headache (MOH) is one of the headache forms that most frequently prompts patients to consult a specialist headache centre. The prevaence of this form in the general population is approximately 1–2%. Around 40% of patients seen at headache centres present with a chronic form of headache and 80% of this chronic headache patients make excessive use of symptomatic drugs. MOH shows a clinical improvement, accompained by a reduction in the consumption of analgesic drugs, if patients are submitted to detoxification therapy. But detoxification is only the first stage in a long and complex course of care and global approach demands adequate follow–up visit to prevent early relapses. At the Headache Centre of the C. Mondino Institute of Neurologt in Pavia, a course of care (CARE) has been developed for the complente management of patients with MOH both during Hospitalization and durimg the subsequent follow–up period. CARE IS designed to trace the clinical, psychopathological and pharmacological profile of MOH in the short–, medium– and long–term; to look for factors possibility predictive of relapse; to assess the direct costs linked to overuse–headache in the year leading up to and following detoxification; and to evaluate disability, in terms of working days lost, before and after detoxification.

Empty Sella and Headache

SYNOPSIS

Psychiatric disorders in chronic daily headache: detection by means of the SCID interview

Abstract The identification of possible individual or/and environmental factors responsible for the chronic evolution of headache has represented a critical issue in recent years. The goal of this research was to enroll adult chronic daily headache (CDH) sufferers and to seek for psychiatric disorders, as possible transformation factor, by means of a complex neuropsychological investigation. The psychiatric evaluation was performed using the Structured Clinical Interview (SCID), according to the DSM-IV diagnostic criteria. The overall prevalence of psychiatric disorders according to DSM-IV criteria was 66.1%. No statistical difference was found in psychiatric comorbidity according to gender (women, 68.9% men, 52,4%). The prevalence of psychiatric disorders was 69.7% in drug abusers (classified in accordance with clinical interview) and 57.1% in non-abusers (the difference was not statistically significant). Comparing the three subtypes of CDH, a psychiatric disorder was found in 50% of chronic tension-type headache patients, in 72.2% of those with chronic coexisting migraine and tension-type headache(CT vs. CCMT-TH, p<0.01) and in 70.3% of patients with chronic migraine.

Nimodipine in migraine: clinical efficacy and endocrinological effects.

SummarySerum prolactin is increased during chronic flunarizine treatment of patients suffering from migraine. In order to clarify the role of calcium in control of the secretion of anterior pituitary hormones, a study has now been made of the effects of chronic nimodipine and propranolol treatment of migraine patients on prolactin (PRL), luteinizing hormone (LH) and growth hormone (GH) levels. 11 patients were treated with nimodipine and 8 with propranolol for four months. A statistically significant reduction in the frequency of the attacks was demonstrated in both groups. No significant change was found in the hormones levels during nimodipine treatment.

The Dexamethasone Suppression Test in Essential Headache

SYNOPSIS

P071. Headache self-administered questionnaire in the waiting room, a useful and easy tool for headache centres

Background The diagnosis of headache relies mostly upon the patient’s history, hence a detailed and time consuming medical history collection is required in the clinical setting. Second level headache centres of the Italian National Health Service often face the difficulty of a shorter availability of time. Therefore, we managed to elaborate a self-administered questionnaire to be filled in while the patients are in the waiting room, in order to gather the basic information prior to the visit.

Management of headache patients

Headache is a very common complaint, in both primary care and in specialist settings. Headache patients account for around 20% of all outpatients seen in neurological practices and their management, particularly when they present with intractable headache, or are suspected of having secondary headaches, can be a challenge for the clinician. All the guidelines agree that the diagnosis of headache is merely clinical and that testing is not recommended if the individual is not significantly more likely than anyone else in the general population to have a significant abnormality. A full history of the temporal profile of the headache should be gathered first: when it first started, the circumstances of its onset, whether it has remained the same over time, and, if not, in what way it has changed. The patient should be questioned carefully about the specific characteristics of the attacks (frequency, duration, severity of the pain, efficacy of the treatments). It is also necessary to establish whether there is a history of other diseases and to investigate gynecological and psychological history, and family history. History alone allows a diagnosis of probable primary headache. Signs of a possible secondary headache must be carefully sought in all patients, even in apparently clear-cut cases. The guidelines recommend careful investigation of new headaches or those whose features have recently changed in order to exclude secondary headache. Once a secondary headache has been reasonably ruled out, it can help the patient to investigate possible comorbid pathologies and suggest appropriate lifestyle changes.

Chronic daily headache: a Rorschach study

Abstract The aim of this study was to describe the distinctive personality traits and their interest to the development of a chronic form of headache, by means of the Rorschach test, a projective approach, in an automated version compiled by a trained system (PRALP3). This study did not show the existence of a pathological structure in the chronic headache sufferer personality (in the psychiatric sense of the word). The most important finding is the admission that both neurosis associated with anxious-depressive elements and inhibited emotional overflowing are important factors in the genesis of chronic daily headache. This study does not exclude that other factors different from personality traits may also play a pathogenetic role in headache worsening. In other words, the development of chronic daily headache may be a patterned or learned response generated by the brain in relation to multiple inciting causes (stress, drug abuse) or individual predisposition (personality traits).