Vincenzo Centonze

Immunological Aspects in Migraine: Increase of IL-10 Plasma Levels During Attack

In the present study, 23 patients with migraine without aura were monitored during a migraine attack. Plasma levels of interleukin (IL)‐4, IL‐5, IL‐10, and interferon‐γ were measured by enzyme‐linked immunosorbent assay techniques. Interestingly, we observed low to undetectable IL‐5 and IL‐4 levels, whereas high IL‐10 levels were seen in 52.2% of the patients. Interferon‐γ plasma levels were undetectable in all patients. After treatment with sumatriptan, 10 patients showed a subsequent decrease in IL‐10 and an increase in both IL‐4 and IL‐5 plasma levels. Although these findings are derived from a limited number of patients, the apparent return to the IL‐4 and IL‐5 cytokine profile observed during the interictal period leads us to speculate that a preferential enhancement of TH2‐type cytokine production may contribute to the pathogenesis of migraine.

Cytokines and migraine: increase of IL-5 and IL-4 plasma levels.

Thirty‐two patients suffering from migraine without aura were assessed during the interictal period to evaluate the contribution of cytokines to the pathophysiology of migraine. To this end, plasma levels of IFN‐γ, IL‐4, IL‐5, and IL‐10 were measured by enzyme‐linked immunosorbent assay (ELlSA) techniques. Plasma levels of both IFN‐γ and IL‐10 were not increased in the patients and did not differ significantly from healthy controls. Of interest, we observed a strong increase of IL‐5 levels in 84.3% as well as increased IL‐4 levels in 37.5% of patients with migraine without aura. These results suggest a preferential enhancement of some Th2‐type cytokines and may support the growing arguments of an immunoallergic mechanism in the pathophysiology of migraine.

Effects on migraine headache of MDL 72,222, an antagonist at neuronal 5-HT receptors. Double-blind, placebo-controlled study

MDL 72,222 (1aH, 5aH-tropan-3a-yl 3,5-dichlorobenzoate), a novel agent with antagonist activity at neuronal 5-HT receptors, was tested as an acute treatment for migraine pain under double-blind, placebo-controlled conditions. Forty-seven patients with common (n = 29) or classical (n = 8) migraine or mixed type with or without a psychogenic component (n = 10) received 20–40 mg MDL 72,222 (n = 24) or placebo (n = 23) intravenously during the headache phase of a migraine attack. MDL 72,222 was consistently superior to placebo in rapidly alleviating the migraine pain. The treatment was remarkably well tolerated. The results are consistent with the hypothesis that the pain of migraine is related to activation of neuronal 5-HT receptors and suggest that compounds such as MDL 72,222, which block neuronal 5-HT receptors, could be useful new therapeutic agents for the management of migraine.

Coexistence of Migraine and Cluster Headache: Report of 10 Cases and Possible Pathogenetic Implications

We report on 10 patients suffering from two types of primary headache, migraine and cluster, diagnosed according to IHS criteria, and selected from headache patients attending two Italian headache centers. We briefly review the literature on coexisting migraine and cluster headache, considering the time relationships between these two headaches. The present series seems not to confirm the hypothesis that migraine transforms into cluster headache since both headaches persist together in the patients. The series is of clinical interest particularly with regard to diagnosis and to treatment strategies. Furthermore, while migraine and cluster headache comorbidity must be confirmed by population‐based epidemiological studies, the possibility arises that the two conditions may be linked pathophysiologically: common genetic factors or functional alterations in the same central neurological circuits may play a role in the pathogenesis of both disorders.

Simultaneous Occurrence of Ipsilateral Cluster Headache and Chronic Paroxysmal Hemicrania: A Case Report

A 42‐year‐old man came to our headache unit in October 1995 complaining of recurrent attacks of headache, which had begun in February 1991. Chronic cluster headache was diagnosed, and he was given verapamil, 360 mg per day. The attacks ceased in the following months and verapamil was stopped in March 1996. In May 1997, a recurrence of the attacks required the readministration of verapamil, 360 mg per day. The attacks decreased (one to three per week), but after 2 months the patient reported a worsening in his condition due to the appearance of shorter attacks, which were diagnosed as chronic paroxysmal hemicrania. The administration of indomethacin, 225 mg per day, resulted in the disappearance of the short attacks.

Flunarizine in migraine prophylaxis: efficacy and tolerability of 5 mg and 10 mg dose levels

The use of flunarizine, a drug which has proven its efficacy in migraine, is often associated with important side effects. The aim of this paper has been to check their incidence at different dose levels (5 mg vs 10 mg). Our data confirm the occurrence of important side effects (in particular weight gain); on the other hand, they emphasize the dose-dependency of the side effects.

Non-Familial Hemiplegic Migraine Responsive to Naloxone

Two cases of non-familial hemiplegic migraine are described. Naloxone reversed the neurological deficits accompanying attacks, whereas the pain was uninfluenced. The possibility that the opiate-antagonist naloxone facilitates regression of neurological symptoms associated with migraine attacks in general is voiced….

Use of High Sumatriptan Dosages During Episodic Cluster Headache: Three Clinical Cases

The authors describe three patients with episodic cluster headache whose attacks were all treated with subcutaneous sumatriptan.