Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
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The studies of different antiepileptic drugs (AEDs) in the prophylaxis of episodic migraine, cluster headache (CH) and chronic headache forms (chronic daily headache, transformed or chronic migraine, chronic tension-type headache) are reviewed. The main results from published trials are summarised - focusing on responder rates as reported in placebo-controlled, double-blind studies. ⋯ Overall, evidence of efficacy of different AEDs in chronic headache forms and in CH is still lacking, most studies being open-label, small-sample trials. Nevertheless, encouraging data from controlled trials are emerging for TPM in the treatment of chronic headache forms.
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Over the last 100 years, the discovery of new analgesics has been a complex and difficult task. However, remarkable progress in the identification of novel molecular targets relevant for pain medicines has been reported. ⋯ Recent preclinical and clinical data on the localisation, regulation and plasma levels of CGRP and on the function of CGRP-R will be summarised. The reviewed findings highlight the major function of CGRP in migraine and the use of CGRP-R antagonists as a novel approach for the treatment of migraine attack and, perhaps, as migraine prophylactic medicines.
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The neuroimaging of experimental and clinical pain has revolutionised our understanding of the physiological responses to pain and paved the way for a better understanding of the pathophysiology of chronic pain syndromes. Extensive research on the central mechanisms regarding the sensory-discriminative dimensions of pain have revealed a complex network of cortical and subcortical brain structures involved in the transmission and integration of pain, the so-called pain matrix. Although brain imaging and pharmacological studies have generated some insight into the circuitry that may be involved in the generation of chronic pain symptoms, further research into brain imaging of chronic pain is clearly warranted. However, modern neuroimaging suggests that the chronification of pain (and headaches) involves functional and structural plasticity of both the central and peripheral nervous system.
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We examined 59 consecutive patients presenting between 1993 and 2006 at our centre diagnosed with headache associated with spontaneous intracranial hypotension syndrome (SIH). Thirty-six (61%) patients were women; the mean age was 47 years (range 20-68). Cerebral MRI with contrast confirmed SIH in all patients. ⋯ All SIH patients suffered from headache. Early recognition of SIH may avoid dangerous worsening due to delayed diagnosis. Orthostatic headache, the main symptom, suggests the diagnosis.
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About 60% of patients complain of cutaneous allodynia during migraine episodes, often in the periorbitary region of the pain side. Pre-clinical studies have shown that the underlying mechanism is sensitisation of primary nociceptors and central trigeminovascular neurons and that patients have a lower pain threshold for mechanical stimulation compared to controls. The objective of this study was to determine the prevalence of allodynia during headache attacks in different forms of migraine. ⋯ Allodynia was a common complaint in migraineurs, being present in more than 40% patients of each group. A higher frequency was observed in MA and in CM patients. This observation may suggest that both frequency of attacks and presence of aura episodes may contribute to induce changes in neuronal activation threshold thought to sustain allodynia.