Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
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Randomized Controlled Trial
Greater occipital nerve block in chronic migraine.
Headache syndromes often involve occipital and neck symptoms suggesting a functional connectivity between nociceptive trigeminal and cervical afferents. Several studies have suggested that pain relief in migraine and other types of headache can be achieved by local injections of steroids, local anaesthetics or a mixture of both in the area of greater occipital nerve (GON). Usually greater occipital nerve block (GONB) is performed by using local anaesthetics alone or with steroid. ⋯ Both treatments were full tolerated. In our study, adding triamcinolone to local anaesthetic when performing GONB and TPIs was not associated with improved outcome in the sample of patients with TM. In both groups, the procedure resulted in significant and rapid relief of headache, neck pain, photophobia and phonofobia.
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Patients with chronic migraine are difficult to treat and often analgesic overusers. In this article attention is focused on aspects considered important for producing a definition of refractory in relation to this headache form. I propose that a "chronic migraine" patient should be considered "refractory" to pharmacological prophylaxis when adequate trials of preventive therapies at adequate doses have failed to reduce headache frequency and improve headache-related disability and, in patients with medication overuse, also failed to reduce the consumption of symptomatic drugs.
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Obsessive compulsive disorder is a highly disabling pathological condition which in the most severe and drug-resistant form can severely impair social, cognitive and interpersonal functioning. Deep-brain stimulation has been demonstrated to be an effective and safe interventional procedure in such refractory forms in selected cases. We here report the first Italian experience in the treatment of this pathology by means of nucleus accumbens stimulation, pointing out to some technical data which could be of help in localization of the target.
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The transesophageal echocardiography (TEE) and contrast-enhanced transcranial Doppler/Duplex ultrasonography (ceTCD) are complementary methods for diagnosing a right to left shunt across a patent foramen ovale. We report on a case of paradoxical embolism across a subclavian arterial-venous fistula. This case underlines the necessity of performing the ceTCD, as in this condition the right to left shunt could be detected by means of ceTCD, whereas the TEE reveals regular findings.
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The needle contact test (NCT) is a diagnostic technique useful to identify, through the contact of the needle on the skin of the ear, the most efficacious points for reducing pain during a migraine attack. The aim of this study was to identify the most important auricular zones for pain control by applying the NCT in a group of 15 women during a unilateral attack of migraine without aura. ⋯ The insertion of a semi-permanent needle in these zones allowed stable control of the migraine pain, which occurred within 30 min and persisted at the same levels 24 h later (ANOVA for repeated measures: p < 0.01). Pain was tested by using a visual analogue scale; the values recorded were the following: 7.6 +/- 1.6 at baseline and 4.3 +/- 1.7; 4.1 +/- 1.9; 3.9 +/- 1.8; 3.4 +/- 1.8; 2.3 +/- 1.6 after, respectively, 15, 30, 60, 120 min and 24 h.