Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
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Cluster headache, the most severe of primary headache conditions for functional and social impairment it provokes, has been recently the object of a great amount of clinical, physiopathological, surgical and functional neuroradiological studies aimed to uncover the real mechanisms which underlie its disabling manifestations. Refinement of methodological and systematic features of multidisciplinary researches in this field has been allowing for more and more precise delineations of the role of both peripheral and central nervous system's contribution in pathophysiology of the disease. Aim of this manuscript is the report of the present knowledge in the role of the different surgical options in the treatment of drug-resistant cluster headache and Short-lasting Unilateral neuralgiform headache attacks with Conjunctival injection and Tearing (SUNCT), which take into account their different hypothesized pathological mechanisms and which comprise central nervous system's approach (Deep Brain Stimulation [DBS] and peripheral approach, namely Occipital Nerve Stimulation (ONS) and Vagal Nerve Stimulation (VNS).
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The question in the title of this article arises from ambiguities in the diagnostic criteria for chronic migraine (CM) included in the 2004 International Classification of Headache Disorders, 2nd Edition (ICHD-II), and in the 2006 revision. More broadly speaking, it also arises from the fact that to date the general subject of chronic daily headaches (CDH) has not been approached in a correct and appropriate way. For all its limitations, ICHD-II has unquestionable merits and remains a fundamental tool. ⋯ Currently, then, the only way to approach the CDH issue is to put patients at the center and to focus on their life histories. If we reason strictly in terms of diagnostic classification criteria, which for this headache subtype are artificial and ambiguous, we may have trouble finding an answer to the title question. However, if we reason in broader clinical terms, putting at the center of our reasoning not only headache features, but patients with all their histories, the answer can only be that CM and chronic tension-type headache are two different clinical entities.
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Patients with chronic migraine headaches complicated by medication overuse (MO) present some of the most difficult treatment challenges for headache practitioners. Recent research has identified a variety of risk factors (including MO) that appear to be associated with the escalation of the frequency and severity of migraine headache. ⋯ The present article will highlight treatment issues that must be considered in the assessment and treatment of patients with chronic migraine and MOH. Case examples will be offered to illustrate the process of the implementation of these strategies.
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Drug consumption in older people is usually high and many prescribed medications have unsuspected anticholinergic (ACH) (Table 1) properties. Drug induced ACH side-effects are particularly severe in aging brain and even more in demented patients. This review will focus on the association between ACH drug intake and the risk of developing central nervous system side-effects in elderly people. The threat of developing cognitive impairment, psychosis and delirium will be particularly analyzed.
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The aim of this study was to validate the Italian version of the Neuropathic Pain Symptom Inventory (NPSI) in patients with neuropathic pain due to peripheral nerve diseases, and also to evaluate the validity of a new NPSI score: a frequency weighted NPSI score (NPSI-FW). First, the original version of the NPSI was translated into Italian. Then the validity and reliability of the Italian NPSI (I-NPSI) were tested in 392 Italian patients consecutively referred to 16 Italian outpatient services for peripheral nerve diseases, by correlating the I-NPSI scores with other pain scales. ⋯ Reproducibility and responsiveness were good. Our study shows the validity of the I-NPSI and demonstrates its reliability for assessing neuropathic pain in patients with peripheral nerve diseases. The I-NPSI scores represent reliable measurements to assess neuropathic symptoms and effectiveness of treatment on them.