Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
-
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.
-
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.
-
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.
-
Caffeine is the most widely consumed psychostimulant drug. It is a potent antagonist of adenosine receptors at dosages consistent with common dietary intake. ⋯ With chronic repetitive intake, caffeine is associated with an increased risk of development of analgesicoveruse headache, chronic daily headache and physical dependency. Cessation of caffeine use following chronic exposures leads to a withdrawal syndrome, with headache as a dominant symptom.
-
The placebo effect is the effect that follows the administration of an inert treatment (the placebo), be it pharmacological or not. It is important to understand that a placebo procedure simulates a therapy through the surrounding psychosocial context. ⋯ Thus, there is not a single placebo effect but many, so that we have to look for different mechanisms in different conditions and in different systems and apparatuses. Today we are beginning to understand some of the neurobiological mechanisms of the placebo response, and this knowledge may help better understand the top-down control of the incoming sensory input, like pain, and the intricate interaction between mind and body.