Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
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Observational Study
Electromyography data in chronic migraine patients by using neurostimulation with the Cefaly® device.
The objective of this observational study is to report clinical and instrumental results obtained in 23 chronic migraine sufferers treated with transcutaneous neurostimulation with the Cefaly(®) device. The electrom yography (EMG) parameters of the patients monitored before and during neurostimulation with the Cefaly(®) device showed a significant increase in the EMG amplitude and frequency values in the frontalis, anterior temporalis, auricularis posterior and middle trapezius muscles. The Cefaly(®) device could act on the inhibitory circuit in the spinal cord thus causing a neuromuscular facilitation and may help reduce contraction of frontalis muscles.
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Several observational studies report that subjects with migraine with aura have a higher prevalence of right-to left shunt, commonly due to patent foramen ovale, and that patent foramen ovale is more prevalent in subjects with migraine with aura. Although migraine without aura has been less extensively studied, it does not seem to be associated with an increased prevalence of right-to left shunt. The mechanism that underlies the possible relationship between patent foramen ovale and migraine with aura remains speculative. ⋯ At this moment, there is no convincing evidence that excess stroke risk of migraine is simply mediated by patent foramen ovale through paradoxical embolism. Several non-controlled studies suggest that closure of the foramen ovale significantly reduces attack frequency in migraine patient, but the only prospective placebo-controlled trial does not support these results. Patent foramen ovale closure, at present, is not indicated as a treatment for migraine in clinical practice.
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Orthostatic headache can be the leading symptom of intracranial hypotension, however, not all orthostatic headaches are due to cerebrospinal fluid leaks and these forms can be a clinical problem, especially for treatment. Aim of this study was to review patients with persistent orthostatic headache in whom a detailed head and spinal MRI follow-up did not reveal any sign of intracranial hypotension and to evaluate which treatment can be considered the first choice. Patients admitted to our headache center for evaluation of persistent orthostatic headache and followed after first admission with clinical and neuroradiological controls were systematically reviewed. 11 patients (7 M, 4 F) followed in a period lasted from 10 months up to 2 years were studied. ⋯ We found out that patients with the best outcome were the ones treated with antidepressants. Persistent orthostatic headache without any neuroradiological sign of intracranial hypotension is a challenging problem for clinicians. Although the International Classification of Headache Disorders (ICHD-3 beta version) criteria suggests the possibility of epidural blood patch in orthostatic headache without causes, we believe that a pharmacological treatment tailored on each patient should be always considered and antidepressants can be the first choice.
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The association between headache and changes in intracranial pressure is strong in clinical practice. Syndromes associated with abnormalities of cerebrospinal fluid (CSF) pressure include spontaneous intracranial hypotension (SIH) and idiopathic intracranial hypertension (IIH). In 2013, the Headache Classification Committee of the International Headache Society (IHS) published the third International Classification of Headache Disorders (ICHD-3 beta version). ⋯ In Group B, application of ICHD-2 showed 91 % patients fitting criterion A; 100 %, criterion B; 100 %, criterion C; and 68 %, criterion D; while applying ICHD-3 beta version all patients, 100 % fitted criterion A, B, C, D. 73 % patients of Group A fitted all ICHD-2 criteria and 97.5 % all ICHD-3 beta version criteria for headache attributed to IIH. 68 % patients of Group B fitted all ICHD-2 criteria and 100 % all ICHD-3 beta version criteria for headache attributed to SIH. In Group C and Group D, although patients fitted some clinical criteria, the underlying disorder caused exclusion of both ICHD-2 and ICHD-3 beta version applicability for headache attributed to IIH and SIH; they were coded in criteria for the secondary headaches. In summary, ICHD-3 beta version seems to have better applicability but worse reliability in defining headache features in CSF alterations.
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Migraine is a primary headache characterized by recurrent attacks of head pain associated with nausea or vomit, photophobia, phonophobia and osmophobia. The presence of osmophobia during migraine attacks seems to be a very specific complaint. Cutaneous allodynia (CA) is very common in migraineurs, and it is the most evident clinical manifestation of central sensitization, a mechanism involved in migraine chronification. ⋯ The prevalence of both CA and osmophobia was higher in chronic than in episodic migraineurs. The association between these two symptoms was significant in chronic migraineurs at Chi square test. The highlighted relationship between CA and osmophobia may be interpreted in different ways: central sensitization induced by recurrent pain stimulation may in parallel induce a distortion of both cutaneous sensitivity (CA) and olfaction (osmophobia); alternatively, the recurrent olfactory stimulation in subjects with a hypersensitivity to olfactory stimuli may co-work with repetitive pain stimulation to induce the central sensitization process.