Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
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The aim of the present study was to investigate the possible relationships between the presence of headache-related photophobia and migraine-associated allodynia--a hallmark of central sensitization--among patients with different migraine types. A sample of 456 migraineurs was studied. ⋯ Overall, these findings suggest that light stimulation may contribute to central sensitization of pain pathways in migraineurs, possibly contributing to progression into chronic forms. The possible connections underlying this type of sensitization is offered by the recently published data on a non-image-forming visual retino-thalamo-cortical pathway which may allow photic signals to converge on a thalamic region which is selectively activated during migraine headache.
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Headache is a key symptom of idiopathic intracranial hypertension (IIH). Operational diagnostic criteria for "Headache attributed to IIH" are included in the international classification of headache disorders, the ICHD-2. The association of IIH with obesity was established by several reports. ⋯ According to statistical analyses, no differences were found for age, BMI, and ICP between patients with and without headache. Our results confirmed the strong association between headache and IIH. Although no significant correlations between some of the key features of IIH were found in this study, we suggest that further studies on larger series--possibly with a longitudinal evaluation--are needed, to help clinicians in categorizing different subgroups among IIH patients as well as in identifying the main factors influencing the prognosis of this disorder.
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The newly released version of the Global Burden of Disease (GBD 2010) ranks migraine between the most disabling diseases, the first among neurological ones, with a two-fold increase with respect to the previous GBD 2000 version. Almost 3 % of worldwide disability attributable to a specific disease, in terms of years lived with a disability, is due to migraine. The public health impact of migraine and headache disorders is thus a consolidated fact; however, further research is needed to provide stronger recognition of and policy actions for headache disorders in general, and in particular with regard to chronic forms of headache.
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The use of opioids for migraine is still controversial. Evidence-based guidelines do not recommend opioids as first-line treatment of migraine attacks, while clinical and epidemiological surveys demonstrate that the use of opioids is associated with more severe headache-related disability, symptomology and comorbidities, and greater health-care resource utilization. There are concerns that opioids may be misused or abused, leading to opioid abuse or dependence and migraineurs are particularly prone and at risk for the development of chronic daily headache from opioids overuse. Since clinical and preclinical studies evidence a pathophysiological role of opioids in migraine progression, opioids should be avoided in migraine patients.
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The use of opioids in headache treatment is very controversial. In the migraine acute attack use of short-acting opioids is not recommended by the principal guidelines but is frequent in North American emergency departments. Their efficacy in migraine acute attack has not been extensively studied but seems to be similar to non-steroidal anti-inflammatory drugs and metoclopramide. ⋯ Chronic migraine is a highly disabling condition. Although the options for prophylaxis therapy of migraine have expanded and improved considerably over recent years, chronic migraine remains very difficult to treat. The results coming from small clinical series are described, suggesting that in expert hands daily long-acting opioids provide an option for the treatment of some individuals with chronic intractable headaches.