ONS and DBS for the Treatment of Chronic Cluster Headache

Research focus: Chronic cluster headache (CCH) is a pathological entity leading to a severe degree of disability. It is characterized by pain attacks occurring daily or spaced out by remission periods of <1 month, contrarily to the episodic form. When the condition results to be refractory to conservative treatments (both prophylactic and abortive treatments) and when such condition is present for at least 2 years, surgical treatment is suggested

La classificazione delle cefalee. Sua rilevanza per le forme correlate all’emergenza

La classificazione delle cefalee primarie comprende sia le forme primarie che secondarie. I criteri diagnostici specificano su quale base si debba escludere che un processo sottostante possa essere responsabile di una sintomatologia che simula una delle forme primarie. Alcuni segnali di allarme vanno tenuti in particolare attenzione e, anche se una percentuale relativamente bassa di pazienti con cefalea che si presentano ai Dipartimenti di Emergenza, soffre di forme secondarie queste devono sempre essere tenute in considerazione

Chronic daily headache: old problems, new vistas

In 1998 the problems concerning chronic daily headache (CDH) were neglected by the classification of International Headache Society (IHS). More than ten years later, this issue is still debated, also in light of the foreseen revised classification. Several therms have been used to define the clinical picture of CDH, and different criteria have been proposed for the diagnosis of these forms. In most cases, CDH appears to evolve from an episodic migraine, but the temporal limits between an episodic and a no-longer episodic form of migraine are questionabl

Abnormal modulatory influence of diffuse noxious inihibitory controls in migraine and chronich tension-type headache patients

The aim of this study was to evaluate the function of pain modulating systems subserving diffuse noxious inhibitory controls (DNICs) in primary headaches. DNICs were examined in 24 migraineurs, 17 patients with chronic tension-type headache (CTTH) and 20 healthy subjects by means of nociceptive flexion RIII reflex and the cold pressor test (CPT) as heterotopic noxious conditioning stimulation (HNCS). The subjective pain thresholds (Tp) and the RIII reflex threshold (Tr) were significantly lower in CTTH vs. controls. In controls a significant inhibition of the RIII reflex was observed during the CPT (-30%, P < 0.05). Conversely, migraine and CTTH patients showed facilitation (+31%, P < 0.05 and +40%, P < 0.01, respectively) of the RIII reflex during the HNCS. This study demonstrates a dysfunction in systems subserving DNICs in both migraine and CTTH. Impairment of endogenous supraspinal pain modulation systems may contribute to the development and/or maintenance of central sensitization in primary headaches