Italian guidelines for primary headaches: 2012 revised version

The first edition of the Italian diagnostic and therapeutic guidelines for primary headaches in adults was published in J Headache Pain 2(Suppl. 1):105–190 (2001). Ten years later, the guideline committee of the Italian Society for the Study of Headaches (SISC) decided it was time to update therapeutic guidelines. A literature search was carried out on Medline database, and all articles on primary headache treatments in English, German, French and Italian published from February 2001 to December 2011 were taken into account. Only randomized controlled trials (RCT) and meta-analyses were analysed for each drug. If RCT were lacking, open studies and case series were also examined. According to the previous edition, four levels of recommendation were defined on the basis of levels of evidence, scientific strength of evidence and clinical effectiveness. Recommendations for symptomatic and prophylactic treatment of migraine and cluster headache were therefore revised with respect to previous 2001 guidelines and a section was dedicated to non-pharmacological treatment. This article reports a summary of the revised version published in extenso in an Italian version

Drug-Induced Atrophic Rhinitis

Drug-induced atrophic rhinitis is a chronic condition characterized by destruction of nasal mucosa and sometimes osteocartilaginous structures, caused by severe chronic inflammation [1]. Many different conditions might be causative of atrophic rhinitis: infective diseases (tuberculosis, syphilis, leprosy, rhinoscleroma); systemic granulomatous diseases involving the upper airways (sarcoidosis, granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangioitis); non-Hodgkin extranodal lymphomas (Stewart’s granuloma), previous sinonasal surgery (empty nose syndrome), and abuse of nasal decongestants or drugs (cocaine) [1–4]. Patients suffering from secondary atrophic rhinitis usually come to the attention of ENT specialists mostly because of chronic nasal obstruction and sensation of 44 stuffy nose, which may become a considerable morbidity for them, decreasing their quality of life. Here are described secondary atrophic rhinitis caused by patient’s addiction to nasal vasoconstrictors and cocaine, leading respectively to rhinitis medicamentosa (RM), or rebound rhinitis, and cocaine-induced midline destructive lesions (CIMDLs)

Impulse control disorders in Parkinson's disease:a psychosocial perspective

Parkinson's disease (PD) is a progressive neurodegenerative disease primarily characterised by motor symptoms. However, another feature of PD which is receiving increasing attention is the phenomenon of impulse control disorders (ICDs), such as pathological gambling. To date, research into ICDs in PD has centred on a biomedical model of cause, related to the effects of dopamine replacement therapy. However, there are several areas of discrepancy in the current biomedical account of ICDs in PD. In addition, we argue that social and psychological factors also need to be considered to achieve a more complete understanding of the phenomenon. We present a novel conceptual model which combines biomedical and psychosocial factors in the genesis of ICDs in PD and use the model to identify a number of potential treatment intervention points and to highlight important outstanding questions concerning the inter-relationship between psychosocial and biomedical factors in the genesis of ICDs in PD