Cluster headache: a quasi-rare disorder needing a reappraisal

Editoria

Update on medication-overuse headache and its treatment

OPINION STATEMENT: Medication-overuse headache-i.e., a too-frequent consumption of acute headache medications leading to increased headache frequency and reduced effectiveness of acute and preventive treatments-is a serious medical condition whose pathophysiology still remains incompletely known, which is reflected into a lack of mechanism-based treatments. The first mandatory step in the therapeutic strategy remains withdrawal of the abused drug, preferably abrupt, in concomitance with a detoxification pharmacological regimen to lessen withdrawal symptoms. Intravenous hydration, antiemetics, corticosteroids (prednisone), tranquilizers (benzodiazepine), neuroleptics, and rescue medication (another analgesic than the overused) should be delivered in various combinations, on an inpatient (hospitalization and day hospital) basis or outpatient basis, depending on the characteristics of the specific patient and type of overuse. Inpatient withdrawal should be preferred in barbiturate and opioid overuse, in concomitant depression, or, in general, in patients who have difficulty in stopping the overused medication as outpatients. In contrast, in overuse limited to simple analgesics in highly motivated patients, without high levels of depression and/or anxiety, home detoxification should be chosen. Re-prophylaxis should immediately follow detoxification, ideally with local injections of onabotulinumtoxinA every 3 months or topiramate orally for at least 3 months. Adequate information to patients about the risks of a too-frequent consumption of symptomatic headache medications is essential and should constantly parallel treatment to help preventing relapse after detoxification and re-prophylaxis

New players in the preventive treatment of migraine.

Migraine is a common, chronic disorder of the brain causing much disability, as well as personal, familial and societal impact. Several oral preventive agents are available in different countries for the prevention of migraine, but none have performed better than 50% improvement in 50% of patients in a clinical trial. Additionally, each has various possible adverse events making their tolerability less than optimal. Recently, three monoclonal antibodies targeting the calcitonin gene-related peptide (CGRP) ligand (LY2951742, ALD403 and TEV-48125) and one targeting the CGRP receptor (AMG 334) have completed phase 2 trials, and the results have been reported. These early results show them all to be somewhat more effective than placebo, with no serious adverse events. Three have been studied for episodic migraine, and only TEV-48125 has been studied for both high frequency episodic and chronic migraine. Moreover, preliminary data suggests that neurostimulation is effective in migraine treatment, including stimulation of the sphenopalatine ganglion, transcutaneous supraorbital and supratrochlear nerve, and transcutaneous vagus nerve. In this article, these innovative therapies will be reviewed

Fathoming the kynurenine pathway in migraine: why understanding the enzymatic cascades is still critically important

Kynurenine pathway, the quantitatively main branch of tryptophan metabolism, has been long been considered a source of nicotinamide adenine dinucleotide, although several of its products, the so-called kynurenines, are endowed with the capacity to activate glutamate receptors, thus potentially influencing a large group of functions in the central nervous system (CNS). Migraine, a largely unknown pathology, is strictly related to the glutamate system in the CNS pathologic terms. Despite the large number of studies conducted on migraine etio-pathology, the kynurenine pathway has been only recently linked to this disease. Nonetheless, some evidence suggests an intriguing role for some kynurenines, and an exploratory study on the serum kynurenine level might be helpful to better understand possible alterations of the kynurenine pathway in patients suffering from migrain

Monitorización y optimización de tierras con drones y fotogrametría aérea para aplicaciones de precisión en agricultura

[ES] El proyecto consiste en aplicar una tecnología específica para la rama de agricultura de precisión. La tecnología como todos sabemos, sufre una enorme evolución y tenemos que ser capaces de demostrar que somos los mejores en usarla. En concreto, en mi profesión he decido de seguir la rama de agricultura de precisión y esto porque es un nuevo aspecto de mi carrera. El objetivo de este proyecto, es proporcionar unos resultados óptimos para la mejora de producción para los agricultores. Con manera de que ellos reducirán los fertilizantes y los usos químicos en sus productos y tendrán muchos beneficios económicos. El trabajo se desarrolló para la zona de Algemesí en la Comunidad Valenciana en 17 de Octubre en 2016. El vuelo se realizó con un Multicóptero, modelo DJI F-450 UAV (UnmannedAerialVehicle) o VANT (Vehículo Aéreo No Tripulado), con una cámara Multiespectral y RGB llamada MicraSense para poder sacar el índice de vegetación NDVI (Normalized Difference Vegetation Index). Los resultados que queremos presentar son unos modelos de MDS (Modelo Digital de Superficie), MDT (Modelo Digital de Terreno) y un Ortomosáico. Sobre ello, he tomado unos puntos de control con un GPS de Leica para poder georreferenciar el Ortomosáico. Realice con los puntos de apoyo una imagen junto con el Google Maps del área para poder mostrar que los puntos tomados en el área se diferencian. El proceso de los datos se realizó en el Departamento de Topografía y en mi casa utilizando dos diferentes ordenadores. El Software que utilice para procesar los datos fue el Pix4D Mapper Pro. Estos hechos sugieren que los instrumentos utilizados en este estudio representan una solución rápida, fiable y eficiente para la evaluación de los cultivos para aplicaciones agrícolas.[EN] The project consists of applying a specific technology for the precision agriculture branch. Technology as we all know undergoes enormous evolution and we have to be able to demonstrate that we are the best in using it. Specifically, in my profession I have decided to follow the branch of precision agriculture and this because it is a new aspect of my career. The objective of this project is to provide optimum results for improved production for agriculturists. So that they will reduce the fertilizers and the chemical uses in their products and will have many economic benefits. The work was developed for the area of Algemesí in the Valencian Community on 17 of October of 2016. The flight was realized with a Multicopter, model DJI F-450 UAV (Unmanned Aerial Vehicle) or VANT (VehículoAéreo No Tripulado), with a Multispectral and RGB camera called MicraSense to be able to extract the index of vegetation NDVI (Normalized Difference Vegetation Index). The results that we want to present are models of DSM (Digital Surface Model), DTM (Digital Terrain Model) and an Orthomosaic. On this, I have taken some control points with a Leica GPS to be able togeoreferentiate the Orthomosaic.I made with the points of control an image along with the Google Maps of the area, to be able to show that the points taken in the area they differ. The data processing was done in the Department of Surveying and in my house using two different computers. The software used to process the data was the Pix4D Mapper Pro. These facts suggest that the instruments used in this study represent a fast, reliable and efficient solution for the evaluation of crops for agricultural applications.Mitsikostas, E. (2017). Monitorización y optimización de tierras con drones y fotogrametría aérea para aplicaciones de precisión en agricultura. Universitat Politècnica de València. http://hdl.handle.net/10251/86353TFG

Guideline on the use of onabotulinumtoxinA in chronic migraine. a consensus statement from the European Headache Federation

OnabotulinumtoxinA is being increasingly used in the management of chronic migraine (CM). Treatment with onabotulinumtoxinA poses challenges compared with traditional therapy with orally administered preventatives. The European Headache Federation identified an expert group that was asked to develop the present guideline to provide recommendations for the use of onabotulinumtoxinA in CM. The expert group recommend onabotulinumtoxinA as an effective and well-tolerated treatment of CM. Patients should preferably have tried two to three other migraine prophylactics before start of onabotulinumtoxinA. Patients with medication overuse should be withdrawn from the overused medication before initiation of onabotulinumtoxinA if feasible, if not onabotulinumtoxinA can be initiated from the start or before withdrawal. OnabotulinumtoxinA should be administered according to the PREEMPT injection protocol, i.e. injecting 155 U-195 U to 31-39 sites every 12-weeks. We recommend that patients are defined as non-responders, if they have less than 30% reduction in headache days per month during treatment with onabotulinumtoxinA. However other factors such as headache intensity, disability and patient preferences should also be considered when evaluating response. Treatment should be stopped, if the patient does not respond to the first two to three treatment cycles. Response to continued treatment with onabotulinumtoxinA should be evaluated by comparing the 4 weeks before with the 4 weeks after each treatment cycle. It is recommended that treatment is stopped in patients with a reduction to less than 10 headache days per month for 3 months and that patients are re-evaluated 4-5 months after stopping onabotulinumtoxinA to make sure that the patient has not returned to CM. Questions regarding efficacy and tolerability of onabotulinumtoxinA could be answered on the basis of scientific evidence. The other recommendations were mainly based on expert opinion. Future research on the treatment of CM with onabotulinumtoxinA may further improve the management of this highly disabling disorder

Refractory Headache: One Term does Not cover All – A Statement of the European Headache Federation

[No abstract available

Framing education on headache disorders into the Global Burden of Disease Study 2010 : the European Headache Federation stands ready

Framing education on headache disorders into the Global Burden of Disease Study 2010. The European Headache Federation stands ready

Aging, cellular senescence, and progressive Multiple Sclerosis

Aging is one of the most important risk factors for the development of several neurodegenerative diseases including progressive multiple sclerosis (MS). Cellular senescence (CS) is a key biological process underlying aging. Several stressors associated with aging and MS pathology, such as oxidative stress, mitochondrial dysfunction, cytokines and replicative exhaustion are known triggers of cellular senescence. Senescent cells exhibit stereotypical metabolic and functional changes, which include cell-cycle arrest and acquiring a pro-inflammatory phenotype secreting cytokines, growth factors, metalloproteinases and reactive oxygen species. They accumulate with aging and can convert neighboring cells to senescence in a paracrine manner. In MS, accelerated cellular senescence may drive disease progression by promoting chronic non-remitting inflammation, loss or altered immune, glial and neuronal function, failure of remyelination, impaired blood-brain barrier integrity and ultimately neurodegeneration. Here we discuss the evidence linking cellular senescence to the pathogenesis of MS and the putative role of senolytic and senomorphic agents as neuroprotective therapies in tackling disease progression