Management of cluster headache in the Emergency Department.

Although cluster headache (CH) is considered one of the most distinctive and painful primary headache disorders in clinical practice because of the brevity of each attack, its management is not always ergonomic or possible in the Emergency Department. In case of a previously competent diagnosis, the Emergency Department's team should send the patient to a headache centre where specialists in the management of CH can handle the pathology in the best way. In our headache centre we treat patients with CH attacks with a hyperbaric chamber, confirming the effectiveness of hyperbaric oxygen in CH patients.

Heart rate variability in cluster headache.

Eight patients with cluster headache were studied by evaluating the heart rate variability on the basis of 24-hour ECG monitoring performed during attacks (critic periods) to demonstrate if any imbalance of the autonomic nervous system was present and to determine its temporal correlation, if any, with the attack. The same monitoring allowed us to compare the patients' data during headache-free periods (intercritic periods) with those of normal controls. Our investigation demonstrated a severe sympathovagal imbalance during spontaneous attacks: the parasympathetic drive is at once increased at the onset with a mild reduction of the sympathetic drive, and all these modifications slowly disappear at the end of each attack.

Association between migraine and Celiac disease: results from a preliminary case-control and therapeutic study.

Objectives: Subclinical celiac disease (CD) has been associated with various neurological disorders, the most common being neuropathy and cerebellar ataxia. The aims of the present study were to assess the following: 1) the prevalence of CD in patients affected by migraine; 2) whether there are regional cerebral blood flow abnormalities in migraine patients with CD compared to migraine patients without CD; and 3) the effects of a gluten free diet in migraine patients with CD.

Methods: A total of 90 patients affected by idiopathic migraine were enrolled, and 236 blood donors were used as controls.

Tumor necrosis factor gene polymorphism in migraine.

Objective: To better define the involvement of human leukocyte antigen region (HLA) genes in migraine via an association study of the tumor necrosis factor (TNF) genes, located in the HLA class III region, with migraine with and without aura.

Background: Migraine without aura and migraine with aura are disorders involving multiple factors-environmental and genetic. In a previous study, we hypothesized a protective role for the HLA-DR2 antigen, providing additional basis for the proposed genetic heterogeneity between migraine without aura and migraine with aura.

Hyperbaric oxygen therapy in cluster headache.

Preliminary reports have shown that hyperbaric oxygen (HBO) interrupts cluster headache (CH) attacks. In the present study, 6 of 7 patients with episodic cluster headache who were treated with hyperbaric oxygen experienced an interruption of the attack. In 3 of 6 responders the florid period of the cluster headache was interrupted.