Publications by authors named "Paul Rizzoli"
Background: Mindfulness-based treatments gained popularity for migraine treatment. In this manuscript we report the results of a single-arm open pilot study that evaluated the impact of a multimodal web-based intervention combining home-based medication withdrawal, patients' education, and online mindfulness-based interventions. We aimed to address whether our program had the ability to show a change in the observed parameters and the study should therefore be intended as an early phase trial.
View Article and Find Full Text PDFObjective: Medication-overuse headache (MOH) has been described for almost 100 years and is characterized as a daily or near-daily headache that usually presents in patients with preexisting primary headache disorders who are overusing one or more acute or symptomatic headache medications. This article reviews the diagnosis and management of patients with MOH.
Latest Developments: The International Classification of Headache Disorders criteria for MOH have changed over time.
Article Synopsis
- - Atogepant is a specific oral medication for preventing migraines in adults, addressing the need for treatments that are both effective and well-tolerated, as traditional options often fail to maintain patient adherence due to side effects.
- - The analysis combined data from two short-term trials and two long-term safety studies, involving over 2,900 participants to evaluate atogepant's safety and tolerability compared to a placebo and standard care.
- - Results showed that while a significant portion of participants on atogepant experienced treatment-emergent adverse events, most events were not serious and only a few caused participants to drop out, with common side effects including upper respiratory infections, constipation, and nausea.
Though clearly described as far back as the 17th century, chronic migraine has defied precise categorization and has continued to develop as an important diagnostic concept with significant societal impact. Worldwide prevalence is estimated to be between 1% and 3%, and these patients form a dynamic group cycling between chronic and episodic migraine. Theories of pathogenesis are developing supported by recent imaging and other findings.
View Article and Find Full Text PDFMigraine disorders are common in populations of children and adolescents. There are different pharmacological treatments for migraine in young patients, but none have specific indications, and doubts about their efficacy exist. The feasibility and effectiveness of behavioral approaches have already been documented in clinical experiences, and they are generally associated with fewer or no unpleasant effects.
View Article and Find Full Text PDFArticle Synopsis
- Pain catastrophizing and cutaneous allodynia are common issues in patients with chronic migraines linked to medication overuse, and their improvement is associated with overall clinical recovery.
- In a study involving 96 patients receiving OnabotulinumtoxinA therapy, significant improvements were observed in headache frequency, medication usage, and disability within six months, with effects sustained over 12 months.
- The reduction in pain catastrophizing, particularly related to feelings of helplessness, was identified as a predictor for lower headache frequency and decreased medication intake, suggesting that combining OnabotulinumtoxinA with behavioral treatments targeting pain catastrophizing could optimize patient outcomes.
Medication overuse headache (MOH), new daily persistent headache (NDPH), and persistent refractory headache attributed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection represent a significant burden in terms of disability and quality of life, and a challenge in terms of definition, pathophysiology, and treatment. Regarding MOH, prevention without withdrawal is not inferior to prevention with withdrawal. Preventive medications like topiramate, onabotulinumtoxinA, and calcitonin gene-related peptide (CGRP) monoclonal antibodies improve chronic migraine with MOH regardless of withdrawal.
View Article and Find Full Text PDFBackground: Migraine disorders are common among adolescents: however, the efficacy of medical prophylaxis is limited in this population. This study reports preliminary findings on the feasibility and effect of a mindfulness-based intervention delivered via web for adolescents with chronic migraine (CM) and high-frequency episodic migraine (HFEM) without aura.
Methods: Patients with CM or HFEM received six session of a mindfulness-based treatment and were followed-up for 6 months as part of a larger study.
Background: The study had been initiated because of restrictions put in place to control the spread of coronavirus in Milan in March 2020 that impacted clinical activities at our tertiary headache center in Milan (Foundation IRCSS Carlo Besta Neurological Institute). Treatment efforts were modified to make use of telephonic and internet communication to maintain care of our patients.
Methods: Nineteen patients had undergone our withdrawal protocol for medication overuse headache and were scheduled for follow-up that included pharmacological prophylaxis combined with behavioral therapy and mindfulness, generally performed in small group face-to-face sessions.
In this single-arm pilot open-label study we examined the effect of a mindfulness-based intervention on reduction of headache frequency after 12 months in adolescents aged 12-18 with chronic or high-frequency migraine without aura. Adolescents were recruited at the headache center of the C. Besta Neurological Institute and followed-up for 12 months.
View Article and Find Full Text PDFObjective: Trigeminal neuralgia (TN) is a chronic, often refractory, pain condition, which adversely affects the lives of patients. Current treatments are only mildly effective. Anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies have been successfully studied in the treatment of migraines.
View Article and Find Full Text PDFObjective: To assess telehealth practice for headache visits in the United States.
Background: The rapid roll out of telehealth during the COVID-19 pandemic impacted headache specialists.
Methods: American Headache Society (AHS) members were emailed an anonymous survey (9/9/20-10/12/20) to complete if they had logged ≥2 months or 50+ headache visits via telehealth.
Objective: We compared the incremental effects of adding acceptance and commitment therapy (ACT) to pharmacological treatment as usual (TAU) in a sample of patients with high frequency episodic migraine without aura (HFEM), assessing impact on a spectrum of measures across multiple domains.
Background: Patients with HFEM are at risk of developing chronic migraine and medication overuse headache. ACT has been shown to be effective for the treatment of various chronic pain conditions, but little attention has been given to its therapeutic value in the management of recurring headaches.
Objective: "Pain interference" and "headache impact" refer to negative consequences that pain and headache have on one's life. This study investigated determinants of these negative impacts in a large patient cohort who have chronic migraine with medication overuse.
Methods: Six hundred and eleven adults were enrolled from 34 headache, neurology, and primary care clinics.
A recent study reports an improvement in migraine symptoms during a COVID-19 lockdown in the Netherlands. The findings suggest that lifestyle changes can substantially alter the course of migraine, opening the door for greater use of behavioural interventions alongside existing pharmacological therapies.
View Article and Find Full Text PDFBackground And Objectives: Accurate, up-to-date estimates of the burden of migraine and severe headache are important for evidence-based decision-making about workforce needs and the distribution of health resources. We used data from US government health surveys to report the prevalence, trends, and impact of this condition by age, sex, and poverty status.
Methods: We identified the most recent, publicly available summary statistics from the National Hospital Ambulatory Medical Care Survey, the National Ambulatory Medical Care Survey, and the National Health Interview Survey.
Objective: To assess the PREEMPT protocol modifications that have developed in clinical practice over time.
Background: The United States Food and Drug Administration approved the 155-unit fixed-dose, fixed-site PREEMPT protocol of onabotulinumtoxinA (BoNT-A) injections for migraine prevention 9 years ago.
Methods: This is an anonymous survey with free text response options of Headache Medicine clinicians.
Background: We assessed the safety profile of lasmiditan, a selective 5-HT receptor agonist without vasoconstrictive activity being developed as an acute therapy for migraine.
Methods: SAMURAI and SPARTAN were Phase 3 double-blind studies of patients with migraine, randomized to oral lasmiditan 50 mg (SPARTAN only), 100 mg, 200 mg, or placebo to be taken within 4 hours of onset of migraine pain. Safety data from the studies were integrated.