Clinical and para-clinical tests in the routine examination of headache patients.

Para-clinical examinations in the diagnosis and treatment control of headache patients vary considerably between clinics and headache centers. Among the neurological societies in Europe there has been a consensus that some common procedures and recommendations should be created. In the Fall of 1998, the European Federation of Neurological Societies (EFNS) commissioned a Task Force on Neurophysiological Tests and Imaging Procedures in Headache Patients.

Headache in the Diagnosis-Related Groups (DRG) era: management and appropriateness of admission.

Headache is an extremely common disorder which has a marked impact on the utilisation of healthcare resources and constitutes a considerable socio-economic burden. The related costs, both direct and indirect, are especially high in developed countries, since headache predominantly affects an economically-active section of the population. The Diagnosis-Related Groups (DRG) system, a method for reimbursing healthcare structures for patient admissions, was introduced in Italy in 1995.

Asymmetrical reduction of the nociceptive flexion reflex threshold in cluster headache.

The nociceptive flexion reflex (NFR) of the lower limbs (RIII reflex) was examined bilaterally in 54 cluster headache (CH) patients suffering from episodic CH (ECH) and chronic CH (CCH). Fifteen ECH patients were examined in both remission and active phases. The RIII reflex threshold (Tr) and the threshold of pain sensation (Tp) were significantly reduced on the symptomatic side in patients with episodic CH during the bout.

Effects of hypnosis on diffuse noxious inhibitory controls.

The neurophysiological mechanisms of hypnotic analgesia are still under debate. It is known that pain occurring in one part of the body (counterstimulation) decreases pain in the rest of the body by activating the diffuse noxious inhibitory controls (DNICs). The aim of this study was to explore the effects of hypnosis on both pain perception and heterotopic nociceptive stimulation.

[Pathogenesis of tension headache: role of temporomandibular disorders. A research protocol].

Background: The purpose of this research is to verify through a blind, controlled study if there is a positive correlation between tension-type headache and the most likely causative factors. In accordance with the headache classification of the international headache society, they are: oro-mandibular dysfunction; psychosocial stress; anxiety; depression; headache as a delusion or an idea; muscular stress; drug overuse for tension-type headaches.

Methods: The subjects who participated in the study were selected from patients diagnosed as having tension-type headache.

Psychiatric comorbidity and psychosocial stress in patients with tension-type headache from headache centers in Italy. The Italian Collaborative Group for the Study of Psychopathological Factors in Primary Headaches.

A multicenter study was carried out in 10 Italian Headache Centers to investigate the prevalence of psychosocial stress and psychiatric disorders listed by the IHS classification as the "most likely causative factors" of tension-type headache (TTH). Two hundred and seventeen TTH adult outpatients consecutively recruited underwent a structured psychiatric interview (CIDI-c). The assessment of psychosocial stress events was carried out using an ad hoc questionnaire.

Different effect of high doses of naloxone on spinal reflexes in normal subjects and chronic paraplegic patients.

There is still controversy over the effects of naloxone on spinal reflexes in view of the fact that both facilitatory and inhibitory activities have been observed. Dosage, supraspinal influences and interactions with different opiate receptors may account for the different findings. We investigated the effect of placebo (saline) and high doses of naloxone (1.

Effectiveness of ibuprofen-arginine in the treatment of acute migraine attacks.

The purpose of this study was to evaluate the effectiveness of a new formulation of ibuprofen (ibuprofen-arginine [IA]) in the treatment of migraine attacks. This is a faster absorbed formulation as compared with ibuprofen alone. The rapidity of action is considered to be a crucial factor in the treatment of migraine attacks.

A 3D kinematic method for evaluating voluntary movements of the cervical spine in humans.

The purpose of this study was to assess the reliability of a 3D kinematic method of evaluating movements of the cervical spine. Range of motion (ROM) of the cervical spine was evaluated in 8 control subjects during flexion-extension, rotation and lateral bending movements. The test was repeated on two separate occasions.

Eye movement abnormalities in myotonic dystrophy.

We studied saccade and smooth pursuit eye movements in 31 patients suffering from myotonic dystrophy (MD). On the basis of mean value comparisons, saccades were slower and hypometric and smooth pursuit eye movements performed worse in MD patients than in controls. On an individual basis, saccade duration was prolonged in 67.

Trigeminal evoked potentials in man: a new olfactory stimulation device.

The recording of olfactory evoked potentials in healthy humans, using a continuous flow olfactory stimulator, is described. A stimulator pushed inert gas (N2) in a continuous flow through the nose at a rate of 4 l/min. At fixed 30-second intervals, (32 times) the flow was replaced by an equal amount of CO2, a trigeminal stimulant.

Psychiatric comorbidity in chronic daily headache.

Clinical evidence suggests that chronic daily headache (CDH) occurs in association with psychopathologies: previous studies have focused particularly on migraine. To evaluate this association, we studied, using the DSM-IIIR criteria, a population of 88 patients (18M, 70F) affected by CDH (mean duration 7.4 +/- 8.

Long-term outcome of migraine.

Migraine prevalence increases from childhood up until 40 years of age, and thereafter declines. Several hypotheses can be advanced to explain the decrease in migraine with advancing age: (i) favorable effect of preventive treatments; (ii) increased mortality in migraineurs (due to higher vulnerability to other fatal diseases); (iii) cohort effect (increased incidence in young subjects); (iv) spontaneous remission. The first two theses are poorly supported by data in the literature.

Pain pressure threshold in cluster headache patients.

Pain perception threshold (PPT) in the head was assessed with a pressure algometer in 58 cluster headache (CH) patients (52M, 6F; 41 episodic and 17 chronic). Fourteen patients in cluster period were retested in remission. Thresholds were assessed at 10 symmetrical points on each side of the head and at the deltoid.

A record card for the study of Neuronal Hyperexcitability Syndrome.

Neuronal Hyperexcitability Syndrome (NHS) is a nosographic picture which is difficult to diagnose, due to the lack of specific standard diagnostic criteria. With slightly varying symptoms the syndrome has also been defined as Spasmophilia and Hyperventilation Syndrome. It is difficult to distinguish between NHS and panic attack disorder as there is considerable overlapping of symptomatology.

Classification of chronic daily headache by International Headache Society criteria: limits and new proposals.

We conducted a retrospective study of 150 patients with chronic daily headache (CDH) to determine how to categorize their headache according to the classification of the International Headache Society (IHS). All patients were first evaluated at Parma and Pavia Headache Centres (from January 1992 to March 1993) and had had headache for at least 15 days a month during the previous 6 months. Four patients were thereafter excluded due to poor reliability.

Comparative study with EMG, pressure algometry and manual palpation in tension-type headache and migraine.

According to International Headache Society classification criteria, the presence of pericranial muscle disorder in tension-type headache should be evaluated using one of the following methods: EMG, pressure algometry or manual palpation. The purpose of this study was to compare the results of these three methods in 15 patients with episodic tension-type headache, 29 with chronic tension-type headache and 22 presenting migraine without aura compared to those obtained in healthy individuals. Algometric and EMG recordings at the frontalis muscle during mental arithmetic were more impaired in episodic and chronic tension headache patients than in controls and migraine patients.

Neurophysiological studies in chronic paroxysmal hemicrania and hemicrania continua.

To explore the possible involvement of the pain control system, pain pressure threshold (PPT), nociceptive flexion reflex (RIII), blink and corneal reflexes have been studied for pain perception assessment in 12 patients with chronic paroxysmal hemicrania (CPH) and 12 patients with hemicrania continua (HC). PPT was found to be reduced in HC and CPH when separately compared to controls. In addition, a significant reduction of subjective pain perception (Tp) which was most marked on the symptomatic side, has been demonstrated after sural nerve stimulation in CPH.

Bilateral sympathetic skin response following nociceptive stimulation: study in healthy individuals.

Bilateral sympathetic skin response (SSR) was evaluated in 25 normal subjects aged (29 +/- 5 years). The stimulation (an electrical pulse train randomly applied to the sural nerve) was equal to 0.5-1.

Effects of dothiepin on nociceptive flexion reflex and diffuse noxious inhibitory controls in humans.

The analgesic activity of dothiepin (an antidepressant interacting with serotonin receptors) was studied (double-blind) in humans. A significant increase in nociceptive flexion reflex threshold and subjective pain threshold was observed after a 14-day dothiepin treatment. The effects of dothiepin on diffuse noxious inhibitory controls were also investigated using the cold-pressor test as conditioning stimuli.