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1. The Global Campaign (GC) to Reduce the Burden of Headache Worldwide. The International Team for Specialist Education (ITSE)

Author

Martelletti, P, Haimanot, RT, Lainez, MJA, Rapoport, AM, Ravishankar, K, Sakai, F, Silberstein, SD, Vincent, M, and Steiner, TJ

Subjects
Biomedical and Clinical Sciences, Neurosciences, Clinical Sciences, Headaches, Chronic Pain, Dental/Oral and Craniofacial Disease, Clinical Research, Pain Research, Migraines, Quality Education, Education, Medical, Graduate, Global Health, Headache, Humans, Neurology, World Health Organization, Genetics, Neurology & Neurosurgery, Clinical sciences
Abstract

The social perception of headache, everywhere at low levels in industrialised countries, becomes totally absent in developing ones. Headache disorders came into the World Health Organization's strategic priorities after publication of the 2001 World Health Report. Among the leading causes of disability, migraine was ranked 19th for adults of both sexes together and 12th for females. The Global Campaign (GC) to Reduce the Burden of Headache Worldwide was planned by the major international headache organizations together with WHO in order to identify and remove those cultural, social and educational barriers recognised as responsible factors for the inadequate treatment of headache disorders worldwide. Within the GC activities, the education of the medical body will represents a central pillar. An International Team for Specialist Education (ITSE) has been created to train physicians from all over the world through the acquisition of a university level Master Degree in Headache Medicine. Once trained as headache specialists, physicians will become trainers, offering education in this field to other health care providers in their own countries. In this way they will give life to a cultural chain raising awareness locally of headache, its burden and its medical control.

Published
2005

2. Clinical factors associated with death in 3044 COVID-19 patients managed in internal medicine wards in Italy: results from the SIMI-COVID-19 study of the Italian Society of Internal Medicine (SIMI)

Author

Corradini E., Ventura P., Ageno W., Cogliati C. B., Muiesan M. L., Girelli D., Pirisi M., Gasbarrini A., Angeli P., Querini P. R., Bosi E., Tresoldi M., Vettor R., Cattaneo M., Piscaglia F., Brucato A. L., Perlini S., Martelletti P., Pontremoli R., Porta M., Minuz P., Olivieri O., Sesti G., Biolo G., Rizzoni D., Serviddio G., Cipollone F., Grassi D., Manfredini R., Moreo G. L., Pietrangelo A., Teatini T., Salvetti M., Crisafulli E., Sainaghi P. P., Zileri Dal Verme L., Piano S., De Lorenzo R., Arcidiacono G., Podda M., Muratori L., Gabiati C., Salinaro F., Luciani M., Barnini C., Morra di Cella S., Dalbeni A., Friso S., Mearelli F., Malerba P., Cavallone F., D'Ardes D., Notargiacomo S., De Giorgi A., Mansi M., Buzzetti E., Ricci A., Martelli F., Corradini E., Ventura P., Ageno W., Cogliati C.B., Muiesan M.L., Girelli D., Pirisi M., Gasbarrini A., Angeli P., Querini P.R., Bosi E., Tresoldi M., Vettor R., Cattaneo M., Piscaglia F., Brucato A.L., Perlini S., Martelletti P., Pontremoli R., Porta M., Minuz P., Olivieri O., Sesti G., Biolo G., Rizzoni D., Serviddio G., Cipollone F., Grassi D., Manfredini R., Moreo G.L., Pietrangelo A., Teatini T., Salvetti M., Crisafulli E., Sainaghi P.P., Zileri Dal Verme L., Piano S., De Lorenzo R., Arcidiacono G., Podda M., Muratori L., Gabiati C., Salinaro F., Luciani M., Barnini C., Morra di Cella S., Dalbeni A., Friso S., Mearelli F., Malerba P., Cavallone F., D'Ardes D., Notargiacomo S., De Giorgi A., Mansi M., Buzzetti E., Ricci A., Martelli F., Corradini, E., Ventura, P., Ageno, W., Cogliati, C. B., Muiesan, M. L., Girelli, D., Pirisi, M., Gasbarrini, A., Angeli, P., Rovere-Querini, P., Bosi, E., Tresoldi, M., Vettor, R., Cattaneo, M., Piscaglia, F., Brucato, A. L., Perlini, S., Martelletti, P., Pontremoli, R., Porta, M., Minuz, P., Olivieri, O., Sesti, G., Biolo, G., Rizzoni, D., Serviddio, G., Cipollone, F., Grassi, D., Manfredini, R., Moreo, G. L., Pietrangelo, A., Teatini, T., Salvetti, M., Crisafulli, E., Sainaghi, P. P., Zileri Dal Verme, L., Piano, S., De Lorenzo, R., Arcidiacono, G., Podda, M., Muratori, L., Gabiati, C., Salinaro, F., Luciani, M., Barnini, C., Morra di Cella, S., Dalbeni, A., Friso, S., Mearelli, F., Malerba, P., Cavallone, F., D'Ardes, D., Notargiacomo, S., De Giorgi, A., Mansi, M., Buzzetti, E., Ricci, A., and Martelli, F.

Subjects
Mortality from COVID-19, Comorbidity, 030204 cardiovascular system & hematology, Cohort Studies, 0302 clinical medicine, 80 and over, Medicine, 030212 general & internal medicine, Hospital Mortality, Internal medicine, Comorbidity, Internal medicine, Mortality from COVID-19, Polypharmacy, SARS-CoV-2, Aged, 80 and over, LS7_9, Mortality rate, Respiration, Middle Aged, Hospitals, Survival Rate, Hospitalization, Italy, Polypharmacy, SARS-CoV-2, Cohort, Artificial, Emergency Medicine, Adult, Aged, COVID-19, Critical Care, Humans, Respiration, Artificial, Internal Medicine, medicine.symptom, Cohort study, medicine.medical_specialty, Settore MED/12 - GASTROENTEROLOGIA, Socio-culturale, 03 medical and health sciences, Intensive care, Survival rate, business.industry, Organ dysfunction, Settore MED/09 - MEDICINA INTERNA, medicine.disease, Im - Original, business
Abstract

During the COVID-19 2020 outbreak, a large body of data has been provided on general management and outcomes of hospitalized COVID-19 patients. Yet, relatively little is known on characteristics and outcome of patients managedin Internal Medicine Units (IMU). To address this gap, the Italian Society of Internal Medicine has conducted a nationwide cohort multicentre study on death outcome in adult COVID-19 patients admitted and managed in IMU. This study assessed 3044 COVID-19 patients at 41 referral hospitals across Italy from February 3rd to May 8th 2020. Demographics, comorbidities, organ dysfunction, treatment, and outcomes including death were assessed. During the study period, 697 patients (22.9%) were transferred to intensive care units, and 351 died in IMU (death rate 14.9%). At admission, factors independently associated with in-hospital mortality were age (OR 2.46, p = 0.000), productive cough (OR 2.04, p = 0.000), pre-existing chronic heart failure (OR 1.58, p = 0.017) and chronic obstructive pulmonary disease (OR 1.17, p = 0.048), the number of comorbidities (OR 1.34, p = 0.000) and polypharmacy (OR 1.20, p = 0.000). Of note, up to 40% of elderly patients did not report fever at admission. Decreasing PaO2/FiO2 ratio at admission was strongly inversely associated with survival. The use of conventional oxygen supplementation increased with the number of pre-existing comorbidities, but it did not associate with better survival in patients with PaO2/FiO2 ratio

Published
2021

3. The evaluation of the intracavitary effusions by a bedside ultrasound examination

Author

Martocchia, A, Ialungo, S, Dulcetti, A, Malena, D M, Proietta, M, Del Porto, F, Landolfi, F, Sesti, G, Sergi, D, and Martelletti, P

Subjects
x-ray computed, intracavitary effusions, Physiology, Reproducibility of Results, computed tomography, Hematology, tomography, bedside ultrasound, comorbidity, humans, reproducibility of results, ultrasonography, abdomen, Physiology (medical), Abdomen, Humans, Cardiology and Cardiovascular Medicine, Tomography, X-Ray Computed, Ultrasonography
Abstract

OBJECTIVE: This study aims to evaluate the bedside use of the pocket-sized ultrasound (US) device for the detection of the intracavitary effusions. METHODS: We randomly enrolled 40 patients admitted to S. Andrea Hospital of Rome. Every patient received a clinical and biochemical evaluation and a bedside US examination to detect and estimate the intracavitary (pleural, pericardial and intra-abdominal) effusions; the US measurements have been compared to the computed tomography (CT) scans (as gold standard). RESULTS: The patients presented a high prevalence of effusions: right pleural 16/40 = 40% (esteemed volume 236.3±500.7 ml, mean±standard deviation m±SD), left pleural 8/40 = 20% (127.0±377.4 ml), pericardial 12/40 = 30% (47.5±72.8 ml) and intra-abdominal effusions 5/40 = 12.5% of cases (110.9±600.6 ml). Linear regression analysis showed a significant correlation between US and CT measurements: pleural r = 0.973 p < 1×10–38, pericardial r = 0.927 p < 1×10–39, intra-abdominal space r = 0.921 p < 1×10–59. The accuracy of the bedside US at the pleural, pericardial and abdominal level was respectively 98%, 93% and 96% (Cohen’s kappa coefficient 0.966, 0.841 and 0.833). CONCLUSIONS: The present study showed a high prevalence of the intracavitary effusions and a high accuracy of the bedside US. The bedside US by a pocket-sized device is promising tool for its advantages of reproducibility and non-invasiveness of the device.

Published
2022

4. Burden and attitude to resistant and refractory migraine: a survey from the European Headache Federation with the endorsement of the European MigraineHeadache Alliance

Author

Sacco S., Lampl C., Maassen van den Brink A., Caponnetto V., Braschinsky M., Ducros A., Little P., Pozo-Rosich P., Reuter U., Ruiz de la Torre E., Sanchez Del Rio M., Sinclair A. J., Martelletti P., Katsarava Z., Cakciri G., Djamandi P., Grabova S., Halili G., Kruja J., Kuqo A., Naco D., Quka A., Stefanidhi L., Vyshka G., Zekja I., Bruera O., Gomez D., Guitian B., Roma J. C., Chen I. L., Bashirova S., Linkov M., Van Den Abbeele D., Vanderschueren G., Araujo R., Arruda R., Catharino A., Ciriaco J., Dalla Corte A., Dornas R., Felsenfeld B., Fonseca Taufner A., Fragoso Y., Hurtado R., Isoni Martins D., Londero R., Melo L., Mignoni K. S., Sgobbi De Souza P. V., Souza M. N., Osman S., Baltzer V., Pacheco Mosquera L. F., Dubroja I., Hucika Z., Lisak M., Lovrencic-Huzjan A., Lusic I., Mahovic Lakusic D., Mikulenka P., Rehulka P., Amin F. M., Antic S., Fakhril-Din Z., Moeller-Hansen J., Munksgaard S., Nan A. M., Pellesi L., Schytz H., Vides M., Braschinsky K., Krikmann U., Roos C., Cauchie A., Christian L., Guegan-Massardier E., Demarquay G., Gilles G., Mawet J., Kuhn E., Lanteri Minet M., Bustuchina Vlaicu M., Moisset X., Muresan M., Najjar-Ravan M., Giraud P., Simonin S., De Gaalon S., Chakhava G., Demuria M., Gegelashvili G., Kapanadze N., Antonakakis A., Gaul C., Forderreuther S., Huhn J. -I., Ibragimov S., Kamm K., Raffaelli B., Czaniera R., Ruscheweyh R., Gavanozi E., Karagiorgis G., Mavridism T., Ertsey C., Shubham D., Callista Tanowi A. D., Erdana Putra S., Hadi D. W., Kurnia L., Nasrul M., Albanese M., Antonaci F., Asioli G. M., Baschi R., Bentivegna E., Brunelli N., Caratozzolo S., Catarci T., Cherchi A., Corbelli I., Costa A., De Luca C., Doretti A., Favoni V., Ghiotto N., Giamberardino M. A., Giani L., Zanchin G., Govone F., Grillo G., Mampreso E., Negro A., Ornello R., Pasculli M., Pensato U., Prudenzano M. P. A., Quintana S., Rapisarda R., Romoli M., Russo A., Russo M., Spuntarelli V., Tiseo C., Torrente A., Vacca A., Vaula G., Vigano A., Vigneri S., Freimane A., Slosberga E., Zvaune L., Tan H. J., Fenech C., Cobilt-Catana R., De La Garza Neme Y., Martinez M., Proano Narvaez J. V., Rodriguez Herrera A., Vazquez D., Grosu O., Jakupi A., Kristoffersen E. S., Tronvik E., Winsvold B. S., Azhar M., Reyes Alvarez M. T., Vilchez Fernandez L., Dayrit G. D., Czapinska-Ciepiela E. K., Fila M., Gryglas-Dworak A., Couto M., Esperanca P., Ferreira A., Gil-Gouveia R., Goncalves A., Lopes M., Lourenco M., Machado J., Marinho M., Miranda M. A., Palavra F., Parreira E., Pavao Martins I., Pereira L., Pereira Monteiro J. M., Leahu P., Aloman S., Abramova E., Akhmadeeva L., Belopasova A., Bogdanova I., Chernyak M., Epifanova M., Fedorova E., Felbush A., Karpova M., Korobkova D., Korotkova D., Latysheva N., Makeeva T., Mikhalkina K., Osipova V., Roshchina O., Serga A., Serousova O. V., Sidorova Y., Skiba I., Skorobogatykh K., Vashchenko N., Apostolski S., Buder N., Kopitovic A., Mirjana J., Podgorac A., Rakic D., Simic S., Zarko M., Trajkovic J. Z., Beltran-Blasco I., Calabria Gallego M. D., Diaz Insa S., Ezpeleta D., Fernandez M., Garcia-Azorin D., Gonzalez-Garcia N., Guerrero A. L., Guillamon E., Herreros Rodriguez J., Layos-Romero A., Medrano V., Minguez-Olaondo A., Navarro Munoz S., Pare Curell M., Ruibal M., Sanchez Alvarez J. M., Santos S., Soler R., Viguera J., Zabalza R., Abdelrahman T., Abobaker Hamza S. B., Mustafa M. N., Edvinsson L., Gantenbein A., Maraffi I., Couturier E., Dirkx T., Hoebert M., Van Oosterhout W., Wim M., Zwartbol R., Bakir M., Demirel H., Erdemoglu A. K., Ertem D. H., Gonullu S., Ilgaz Aydinlar E., Inan L. E., Olmez B., Ozbenli T., Ozge A., Uluduz D., Uyar Cankay T., Yalinay Dikmen P., Saxena A. B., Bozhenko M., Bozhenko N., Bubnov R., Tsurkalenko O., Abu-Arafeh I., Idrovo L., Miller S., Nirmalananthan N., Sinclair A., Taleti E., Valori A., Whitehouse W., Zermansky A., Thura M., Institut Català de la Salut, [Sacco S, Caponnetto V] Neuroscience section – Department of Biotechnological and Applied Clinical Sciences and (Edificio Coppito 2), University of L’Aquila, Via Vetoio, 67100 L’Aquila, Italy. Regional Referral Headache Center of the Abruzzo Region, ASL Avezzano-Sulmona-L’Aquila, L’Aquila, Italy. [Lampl C] Department of Neurology, Headache Medical Centre Linz, Hospital Barmherzige Brüder, Centre of Integrative Medicine (ZiAM) Ordensklinikum Linz, Linz, Austria. [Maassen van den Brink A] Division of Pharmacology, Department of Internal Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands. [Braschinsky M] Headache Clinic, Department of Neurology, Tartu University Clinics, Tartu, Estonia. [Ducros A] Headache Unit, Neurology Department, Montpellier University Hospital and Montpellier University, Montpellier, France. [Pozo-Rosich P] Unitat de Cefalea, Servei de Neurologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain. Grup d'Investigació en Cefalees i Dolors Neurològics, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain, Vall d'Hebron Barcelona Hospital Campus, Sacco, S., Lampl, C., Maassen van den Brink, A., Caponnetto, V., Braschinsky, M., Ducros, A., Little, P., Pozo-Rosich, P., Reuter, U., Ruiz de la Torre, E., Sanchez Del Rio, M., Sinclair, A. J., Martelletti, P., Katsarava, Z., Cakciri, G., Djamandi, P., Grabova, S., Halili, G., Kruja, J., Kuqo, A., Naco, D., Quka, A., Stefanidhi, L., Vyshka, G., Zekja, I., Bruera, O., Gomez, D., Guitian, B., Roma, J. C., Chen, I. L., Bashirova, S., Linkov, M., Van Den Abbeele, D., Vanderschueren, G., Araujo, R., Arruda, R., Catharino, A., Ciriaco, J., Dalla Corte, A., Dornas, R., Felsenfeld, B., Fonseca Taufner, A., Fragoso, Y., Hurtado, R., Isoni Martins, D., Londero, R., Melo, L., Mignoni, K. S., Sgobbi De Souza, P. V., Souza, M. N., Osman, S., Baltzer, V., Pacheco Mosquera, L. F., Dubroja, I., Hucika, Z., Lisak, M., Lovrencic-Huzjan, A., Lusic, I., Mahovic Lakusic, D., Mikulenka, P., Rehulka, P., Amin, F. M., Antic, S., Fakhril-Din, Z., Moeller-Hansen, J., Munksgaard, S., Nan, A. M., Pellesi, L., Schytz, H., Vides, M., Braschinsky, K., Krikmann, U., Roos, C., Cauchie, A., Christian, L., Guegan-Massardier, E., Demarquay, G., Gilles, G., Mawet, J., Kuhn, E., Lanteri Minet, M., Bustuchina Vlaicu, M., Moisset, X., Muresan, M., Najjar-Ravan, M., Giraud, P., Simonin, S., De Gaalon, S., Chakhava, G., Demuria, M., Gegelashvili, G., Kapanadze, N., Antonakakis, A., Gaul, C., Forderreuther, S., Huhn, J. -I., Ibragimov, S., Kamm, K., Raffaelli, B., Czaniera, R., Ruscheweyh, R., Gavanozi, E., Karagiorgis, G., Mavridism, T., Ertsey, C., Shubham, D., Callista Tanowi, A. D., Erdana Putra, S., Hadi, D. W., Kurnia, L., Nasrul, M., Albanese, M., Antonaci, F., Asioli, G. M., Baschi, R., Bentivegna, E., Brunelli, N., Caratozzolo, S., Catarci, T., Cherchi, A., Corbelli, I., Costa, A., De Luca, C., Doretti, A., Favoni, V., Ghiotto, N., Giamberardino, M. A., Giani, L., Zanchin, G., Govone, F., Grillo, G., Mampreso, E., Negro, A., Ornello, R., Pasculli, M., Pensato, U., Prudenzano, M. P. A., Quintana, S., Rapisarda, R., Romoli, M., Russo, A., Russo, M., Spuntarelli, V., Tiseo, C., Torrente, A., Vacca, A., Vaula, G., Vigano, A., Vigneri, S., Freimane, A., Slosberga, E., Zvaune, L., Tan, H. J., Fenech, C., Cobilt-Catana, R., De La Garza Neme, Y., Martinez, M., Proano Narvaez, J. V., Rodriguez Herrera, A., Vazquez, D., Grosu, O., Jakupi, A., Kristoffersen, E. S., Tronvik, E., Winsvold, B. S., Azhar, M., Reyes Alvarez, M. T., Vilchez Fernandez, L., Dayrit, G. D., Czapinska-Ciepiela, E. K., Fila, M., Gryglas-Dworak, A., Couto, M., Esperanca, P., Ferreira, A., Gil-Gouveia, R., Goncalves, A., Lopes, M., Lourenco, M., Machado, J., Marinho, M., Miranda, M. A., Palavra, F., Parreira, E., Pavao Martins, I., Pereira, L., Pereira Monteiro, J. M., Leahu, P., Aloman, S., Abramova, E., Akhmadeeva, L., Belopasova, A., Bogdanova, I., Chernyak, M., Epifanova, M., Fedorova, E., Felbush, A., Karpova, M., Korobkova, D., Korotkova, D., Latysheva, N., Makeeva, T., Mikhalkina, K., Osipova, V., Roshchina, O., Serga, A., Serousova, O. V., Sidorova, Y., Skiba, I., Skorobogatykh, K., Vashchenko, N., Apostolski, S., Buder, N., Kopitovic, A., Mirjana, J., Podgorac, A., Rakic, D., Simic, S., Zarko, M., Trajkovic, J. Z., Beltran-Blasco, I., Calabria Gallego, M. D., Diaz Insa, S., Ezpeleta, D., Fernandez, M., Garcia-Azorin, D., Gonzalez-Garcia, N., Guerrero, A. L., Guillamon, E., Herreros Rodriguez, J., Layos-Romero, A., Medrano, V., Minguez-Olaondo, A., Navarro Munoz, S., Pare Curell, M., Ruibal, M., Sanchez Alvarez, J. M., Santos, S., Soler, R., Viguera, J., Zabalza, R., Abdelrahman, T., Abobaker Hamza, S. B., Mustafa, M. N., Edvinsson, L., Gantenbein, A., Maraffi, I., Couturier, E., Dirkx, T., Hoebert, M., Van Oosterhout, W., Wim, M., Zwartbol, R., Bakir, M., Demirel, H., Erdemoglu, A. K., Ertem, D. H., Gonullu, S., Ilgaz Aydinlar, E., Inan, L. E., Olmez, B., Ozbenli, T., Ozge, A., Uluduz, D., Uyar Cankay, T., Yalinay Dikmen, P., Saxena, A. B., Bozhenko, M., Bozhenko, N., Bubnov, R., Tsurkalenko, O., Abu-Arafeh, I., Idrovo, L., Miller, S., Nirmalananthan, N., Sinclair, A., Taleti, E., Valori, A., Whitehouse, W., Zermansky, A., Thura, M., and Internal Medicine

Subjects
Investigative Techniques::Epidemiologic Methods::Data Collection::Surveys and Questionnaires [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT], medicine.medical_specialty, Pediatrics, Neurology, Consensus, enfermedades del sistema nervioso::enfermedades del sistema nervioso central::enfermedades cerebrales::trastornos con cefaleas::cefaleas primarias::trastornos migrañosos [ENFERMEDADES], migraine, migraine care, refractory migraine, resistant migraine, consensus, cross-sectional studies, headache, humans, surveys and questionnaires, migraine disorders, Pain medicine, Moderate confidence, Migraine Disorders, Medizin, Consensu, Migranya - Tractament, Qüestionaris, Refractory, Surveys and Questionnaires, medicine, Surveys and Questionnaire, Humans, Clinical significance, Nervous System Diseases::Central Nervous System Diseases::Brain Diseases::Headache Disorders::Headache Disorders, Primary::Migraine Disorders [DISEASES], Otros calificadores::/terapia [Otros calificadores], Migraine, Cross-Sectional Studie, business.industry, Headache, técnicas de investigación::métodos epidemiológicos::recopilación de datos::encuestas y cuestionarios [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS], General Medicine, Other subheadings::/therapy [Other subheadings], medicine.disease, Refractory migraine, Anesthesiology and Pain Medicine, Cross-Sectional Studies, Burden, Medicine, Neurology (clinical), Level of care, business, Resistant migraine, Migraine care, Human, Research Article
Abstract

Background New treatments are currently offering new opportunities and challenges in clinical management and research in the migraine field. There is the need of homogenous criteria to identify candidates for treatment escalation as well as of reliable criteria to identify refractoriness to treatment. To overcome those issues, the European Headache Federation (EHF) issued a Consensus document to propose criteria to approach difficult-to-treat migraine patients in a standardized way. The Consensus proposed well-defined criteria for resistant migraine (i.e., patients who do not respond to some treatment but who have residual therapeutic opportunities) and refractory migraine (i.e., patients who still have debilitating migraine despite maximal treatment efforts). The aim of this study was to better understand the perceived impact of resistant and refractory migraine and the attitude of physicians involved in migraine care toward those conditions. Methods We conducted a web-questionnaire-based cross-sectional international study involving physicians with interest in headache care. Results There were 277 questionnaires available for analysis. A relevant proportion of participants reported that patients with resistant and refractory migraine were frequently seen in their clinical practice (49.5% for resistant and 28.9% for refractory migraine); percentages were higher when considering only those working in specialized headache centers (75% and 46% respectively). However, many physicians reported low or moderate confidence in managing resistant (8.1% and 43.3%, respectively) and refractory (20.7% and 48.4%, respectively) migraine patients; confidence in treating resistant and refractory migraine patients was different according to the level of care and to the number of patients visited per week. Patients with resistant and refractory migraine were infrequently referred to more specialized centers (12% and 19%, respectively); also in this case, figures were different according to the level of care. Conclusions This report highlights the clinical relevance of difficult-to-treat migraine and the presence of unmet needs in this field. There is the need of more evidence regarding the management of those patients and clear guidance referring to the organization of care and available opportunities.

Published
2021
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5. Comorbidities of primary headache disorders: a literature review with meta-analysis

Author

Caponnetto, V., Deodato, M., Robotti, M., Koutsokera, M., Pozzilli, V., Galati, C., Nocera, G., De Matteis, E., De Vanna, G., Fellini, E., Halili, G., Martinelli, D., Nalli, G., Serratore, S., Tramacere, I., Martelletti, P., Raggi, A., European Headache Federation School of Advanced Studies (EHF-SAS), Caponnetto, V., Deodato, M., Robotti, M., Koutsokera, M., Pozzilli, V., Galati, C., Nocera, G., De Matteis, E., De Vanna, G., Fellini, E., Halili, G., Martinelli, D., Nalli, G., Serratore, S., Tramacere, I., Martelletti, P., Raggi, A., and European Headache Federation School of Advanced Studies, (EHF-SAS)

Subjects
Headache Disorders, Primary, Cross-sectional study, Review Article, Comorbidity, Anxiety, Diabete, CH, Depression, Diabetes, Hypertension, Migraine, Obesity, Primary headache, Sleep disorders, Stroke, TTH, 0302 clinical medicine, Prevalence, 030212 general & internal medicine, Depression (differential diagnoses), education.field_of_study, General Medicine, Anxiety Disorders, Meta-analysis, Medicine, Female, medicine.symptom, Headaches, Adult, medicine.medical_specialty, Headache Disorders, Population, 03 medical and health sciences, Internal medicine, primary, medicine, Humans, ch, comorbidity, depression, diabetes, hypertension, migraine, obesity, primary headache, sleep disorders, stroke, tth, adult, anxiety, anxiety disorders, cross-sectional studies, female, humans, prevalence, headache disorders, education, Sleep disorder, business.industry, medicine.disease, Anesthesiology and Pain Medicine, Cross-Sectional Studies, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

Background Primary headache disorders are common and burdensome conditions. They are associated to several comorbidities, such as cardiovascular or psychiatric ones, which, in turn, contribute to the global burden of headache. The aim of this study is to provide a comprehensive description of the pooled prevalence of comorbidities of primary headache disorders using a meta-analytical approach based on studies published between 2000 and 2020. Methods Scopus was searched for primary research (clinical and population studies) in which medical comorbidities were described in adults with primary headache disorders. Comorbidities were extracted using a taxonomy derived from the Global Burden of Disease (GBD) study. We compared prevalence of comorbidities among headache sufferers against general population using GBD-2019 estimates, and compared comorbidities’ proportions in clinical vs. population studies, and by age and gender. Results A total of 139 studies reporting information on 4.19 million subjects with primary headaches were included: in total 2.75 million comorbidities were reported (median per subject 0.64, interquartile range 0.32–1.07). The most frequently addressed comorbidities were: depressive disorders, addressed in 51 studies (pooled proportion 23 %, 95 % CI 20–26 %); hypertension, addressed in 48 studies (pooled proportion 24 %, 95 % CI 22–26 %); anxiety disorders addressed in 40 studies (pooled proportion 25 %, 95 % CI 22–28 %). For conditions such as anxiety, depression and back pain, prevalence among headache sufferers was higher than in GBD-2109 estimates. Associations with average age and female prevalence within studies showed that hypertension was more frequent in studies with higher age and less females, whereas fibromyalgia, restless leg syndrome, and depressive disorders were more frequent in studies with younger age and more female. Conclusions Some of the most relevant comorbidities of primary headache disorders – back pain, anxiety and depression, diabetes, ischemic heart disease and stroke – are among the most burdensome conditions, together with headache themselves, according to the GBD study. A joint treatment of headaches and of these comorbidities may positively impact on headache sufferers’ health status and contribute to reduce the impact of a group of highly burdensome diseases.

Published
2021

6. Current and emerging evidence-based treatment options in chronic migraine: A narrative review

Author

Agostoni E. C., Barbanti P., Calabresi P., Colombo B., Cortelli P., Frediani F., Geppetti P., Grazzi L., Leone M., Martelletti P., Pini L. A., Prudenzano M. P., Sarchielli P., Tedeschi G., Russo A., The Italian chronic migraine group, Agostoni, E. C., Barbanti, P., Calabresi, P., Colombo, B., Cortelli, P., Frediani, F., Geppetti, P., Grazzi, L., Leone, M., Martelletti, P., Pini, L. A., Prudenzano, M. P., Sarchielli, P., Tedeschi, G., Russo, A., Agostoni E.C., Barbanti P., Calabresi P., Colombo B., Cortelli P., Frediani F., Geppetti P., Grazzi L., Leone M., Martelletti P., Pini L.A., Prudenzano M.P., Sarchielli P., Tedeschi G., Russo A., and The Italian chronic migraine group

Subjects
Botulinum Toxins, lcsh:Medicine, Review Article, Anti-CGRP monoclonal antibodies, Type A, 0302 clinical medicine, Chronic Migraine, Migraine Disorder, Monoclonal, Chronic migraine, Fremanezumab, onabotulinumtoxinA, Prophylaxis, Topiramate, Antibodies, Monoclonal, Botulinum Toxins, Type A, Chronic Disease, Disabled Persons, Humans, Migraine Disorders, Randomized Controlled Trials as Topic, 030212 general & internal medicine, Prophylaxi, anti-CGRP monoclonal antibodies, chronic migraine, fremanezumab, prophylaxis, topiramate, antibodies, monoclonal, botulinum toxins, type A, chronic disease, disabled persons, humans, migraine disorders, randomized controlled Trials as Topic, General Medicine, Settore MED/26 - NEUROLOGIA, Tolerability, Disabled Person, medicine.drug, Human, medicine.medical_specialty, Evidence-based practice, Pain medicine, Anti-CGRP monoclonal antibodie, Calcitonin gene-related peptide, Antibodies, 03 medical and health sciences, medicine, Intensive care medicine, business.industry, lcsh:R, medicine.disease, Clinical trial, Anesthesiology and Pain Medicine, Migraine, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

Background Chronic migraine is a disabling condition that is currently underdiagnosed and undertreated. In this narrative review, we discuss the future of chronic migraine management in relation to recent progress in evidence-based pharmacological treatment. Findings Patients with chronic migraine require prophylactic therapy to reduce the frequency of migraine attacks, but the only currently available evidence-based prophylactic treatment options for chronic migraine are topiramate and onabotulinumtoxinA. Improved prophylactic therapy is needed to reduce the high burden of chronic migraine in Italy. Monoclonal antibodies that target the calcitonin gene-related peptide (CGRP) pathway of migraine pathogenesis have been specifically developed for the prophylactic treatment of chronic migraine. These anti-CGRP/R monoclonal antibodies have demonstrated good efficacy and excellent tolerability in phase II and III clinical trials, and offer new hope to patients who are currently not taking any prophylactic therapy or not benefitting from their current treatment. Conclusions Treatment of chronic migraine is a dynamic and rapidly advancing area of research. New developments in this field have the potential to improve the diagnosis and provide more individualised treatments for this condition. Establishing a culture of prevention is essential for reducing the personal, social and economic burden of chronic migraine.

Published
2019

7. European headache federation consensus on the definition of resistant and refractory migraine

Author

Sacco, S., Braschinsky, M., Ducros, A., Lampl, C., Little, P., Van Den Brink, A. M., Pozo-Rosich, P., Reuter, U., De La Torre, E. R., Del Rio, M. S., Sinclair, A. J., Katsarava, Z., and Martelletti, P.

Subjects
Male, Analgesics, Consensus, Intractable migraine, Migraine Disorders, lcsh:R, lcsh:Medicine, Middle Aged, Refractory migraine, Tryptamines, Chronic migraine, Migraine, Resistant migraine, Pain, Intractable, Europe, Consensus Article, Activities of Daily Living, Humans, Female
Abstract

Introduction Despite advances in the management of headache disorders, some patients with migraine do not experience adequate pain relief with acute and preventive treatments. It is the aim of the present document to provide a definition of those migraines which are difficult-to-treat, to create awareness of existence of this group of patients, to help Healthcare Authorities in understanding the implications, and to create a basis to develop a better pathophysiological understanding and to support further therapeutic advances. Main body Definitions were established with a consensus process using the Delphi method. Patients with migraine with or without aura or with chronic migraine can be defined as having resistant migraine and refractory migraine according to previous preventative failures. Resistant migraine is defined by having failed at least 3 classes of migraine preventatives and suffer from at least 8 debilitating headache days per month for at least 3 consecutive months without improvement; definition can be based on review of medical charts. Refractory migraine is defined by having failed all of the available preventatives and suffer from at least 8 debilitating headache days per month for at least 6 consecutive months. Drug failure may include lack of efficacy or lack of tolerability. Debilitating headache is defined as headache causing serious impairment to conduct activities of daily living despite the use of pain-relief drugs with established efficacy at the recommended dose and taken early during the attack; failure of at least two different triptans is required. Conclusions We hope, that the updated EHF definition will be able to solve the conflicts that have limited the use of definitions which have been put forward in the past. Only with a widely accepted definition, progresses in difficult-to-treat migraine can be achieved. This new definition has also the aim to increase the understanding of the impact of the migraine as a disease with all of its social, legal and healthcare implications. It is the hope of the EHF Expert Consensus Group that the proposed criteria will stimulate further clinical, scientific and social attention to patients who suffer from migraine which is difficult-to-treat.

Published
2020

8. Practical and clinical utility of non-invasive vagus nerve stimulation (nVNS) for the acute treatment of migraine: a post hoc analysis of the randomized, sham-controlled, double-blind PRESTO trial

Author

Licia GrazziEmail author, Cristina, Tassorelli, Marina de Tommaso, Giulia, Pierangeli, Paolo, Martelletti, Rainero, Innocenzo, Pierangelo, Geppetti, Anna, Ambrosini, Paola, Sarchielli, Eric, Liebler, Tassorelli C, Piero Barbanti PRESTO Study Group., Bitetto, V, De Icco, R, Martinelli, D, Sances, G, Bianchi, M, Grazzi, L, Padovan, Am, de Tommaso, M, Ricci, K, Vecchio, E, Cortelli, P, Cevoli, S, Pierangeli, G, Terlizzi, R, Martelletti, P, Negro, A, Chiariello, Ga, Rainero, I, De Martino, P, Gai, A, Govone, F, Masuzzo, F, Rubino, E, Torrieri, Mc, Vacca, A, Geppetti, P, Chiarugi, A, De Cesaris, F, Puma, Sl, Lupi, C, Marone, I, Ambrosini, A, Perrotta, A, Sarchielli, P, Bernetti, L, Corbelli, I, Romoli, M, Simoni, S, Verzina, A, Barbanti, P, Aurilia, C, Egeo, G, Fofi, L, Liebler, E, Andersson, A, Spitzer, L, Marin, J, Mcclure, C, Thackeray, L, Baldi, Mg, Di Maro, D., Grazzi, Licia, Tassorelli, Cristina, De Tommaso, Marina, Pierangeli, Giulia, Martelletti, Paolo, Rainero, Innocenzo, Geppetti, Pierangelo, Ambrosini, Anna, Sarchielli, Paola, Liebler, Eric, Barbanti, Piero, PRESTO Study Group, and Cortelli, Pietro

Subjects
Male, Neurology, medicine.medical_treatment, lcsh:Medicine, 0302 clinical medicine, Migraine Disorder, Prospective Studies, 030212 general & internal medicine, Rescue medication, neurology (clinical), Neuromodulation, General Medicine, Middle Aged, Treatment Outcome, Anesthesia, Acute Disease, Female, Vagus nerve stimulation, Research Article, Human, Adult, Migraine, Pain intensity, Post hoc analysis, medicine.medical_specialty, Migraine Disorders, anesthesiology and Pain Medicine, Double blind, 03 medical and health sciences, Double-Blind Method, Post-hoc analysis, medicine, Humans, Post hoc analysi, business.industry, migraine, neuromodulation, pain intensity, post hoc analysis, rescue medication, vagus nerve stimulation, Non invasive, lcsh:R, Correction, Self Care, Vagus Nerve Stimulation, Neurology (clinical), Anesthesiology and Pain Medicine, medicine.disease, Prospective Studie, Self care, business, 030217 neurology & neurosurgery
Abstract

Background The PRESTO study of non-invasive vagus nerve stimulation (nVNS; gammaCore®) featured key primary and secondary end points recommended by the International Headache Society to provide Class I evidence that for patients with an episodic migraine, nVNS significantly increases the probability of having mild pain or being pain-free 2 h post stimulation. Here, we examined additional data from PRESTO to provide further insights into the practical utility of nVNS by evaluating its ability to consistently deliver clinically meaningful improvements in pain intensity while reducing the need for rescue medication. Methods Patients recorded pain intensity for treated migraine attacks on a 4-point scale. Data were examined to compare nVNS and sham with regard to the percentage of patients who benefited by at least 1 point in pain intensity. We also assessed the percentage of attacks that required rescue medication and pain-free rates stratified by pain intensity at treatment initiation. Results A significantly higher percentage of patients who used acute nVNS treatment (n = 120) vs sham (n = 123) reported a ≥ 1-point decrease in pain intensity at 30 min (nVNS, 32.2%; sham, 18.5%; P = 0.020), 60 min (nVNS, 38.8%; sham, 24.0%; P = 0.017), and 120 min (nVNS, 46.8%; sham, 26.2%; P = 0.002) after the first attack. Similar significant results were seen when assessing the benefit in all attacks. The proportion of patients who did not require rescue medication was significantly higher with nVNS than with sham for the first attack (nVNS, 59.3%; sham, 41.9%; P = 0.013) and all attacks (nVNS, 52.3%; sham, 37.3%; P = 0.008). When initial pain intensity was mild, the percentage of patients with no pain after treatment was significantly higher with nVNS than with sham at 60 min (all attacks: nVNS, 37.0%; sham, 21.2%; P = 0.025) and 120 min (first attack: nVNS, 50.0%; sham, 25.0%; P = 0.018; all attacks: nVNS, 46.7%; sham, 30.1%; P = 0.037). Conclusions This post hoc analysis demonstrated that acute nVNS treatment quickly and consistently reduced pain intensity while decreasing rescue medication use. These clinical benefits provide guidance in the optimal use of nVNS in everyday practice, which can potentially reduce use of acute pharmacologic medications and their associated adverse events. Trial registration ClinicalTrials.gov identifier: NCT02686034.

Published
2018
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9. Noninvasive vagus nerve stimulation as acute therapy for migraine: The randomized PRESTO study

Author

Tassorelli, C, Grazzi, L, de Tommaso, M, Pierangeli, G, Martelletti, P, Rainero, I, Dorlas, S, Geppetti, P, Ambrosini, A, Sarchielli, P, Liebler, E, Barbanti, P, PRESTO Study Group (Tassorelli, C, Bitetto, V, De Icco, R, Martinelli, D, Sances, Giuseppe, Bianchi, M, Padovan, Anna Maria, Ricci, Katia Ivana, Vecchio, E, Cortelli, Pietro, Cevoli, S, Terlizzi, R, Negro, A, Chiariello, Ga, De Martino, P, Gai, A, Govone, F, Masuzzo, Federica, Rubino, E, Torrieri, MARIA CLAUDIA, Vacca, A, Chiarugi, A, De Cesaris, F, Puma, Sl, Lupi, C, Marone, Isabella, Perrotta, A, Bernetti, L, Corbelli, I, Romoli, M, Simoni, S, Verzina, A, Aurilia, C, Egeo, G, Fofi, L, Andersson, A, Spitzer, L, MARIN ACUNA, JANET MILAGROS, Mcclure, C, Thackerey, L, Baldi, Mg, Di Maro, D. )., Tassorelli, Cristina, Grazzi, Licia, de Tommaso, Marina, Pierangeli, Giulia, Martelletti, Paolo, Rainero, Innocenzo, Dorlas, Stefanie, Geppetti, Pierangelo, Ambrosini, Anna, Sarchielli, Paola, Liebler, Eric, Barbanti, Piero, and Cortelli, Pietro

Subjects
Male, Aura, triptans serotonin, medicine.medical_treatment, diclofenac potassium, efficacy, law.invention, 0302 clinical medicine, Randomized controlled trial, law, Clinical endpoint, Medicine, migraine, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, 5-ht1b/1d agonists, Pain Measurement, Middle Aged, Treatment Outcome, Tolerability, controlled-trial, Anesthesia, Female, double-blind, headache, Vagus nerve stimulation, Adult, Vagus Nerve Stimulation, Migraine Disorders, open-label, Article, 03 medical and health sciences, Double-Blind Method, prevention ampp, vagus nerve, Humans, tolerability, migraine therapy, neurology (clinical), business.industry, Odds ratio, medicine.disease, Migraine, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

ObjectiveTo evaluate the efficacy, safety, and tolerability of noninvasive vagus nerve stimulation (nVNS; gammaCore; electroCore, LLC, Basking Ridge, NJ) for the acute treatment of migraine in a multicenter, double-blind, randomized, sham-controlled trial.MethodsA total of 248 participants with episodic migraine with/without aura were randomized to receive nVNS or sham within 20 minutes from pain onset. Participants were to repeat treatment if pain had not improved in 15 minutes.ResultsnVNS (n = 120) was superior to sham (n = 123) for pain freedom at 30 minutes (12.7% vs 4.2%; p = 0.012) and 60 minutes (21.0% vs 10.0%; p = 0.023) but not at 120 minutes (30.4% vs 19.7%; p = 0.067; primary endpoint; logistic regression) after the first treated attack. A post hoc repeated-measures test provided further insight into the therapeutic benefit of nVNS through 30, 60, and 120 minutes (odds ratio 2.3; 95% confidence interval 1.2, 4.4; p = 0.012). nVNS demonstrated benefits across other endpoints including pain relief at 120 minutes and was safe and well-tolerated.ConclusionThis randomized sham-controlled trial supports the abortive efficacy of nVNS as early as 30 minutes and up to 60 minutes after an attack. Findings also suggest effective pain relief, tolerability, and practicality of nVNS for the acute treatment of episodic migraine.ClinicalTrials.gov identifierNCT02686034.Classification of evidenceThis study provides Class I evidence that for patients with an episodic migraine, nVNS significantly increases the probability of having mild pain or being pain-free 2 hours poststimulation (absolute difference 13.2%).

Published
2018

10. Effect of exogenous estrogens and progestogens on the course of migraine during reproductive age:a consensus statement by the European Headache Federation (EHF) and the European Society of Contraception and Reproductive Health (ESCRH)

Author

Sacco, S., Merki-Feld, G.S., gidius, K.L., Bitzer, J., Canonico, M., Gantenbein, A.R., Kurth, T., Lampl, C., Lidegaard, O., MacGregor, E.A., MaassenVanDenBrink, A., Mitsikostas, D.D., Nappi, R.E., Ntaios, G., Paemeleire, K., Sandset, P.M., Terwindt, G.M., Vetvik, K.G., Martelletti, P., AElig, EHF, ESCRH, University of Zurich, Sacco, Simona, and Internal Medicine

Subjects
medicine.medical_treatment, lcsh:Medicine, Physiology, Reproductive Health/standards, FREE INTERVAL, ONLY CONTRACEPTION, DOUBLE-BLIND, 0302 clinical medicine, Medicine and Health Sciences, Contraceptives, Oral, Combined/administration & dosage, Artikkel, Estrogens/administration & dosage, Societies, Medical, Progestogens, COMBINED ORAL-CONTRACEPTIVES, 030219 obstetrics & reproductive medicine, Combined, PERCUTANEOUS ESTRADIOL, Contraception, Estrogens, Headache, Hormonal contraceptives, Migraine, Consensus, Contraceptives, Oral, Combined, Desogestrel, Europe, Female, Humans, Migraine Disorders, Progestins, Reproductive Health, Neurology (clinical), Anesthesiology and Pain Medicine, Progestins/administration & dosage, Contraceptives, YOUNG-WOMEN, General Medicine, 10175 Clinic for Reproductive Endocrinology, Vaginal ring, Consensus Article, 2728 Neurology (clinical), Pill, 2703 Anesthesiology and Pain Medicine, Headaches, medicine.symptom, hormones, hormone substitutes, and hormone antagonists, medicine.drug, Oral, LIFE EVENTS, combinealth, Societies, Medical/standards, Migraine Disorders/drug therapy, 610 Medicine & health, contraception, estrogens, headache, hormonal contraceptives, migraine, progestogens, consensus, contraceptives, oral, combinealth, societies, medical, neurology (clinical), anesthesiology and pain medicine, Europe/epidemiology, 03 medical and health sciences, Medisinske Fag: 700 [VDP], Medical, medicine, VDP::Medisinske Fag: 700, AURA, Contraception/methods, Headache/drug therapy, Progestogen, business.industry, MENSTRUAL MIGRAINE, lcsh:R, medicine.disease, Desogestrel/administration & dosage, PREVENTION, Hormonal contraception, Societies, business, 030217 neurology & neurosurgery, Hormone
Abstract

We systematically reviewed data about the effect of exogenous estrogens and progestogens on the course of migraine during reproductive age. Thereafter a consensus procedure among international experts was undertaken to develop statements to support clinical decision making, in terms of possible effects on migraine course of exogenous estrogens and progestogens and on possible treatment of headache associated with the use or with the withdrawal of hormones. Overall, quality of current evidence is low. Recommendations are provided for all the compounds with available evidence including the conventional 21/7 combined hormonal contraception, the desogestrel only oral pill, combined oral contraceptives with shortened pill-free interval, combined oral contraceptives with estradiol supplementation during the pill-free interval, extended regimen of combined hormonal contraceptive with pill or patch, combined hormonal contraceptive vaginal ring, transdermal estradiol supplementation with gel, transdermal estradiol supplementation with patch, subcutaneous estrogen implant with cyclical oral progestogen. As the quality of available data is poor, further research is needed on this topic to improve the knowledge about the use of estrogens and progestogens in women with migraine. There is a need for better management of headaches related to the use of hormones or their withdrawal.

Published
2018
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11. European Headache Federation consensus on technical investigation for primary headache disorders

Author

Mitsikostas, D. D, Ashina, M., Craven, A., Diener, H. C., Goadsby, P. J., Ferrari, M. D., Lampl, C., Paemeleire, K., Pascual, J., Siva, A., Olesen, J., Osipova, V., Martelletti, P, Ehf, Committee, and Sacco, Simona

Subjects
Pediatrics, Headache Disorders, Primary, SLEEP-APNEA SYNDROME, FEATURES, Brain MRI, consensus, diagnostic tests, migraine, primary headache disorders, TACs, tension-type headache, Medizin, Consensus, Diagnostic tests, Migraine, Primary headache disorders, Tension-type headache, Humans, Neuroimaging, Physical Examination, Magnetic Resonance Imaging, Neurology (clinical), Anesthesiology and Pain Medicine, Hypnic headache, 0302 clinical medicine, CLINICAL CHARACTERISTICS, Medicine and Health Sciences, EPIDEMIOLOGY, 030212 general & internal medicine, Stroke, Thunderclap headaches, General Medicine, INTRACRANIAL HYPERTENSION, Consensus Article, MIGRAINE, GUIDELINE, medicine.symptom, CLUSTER HEADACHE, Primary, medicine.medical_specialty, Headache Disorders, Clinical Neurology, 03 medical and health sciences, HYPNIC HEADACHE, medicine, EFNS TASK-FORCE, business.industry, Cluster headache, medicine.disease, Persistent aura without infarction, Migraine with aura, Physical therapy, Primary Cough Headache, business, 030217 neurology & neurosurgery
Abstract

The diagnosis of primary headache disorders is clinical and based on the diagnostic criteria of the International Headache Society (ICHD-3-beta). However several brain conditions may mimic primary headache disorders and laboratory investigation may be needed. This necessity occurs when the treating physician doubts for the primary origin of headache. Features that represent a warning for a possible underlying disorder causing the headache are new onset headache, change in previously stable headache pattern, headache that abruptly reaches the peak level, headache that changes with posture, headache awakening the patient, or precipitated by physical activity or Valsalva manoeuvre, first onset of headache ≥50 years of age, neurological symptoms or signs, trauma, fever, seizures, history of malignancy, history of HIV or active infections, and prior history of stroke or intracranial bleeding. All national headache societies and the European Headache Alliance invited to review and comment the consensus before the final draft. The consensus recommends brain MRI for the case of migraine with aura that persists on one side or in brainstem aura. Persistent aura without infarction and migrainous infarction require brain MRI, MRA and MRV. Brain MRI with detailed study of the pituitary area and cavernous sinus, is recommended for all TACs. For primary cough headache, exercise headache, headache associated with sexual activity, thunderclap headache and hypnic headache apart from brain MRI additional tests may be required. Because there is little and no good evidence the committee constructed a consensus based on the opinion of experts, and should be treated as imperfect. OA gold

Published
2016

12. [Verification of the validity of the Giacovazzo skin test with histamine at neutral pH]

Author

Giacovazzo M, Romiti A, Martelletti P, Mf, Gallo, Iuvara E, and Massimo GRANATA

Subjects
Migraine Disorders, Humans, Hydrogen-Ion Concentration, Histamine, Skin Tests
Abstract

In this study the different activities of histamine chloride and histamine phosphate have been tested in the cutaneous test as Giacovazzo in patients with Cluster Headache. The Authors executed the test in 20 C.H. patients and in 20 control subjects, using histamine chloride and phosphate. In order to evaluate the results, three parameters were taken into consideration: Latency Time, Hyperemia Diameter and Extinction Time. A statistical (non orthogonal) comparison of data obtained, showed no difference within the groups, while it showed the significant difference (p less than 0.001) between the groups. There was no difference between the activity of histamine chloride and phosphate in the "histamine skin test" as Giacovazzo.

Published
1984

14. ['Chronic paroxysmal hemicrania' following ophthalmic herpes zoster]

Author

Giacovazzo M, Di Sabato F, Mf, Gallo, Massimo GRANATA, and Martelletti P

Subjects
Migraine Disorders, Herpes Zoster Ophthalmicus, Humans, Female, Aged
Abstract

The authors report the first observation of a 73-year-old woman affected from CPH (Chronic Paroxysmal Hemicrania) which following an ophthalmic herpes-zoster infection. The improvement with a 5-HT 1-like agonist receptors (Sumatriptan) and with Timostimulin is discussed.

15. The role of physical activity in the prevention and treatment of chronic diseases

Author

Paolo Emilio Adami, Negro, A., Lala, N., and Martelletti, P.

Subjects
therapy, public health education, physical activity, Health Promotion, Motor Activity, Combined Modality Therapy, Exercise Therapy, Primary Prevention, Treatment Outcome, evidence-based health promotion, prevention, Quality of Life, Secondary Prevention, Humans, Controlled Clinical Trials as Topic, chronic disease
Abstract

The aim of this review is to assess the current evidence in scientific literature that supports the use of physical activity as a fundamental tool for primary and secondary prevention and to encourage its use conscientiously. Observational studies and international guidelines have been examined to evaluate the positive effects of physical activity as primary prevention on some of the most common diseases. We have also evaluated those studies which demonstrate that the association of physical activity with drug therapy in chronic diseases results in a better prognosis. We researched the Cochrane Controlled Trials Register, MEDLINE, PubMed up to January 2009. Furthermore, we screened references in relevant reviews and clinical trials. Sixty four studies were included in the review and cited as giving consistent evidence for the utilization of physical activity to improve health. There is strong evidence that, according to international guidelines, physical activity should be adopted as a tool in the prevention and treatment of many chronic diseases.

16. Upregulated expression of peripheral serotonergic receptors in migraine and cluster headache by sumatriptan

Author

Martelletti P, Stirparo G, Cristina RINALDI, and Giacovazzo M

Subjects
Adult, Male, Analysis of Variance, Sumatriptan, Migraine Disorders, Cluster Headache, Flow Cytometry, Binding, Competitive, Ondansetron, Monocytes, Up-Regulation, Receptors, Serotonin, Ergotamine, Humans, Female
Abstract

The double-label flow cytometric analysis of peripheral serotonergic pathways of migraine and cluster headache on a monocyte model has been used to evaluate the activity of drugs with a selective activity on central vascular 5-HT1D receptors, such as sumatriptan, ergotamine and ondansetron. The results indicated that sumatriptan and ergotamine progressively increase the peripheral expression of 5-HT (5-hydroxytryptamine, serotonin). The increase obtained in migraine after ergotamine is more evident than that obtained in cases of cluster headache. Ondansetron produced a moderate increase in serotonergic expression only in cluster headache. The events that occur at intracranic neural and vascular level may cause the described changes of 5-HT expression on the monocyte model as an indirect, reflective, peripheral registration of central serotonergic variations during headache attack as well as during the drug-sustained recovery phase.

17. Is the unresponsiveness to sumatriptan in cluster headache related to an alteration in the 5-HT receptors?

Author

Stirparo G, Bm, Fusco, Giacovazzo M, Cristina RINALDI, and Martelletti P

Subjects
Adult, Male, Antigens, CD, Neuroimmunomodulation, Sumatriptan, Receptors, Serotonin, Lipopolysaccharide Receptors, Antigens, Differentiation, Myelomonocytic, Humans, Cluster Headache, Middle Aged, Flow Cytometry, Monocytes
Abstract

It is well established that cluster headache shows impaired functions at the neuroimmunomodulatory system level. Defects in the expression of receptors for 5-HT, IL-1 and IL-2 have been found in these patients. Sumatriptan, an agonist activity for 5-HT1D receptor, truncates cluster headache attack in 74% of patients. Flow cytometric analysis of monocytes expressing 5-HT receptor in cluster headache patients showed different trends clearly correlated with the clinical response to sumatriptan. Our findings strongly support the concept that cluster headache patients which are non-responders to sumatriptan could present a block in their 5-HT receptor expression possibly due to specific autoantibodies for this receptor site.

18. What is changing in chronic migraine treatment? An algorithm for onabotulinumtoxinA treatment by the Italian chronic migraine group

Author

Cristina Tassorelli, Gioacchino Tedeschi, Paolo Martelletti, Antonio Russo, Andrea Negro, Simona Sacco, Licia Grazzi, Pierangelo Geppetti, Sacco, S., Russo, A., Geppetti, P., Grazzi, L., Negro, A., Tassorelli, C., Tedeschi, G., and Martelletti, P.

Subjects
medicine.drug_class, Migraine Disorders, migraine prophylaxi, Pharmacology, Calcitonin gene-related peptide, Monoclonal antibody, calcitonin gene-related peptide, Migraine prophylaxis, 03 medical and health sciences, 0302 clinical medicine, Chronic Migraine, medicine, Humans, Pharmacology (medical), Botulinum Toxins, Type A, migraine prophylaxis, business.industry, General Neuroscience, GCRP-targeting monoclonal antibodie, treatment algorithm, 030227 psychiatry, onabotulinumtoxinA, Italy, Neuromuscular Agents, Calcitonin, chronic migraine, GCRP-targeting monoclonal antibodies, Chronic Disease, Neurology (clinical), business, Algorithms, 030217 neurology & neurosurgery
Abstract

Introduction: OnabotulinumtoxinA (OBT-A) and monoclonal antibodies (mAbs) targeting the calcitonin gene-related peptide (CGRP) pathway are two of the few treatments that ameliorate chronic migraine (CM) in randomized controlled trials and real-life studies. Separate clinical practice guidelines have been developed for the management of CM with OBT-A or CGRP-targeting mAbs. Areas covered: Considering the concomitant availability of OBT-A and CGRP-targeting mAbs as therapeutic treatment options, Italian migraine experts reviewed the evidence supporting the efficacy of OBT-A and CGRP-targeting mAbs in CM in order to rationalize the management of CM patients treated with OBT-A. Experts addressed everyday practice needs to shape the optimal pharmacological management by balancing adherence to regulatory indications, ethical considerations, and clinical expertise. Considering the remarkable challenge of improving the health and quality of life of patients with CM, even partial improvements may be clinically meaningful, particularly for those who are resistant or intolerant to oral migraine treatments. Expert opinion: In this collaborative effort, we propose a treatment algorithm that integrates the relevant aspects of managing patients with CM to provide ready-to-use practical guidance regarding the appropriate use of OBT-A.

Published
2020
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19. Development and validation of the ID-EC - the ITALIAN version of the identify chronic migraine

Author

Maria Pia Prudenzano, Gianluca Coppola, Grazia Sances, Roberto De Icco, Simona Sacco, Paolo Martelletti, Valentina Taranta, Pietro Cortelli, Francesca Pistoia, Giulia Pierangeli, Antonio Russo, Cristina Tassorelli, Luigi Alberto Pini, Francesco Pierelli, Sabina Cevoli, Cristiano Maria De Marco, Maria Trojano, Silvia Benemei, Cherubino Di Lorenzo, Gioacchino Tedeschi, Francesco De Cesaris, Pierangelo Geppetti, Alessia Manni, Raffaele Ornello, Andrea Negro, Lanfranco Pellesi, Sacco, S., Benemei, S., Cevoli, S., Coppola, G., Cortelli, P., De Cesaris, F., De Icco, R., De Marco, C. M., Di Lorenzo, C., Geppetti, P., Manni, A., Negro, A., Ornello, R., Pierangeli, G., Pierelli, F., Pellesi, L., Pini, L. A., Pistoia, F., Prudenzano, M. P., Russo, A., Sances, G., Taranta, V., Tassorelli, C., Tedeschi, G., Trojano, M., Martelletti, P., Sacco, Simona, Benemei, Silvia, Cevoli, Sabina, Coppola, Gianluca, Cortelli, Pietro, De Cesaris, Francesco, De Icco, Roberto, De Marco, Cristiano Maria, Di Lorenzo, Cherubino, Geppetti, Pierangelo, Manni, Alessia, Negro, Andrea, Ornello, Raffaele, Pierangeli, Giulia, Pierelli, Francesco, Pellesi, Lanfranco, Pini, Luigi Alberto, Pistoia, Francesca, Prudenzano, Maria Pia, Russo, Antonio, Sances, Grazia, Taranta, Valentina, Tassorelli, Cristina, Tedeschi, Gioacchino, Trojano, Maria, and Martelletti, Paolo

Subjects
Male, lcsh:Medicine, 0302 clinical medicine, Chronic Migraine, Migraine Disorder, Surveys and Questionnaires, Diagnosis, Mass Screening, Surveys and Questionnaire, 030212 general & internal medicine, Program Development, Medical diagnosis, education.field_of_study, General Medicine, Health Survey, Middle Aged, Test (assessment), Italy, chronic migraine, diagnosis, migraine, neurology, anesthesiology and pain medicine, Female, Research Article, Diagnosi, Human, Adult, medicine.medical_specialty, Migraine Disorders, Population, Sensitivity and Specificity, Young Adult, 03 medical and health sciences, medicine, Humans, education, Migraine, Mass screening, Chronic migraine, business.industry, lcsh:R, Translating, medicine.disease, Health Surveys, Neurology (clinical), Anesthesiology and Pain Medicine, Clinical diagnosis, Chronic Disease, Physical therapy, International Classification of Headache Disorders, business, 030217 neurology & neurosurgery
Abstract

Background Case-finding tools, such as the Identify Chronic Migraine (ID-CM) questionnaire, can improve detection of CM and alleviate its significant societal burden. We aimed to develop and validate the Italian version of the ID-CM (ID-EC) in paper and as a smart app version in a headache clinic-based setting. Methods The study investigators translated and adapted to the Italian language the original ID-CM questionnaire (ID-EC) and further implemented it as a smart app. The ID-EC was tested in its paper and electronic version in consecutive patients referring to 9 Italian tertiary headache centers for their first in-person visit. The scoring algorithm of the ID-EC paper version was applied by the study investigators (case-finding) and by patients (self-diagnosis), while the smart app provided to patients automatically the diagnosis. Diagnostic accuracy of the ID-EC was assessed by matching the questionnaire results with the interview-based diagnoses performed by the headache specialists during the visit according to the criteria of International Classification of Headache Disorders, III edition, beta version. Results We enrolled 531 patients in the test of the paper version of ID-EC and 427 in the validation study of the smart app. According to the clinical diagnosis 209 patients had CM in the paper version study and 202 had CM in the smart app study. 79.5% of patients returned valid paper questionnaires, while 100% of patients returned valid and complete smart app questionnaires. The paper questionnaire had a 81.5% sensitivity and a 81.1% specificity for case-finding and a 30.7% sensitivity and 90.7% specificity for self-diagnosis, while the smart app had a 64.9% sensitivity and 90.2% specificity. Conclusions Our data suggest that the ID-EC, developed and validated in tertiary headache centers, is a valid case-finding tool for CM, with sensitivity and specificity values above 80% in paper form, while the ID-EC smart app is more useful to exclude CM diagnosis in case of a negative result. Further studies are warranted to assess the diagnostic accuracy of the ID-EC in general practice and population-based settings.

Published
2019
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20. Pharmacokinetics and safety of a new aspirin formulation for the acute treatment of primary headaches

Author

Lidia D'Alonzo, Paolo Martelletti, Marzia Lecchi, Andrea Negro, Lecchi, M, D'Alonzo, L, Negro, A, and Martelletti, P

Subjects
Drug, safety, aspirin, media_common.quotation_subject, Migraine Disorders, Absorption (skin), Pharmacology, Toxicology, micronized aspirin, Primary headache, Pharmacokinetics, Migraine Disorder, medicine, Humans, headache treatment, migraine, pharmacokinetics, speed of action, tension-type headache, pharmacokinetic, media_common, Aspirin, Dose-Response Relationship, Drug, business.industry, Sumatriptan, Anti-Inflammatory Agents, Non-Steroidal, Headache, General Medicine, medicine.disease, Safety profile, Migraine, Anesthesia, Practice Guidelines as Topic, business, medicine.drug, Human, Tablets
Abstract

For more than a century, aspirin has been used for the acute treatment of primary headaches. However, the many formulations available are characterized by differences in the pharmacokinetic profile that could affect therapy effectiveness.The formulations of aspirin affect the speed of absorption of the drug. This feature, in turn, moduates the peak plasmatic concentration (the faster the absorption, the higher the peak plasmatic concentration of aspirin). Recently, a new formulation, consisting in a micronized tablet with an effervescent nucleus, has been shown to be comparable to the formulations associated to the faster absorption. The efficacy of aspirin in migraine is well characterized: the drug is able to rapidly reduce pain and restore functionality, acting also on associated symptoms, in a manner comparable to that of oral sumatriptan. In tension-type headache, aspirin acts in a dose-dependent fashion. The safety profile of the drug is favorable: gastrointestinal complaints are generally mild in intensity and with an incidence comparable to that of ibuprofen and paracetamol.According to international guidelines, aspirin should be considered as first-line therapy in primary headaches. Formulations that allow fast absorption, like the new micronized tablets, and portability, are to be preferred.

Published
2014

21. Neuromodulation of chronic headaches: position statement from the European Headache Federation

Author

Marina de Tommaso, Stefano Palmisani, Denys Fontaine, Filippo Brighina, Andrea Antal, Tim P Jürgens, Delphine Magis, Walter Paulus, Max Heiland, Arne May, R. Arcioni, Rigmor Jensen, Koen Paemeleire, Massimo Leone, Paolo Martelletti, Angelo Franzini, Martelletti, P, Jensen, RH, Antal, A, Arcioni, R, Brighina, F, de Tommaso, M, Franzini, A, Fontaine, D, Heiland, M, Jürgens, TP, Leone, M, Magis, D, Paemeleire, K, Palmisani, S, Paulus, W, and May, A.

Subjects
TRANSCRANIAL MAGNETIC STIMULATION, Deep Brain Stimulation, medicine.medical_treatment, SPG, SPINAL-CORD STIMULATION, DBS, ARTERIAL BLOOD-PRESSURE, tDCS, 0302 clinical medicine, chronic headache, tms, VNS, Medicine and Health Sciences, migraine, 030212 general & internal medicine, HUMAN MOTOR CORTEX, european headache federation, VAGAL AFFERENT STIMULATION, Transcranial direct-current stimulation, spg, Headache, European headache federation, cluster headache, Hemicrania continua, dbs, General Medicine, Transcranial Magnetic Stimulation, Neuromodulation (medicine), 3. Good health, Consensus Article, Chronic headache, vns, Settore MED/26 - Neurologia, DEEP-BRAIN-STIMULATION, Chronic Pain, Headaches, medicine.symptom, Vagus nerve stimulation, UNILATERAL NEURALGIFORM HEADACHE, neurostimulation, medicine.medical_specialty, POSTERIOR HYPOTHALAMIC AREA, Cluster headache, Headache Disorders, TENS, Clinical Neurology, Electric Stimulation Therapy, ONS, 03 medical and health sciences, Physical medicine and rehabilitation, medically intractable headache, medicine, Humans, tdcs, ons, gon, tens, GON, Neurostimulation, Migraine, OCCIPITAL NERVE-STIMULATION, Medically intractable headache, business.industry, medicine.disease, Anesthesiology and Pain Medicine, TMS, Physical therapy, Neurology (clinical), business, CHRONIC CLUSTER HEADACHE, 030217 neurology & neurosurgery
Abstract

The medical treatment of patients with chronic primary headache syndromes (chronic migraine, chronic tension-type headache, chronic cluster headache, hemicrania continua) is challenging as serious side effects frequently complicate the course of medical treatment and some patients may be even medically intractable. When a definitive lack of responsiveness to conservative treatments is ascertained and medication overuse headache is excluded, neuromodulation options can be considered in selected cases.Here, the various invasive and non-invasive approaches, such as hypothalamic deep brain stimulation, occipital nerve stimulation, stimulation of sphenopalatine ganglion, cervical spinal cord stimulation, vagus nerve stimulation, transcranial direct current stimulation, repetitive transcranial magnetic stimulation, and transcutaneous electrical nerve stimulation are extensively published although proper RCT-based evidence is limited. The European Headache Federation herewith provides a consensus statement on the clinical use of neuromodulation in headache, based on theoretical background, clinical data, and side effect of each method. This international consensus further gives recommendations for future studies on these new approaches.In spite of a growing field of stimulation devices in headaches treatment, further controlled studies to validate, strengthen and disseminate the use of neurostimulation are clearly warranted. Consequently, until these data are available any neurostimulation device should only be used in patients with medically intractable syndromes from tertiary headache centers either as part of a valid study or have shown to be effective in such controlled studies with an acceptable side effect profile. peerReviewed

Published
2013

22. Cost of healthcare for patients with migraine in five European countries: results from the International Burden of Migraine Study (IBMS)

Author

Andrew M. Blumenfeld, Michel Lanteri-Minet, Peter J. Goadsby, Dawn C. Buse, Zaza Katsarava, Pietro Cortelli, Michael Stokes, Paolo Martelletti, Lisa M. Bloudek, Julio Pascual, Richard B. Lipton, Teresa K. Wilcox, Sepideh F. Varon, Bloudek L.M., Stokes M., Buse D.C., Wilcox T.K., Lipton R.B., Goadsby P.J., Varon S.F., Blumenfeld A.M., Katsarava Z., Pascual J., Lanteri-Minet M., Cortelli P., and Martelletti P.

Subjects
Male, medicine.medical_specialty, Original, Cross-sectional study, Cost, Migraine Disorders, Population, Medizin, Clinical Neurology, Chronic Migraine, Quality of life, Germany, Health care, medicine, Resource utilization, Humans, Disabled Persons, Psychiatry, Unit cost, education, Episodic migraine, Migraine, Chronic migraine, education.field_of_study, business.industry, chronic migraine, cost, episodic migraine, france, germany, italy, migraine, resource utilization, spain, united kingdom, Health Care Costs, General Medicine, Emergency department, medicine.disease, Health Surveys, United Kingdom, Europe, Cross-Sectional Studies, Anesthesiology and Pain Medicine, Italy, Spain, Family medicine, Female, Neurology (clinical), France, business
Abstract

Migraine is a disabling neurological disease that affects 14.7 % of Europeans. Studies evaluating the economic impact of migraine are complex to conduct adequately and with time become outdated as healthcare systems evolve. This study sought to quantify and compare direct medical costs of chronic migraine (CM) and episodic migraine (EM) in five European countries. Cross-sectional data collected via a web-based survey were screened for migraine and classified as CM (≥15 headache days/month) or EM (

Published
2012

23. A double-blind, randomized, multicenter, Italian study of frovatriptan versus almotriptan for the acute treatment of migraine

Author

Paolo Martelletti, Biagio Panascia, Brigida Fierro, Patrizia Santoro, Carlo Lisotto, Stefano Omboni, Maria Adele Giamberardino, Lidia Savi, D. Moscato, Giorgio Zanchin, Marco Bartolini, Michel D. Ferrari, Filippo Brighina, Grazia Sances, Luigi Alberto Pini, Bartolini, M, Giamberardino, MA, Lisotto, C, Martelletti, P, Moscato, D, Ganascia, B, Savi, L, Pini, LA, Sances, G, Santoro, P, Zanchin, G, Omboni, S, Ferrari, MD, Brighina, F, and Fierro, B

Subjects
Adult, Male, Adolescent, Original, Migraine with Aura, Population, Almotriptan, Carbazoles, Clinical Neurology, Migraine, almotriptan, Frovatriptan, Young Adult, frovatriptan, migraine, patient preference, Double-Blind Method, medicine, Humans, Migraine, Frovatriptan, Almotriptan, Patient preference, Patient preference, education, Aged, education.field_of_study, Cross-Over Studies, business.industry, General Medicine, Middle Aged, medicine.disease, Crossover study, Rizatriptan, Tryptamines, Migraine with aura, Serotonin Receptor Agonists, Treatment Outcome, Anesthesiology and Pain Medicine, Italy, Tolerability, Anesthesia, Acute Disease, Female, Settore MED/26 - Neurologia, Neurology (clinical), medicine.symptom, business, medicine.drug
Abstract

The objective of this study was to evaluate patients’ satisfaction with acute treatment of migraine with frovatriptan or almotriptan by preference questionnaire. One hundred and thirty three subjects with a history of migraine with or without aura (IHS 2004 criteria), with at least one migraine attack in the preceding 6 months, were enrolled and randomized to frovatriptan 2.5 mg or almotriptan 12.5 mg, treating 1–3 attacks. The study had a multicenter, randomized, double blind, cross-over design, with treatment periods lasting

Published
2011

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