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  1. Article ; Online: The evolutionary meaning of migraine.

    Pensato, Umberto / Cevoli, Sabina / Pierangeli, Giulia / Cortelli, Pietro

    Cephalalgia : an international journal of headache

    2023  Volume 43, Issue 12, Page(s) 3331024231209303

    Abstract: Introduction: Migraine's astonishing prevalence and preserved genetic background contrast with the definition of a disease and the biological meaning of experiencing recurrent, severe headache attacks is still puzzling.: Methods: To provide a ... ...

    Abstract Introduction: Migraine's astonishing prevalence and preserved genetic background contrast with the definition of a disease and the biological meaning of experiencing recurrent, severe headache attacks is still puzzling.
    Methods: To provide a comprehensive explanation of the migraine evolutionary meaning, we review (i) the putative role of the autonomic nervous system in migraine attacks, (ii) the inter-ictal autonomic, functional, and metabolic signature of migraine patients, (iii) the bio-behavioral perspective of pain, and (iv) the allostatic perception of migraine chronification.
    Results: Migraineurs have inter-ictal cortical hyperexcitability and metabolic dysfunction that predisposes to brain energetic imbalance. Multiple precipitating factors may lead to brain energy consumption over the migraine attack generation threshold. In response, the brain engenders adaptive, evolutionary conserved, autonomic-behavior responses through the antidromic activation of the trigeminovascular system. The sickness behavior and severe pain experienced during migraine attacks result in avoiding mental and physical activity, allowing brain energy restoration. Chronic exposure to stressors may result in an allostatic overload, leading to maladaptive chronic activation of these responses. In this bio-behavioral perspective, the chronification of migraine should be envisioned as a pathological process, whereas the migraine itself should not.
    Conclusion: Migraine has an evolutionary (Darwinian) meaning.
    MeSH term(s) Humans ; Migraine Disorders/genetics ; Brain ; Pain ; Autonomic Nervous System ; Headache
    Language English
    Publishing date 2023-12-02
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 604567-4
    ISSN 1468-2982 ; 0333-1024
    ISSN (online) 1468-2982
    ISSN 0333-1024
    DOI 10.1177/03331024231209303
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  2. Article ; Online: Is physiotherapy in migraines known to sufferers? A cross-sectional study.

    Tedeschi, Roberto / Pillastrini, Paolo / Pierangeli, Giulia / Favoni, Valentina / Cortelli, Pietro / Cevoli, Sabina

    Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology

    2023  Volume 45, Issue 4, Page(s) 1669–1674

    Abstract: Background: Migraine, a prevalent neurological condition, often impairs daily functioning and quality of life. While medications are the primary treatment, the potential of physiotherapy as an integrative approach remains underexplored. The aim of the ... ...

    Abstract Background: Migraine, a prevalent neurological condition, often impairs daily functioning and quality of life. While medications are the primary treatment, the potential of physiotherapy as an integrative approach remains underexplored. The aim of the study was to explore the awareness and experience of migraine patients regarding physiotherapy as a complementary treatment.
    Methods: A comprehensive survey was conducted on 200 migraine patients. Data collected included demographics, diagnosis, Migraine Disability Assessment Score Questionnaire (MIDAS) scores, and perceptions and experiences related to physiotherapy.
    Results: The average age of participants was 47.7 ± 13.2 years, with a predominance of females, 149 out of 200 (74.5%). The mean MIDAS score was 36.7 ± 45.3, indicating a significant impact on daily life. While 39 out of 200 (19.5%) had undergone physiotherapy for their headache, 161 out of 200 (80.5%) had not. Of those who had, 22 out of 39 (56.4%) reported benefits, including reduced attack intensity and frequency. Interestingly, 145 out of 161 (90.1%) expressed interest in physiotherapy, with many expecting it to reduce attack intensity, 57 out of 200 (28.5%) and frequency, 77 out of 200 (38.5%).
    Conclusions: The study highlights the substantial burden of migraines and the potential of physiotherapy as an adjunctive treatment. Increasing awareness and accessibility to physiotherapy could offer migraine patients a more holistic treatment approach; however, randomized controlled trials are mandatory in order to confirm its efficacy.
    MeSH term(s) Female ; Humans ; Adult ; Middle Aged ; Male ; Cross-Sectional Studies ; Quality of Life ; Migraine Disorders/therapy ; Migraine Disorders/diagnosis ; Headache/therapy ; Physical Therapy Modalities
    Language English
    Publishing date 2023-11-15
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2016546-8
    ISSN 1590-3478 ; 1590-1874
    ISSN (online) 1590-3478
    ISSN 1590-1874
    DOI 10.1007/s10072-023-07195-9
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  3. Article ; Online: Prevalence, natural history and dynamic nature of chronic headache and medication overuse headache in Italy: The SPARTACUS study.

    Favoni, Valentina / Mascarella, Davide / Giannini, Giulia / Bauleo, Salvatore / Torelli, Paola / Pierangeli, Giulia / Cortelli, Pietro / Cevoli, Sabina

    Cephalalgia : an international journal of headache

    2023  Volume 43, Issue 4, Page(s) 3331024231157677

    Abstract: Background: Chronic headaches and medication overuse headache are common and burdening conditions. No studies have evaluated the prevalence of chronic headache and medication overuse headache in an unselected Italian population.: Methods: We ... ...

    Abstract Background: Chronic headaches and medication overuse headache are common and burdening conditions. No studies have evaluated the prevalence of chronic headache and medication overuse headache in an unselected Italian population.
    Methods: We performed a three-year cross-sectional and longitudinal population-based study to investigate prevalence, natural history, and prognostic factors of chronic headache. We delivered a self-administered questionnaire to 25,163 subjects. Chronic headache patients were interviewed by General Practitioners. After three years, medication overuse headache patients were invited to undergo a neurological evaluation at our Center.
    Results: 16,577 individuals completed the questionnaire; 6878 (41,5%) were episodic headache sufferers and 636 (3.8%) were chronic headache subjects. 239 (1.4%) patients were acute medication over-users. All medication overuse headache patients had migraine or headache with migrainous features. At the three-year follow-up of 98 patients, we observed conversion to episodic headaches in 53 (54.1%) patients. 27 (50.9%) patients remitted spontaneously.
    Conclusions: We present the first prevalence data on chronic headache and medication overuse headache in an unselected Italian population and a high rate of spontaneous remission. These data support the interpretation of medication overuse headache as a specific migraine-related disorder that may reflect chronic migraine's dynamic nature, the need for more specific medication overuse headache diagnostic criteria, and highlight the priority of targeted public health policies.
    MeSH term(s) Humans ; Prevalence ; Cross-Sectional Studies ; Headache Disorders/epidemiology ; Headache Disorders, Secondary/epidemiology ; Headache Disorders, Secondary/diagnosis ; Migraine Disorders/epidemiology ; Migraine Disorders/drug therapy ; Italy/epidemiology ; Headache/epidemiology
    Language English
    Publishing date 2023-03-23
    Publishing country England
    Document type Journal Article
    ZDB-ID 604567-4
    ISSN 1468-2982 ; 0333-1024
    ISSN (online) 1468-2982
    ISSN 0333-1024
    DOI 10.1177/03331024231157677
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  4. Article ; Online: Migraine chronification as an allostatic disorder: a proof-of-concept study.

    Calabrò, Calogero / Di Tillo, Eliana / Pensato, Umberto / Zenesini, Corrado / Favoni, Valentina / Fontana, Camilla / Cevoli, Sabina / Tossani, Eliana / Cortelli, Pietro / Grandi, Silvana / Pierangeli, Giulia

    Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology

    2024  Volume 45, Issue 6, Page(s) 2775–2782

    Abstract: Objective: The underpinning biologics of migraine chronification are not well understood. We aim to investigate the role of the cumulative burden of stress, namely the allostatic load, in migraine chronification.: Methods: This was a cross-sectional ... ...

    Abstract Objective: The underpinning biologics of migraine chronification are not well understood. We aim to investigate the role of the cumulative burden of stress, namely the allostatic load, in migraine chronification.
    Methods: This was a cross-sectional study. The allostatic load was measured with a composite multi-system score (BALI: Bologna Allostatic Load Index), evaluating 20 biomarkers representing four physiological systems: immune, metabolic, cardiovascular, and neuroendocrinological systems. BALI score was subdivided into high score and low score based on the distribution in controls. Migraine patients were included and subclassified into low-frequency episodic migraine group (low-EM group), high-frequency episodic migraine group (high-EM group), and chronic migraine group (CM group).
    Results: The distribution of BALI high-score increased in parallel with headache attacks monthly frequency: 16% in low-EM group (n = 10), 24% in high-EM group (n = 12), and 40% in CM group (n = 21) (p = 0.017). In a multivariable analysis, the odds ratio of having a high-score BALI in CM patients (vs. low-EM patients) was 2.78 (95% CI 1.07-7.22; p = 0.036). Individual BALI biomarkers values which were significantly different among migraine subgroups included systolic blood pressure (p = 0.018), diastolic blood pressure (p < 0.001), and heart rate (p = 0.019).
    Conclusion: Our study substantiates this emerging concept of migraine chronification as an allostatic disorder.
    MeSH term(s) Humans ; Migraine Disorders/physiopathology ; Migraine Disorders/diagnosis ; Female ; Allostasis/physiology ; Male ; Cross-Sectional Studies ; Adult ; Proof of Concept Study ; Middle Aged ; Chronic Disease ; Biomarkers/blood
    Chemical Substances Biomarkers
    Language English
    Publishing date 2024-01-23
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2016546-8
    ISSN 1590-3478 ; 1590-1874
    ISSN (online) 1590-3478
    ISSN 1590-1874
    DOI 10.1007/s10072-023-07293-8
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  5. Article ; Online: Blood pressure monitoring in elderly migraineurs starting an anti-CGRP monoclonal antibody: a real-world prospective study.

    Mascarella, Davide / Andrini, Giorgia / Baraldi, Carlo / Altamura, Claudia / Favoni, Valentina / Lo Castro, Flavia / Pierangeli, Giulia / Vernieri, Fabrizio / Guerzoni, Simona / Cevoli, Sabina

    Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology

    2024  

    Abstract: Background: While monoclonal antibodies (mAbs) targeting the CGRP pathway have revolutionized migraine management due to their improved tolerance and adherence, concerns remain about their potential impact on blood pressure (BP), especially in older ... ...

    Abstract Background: While monoclonal antibodies (mAbs) targeting the CGRP pathway have revolutionized migraine management due to their improved tolerance and adherence, concerns remain about their potential impact on blood pressure (BP), especially in older patients, due to CGRP-mediated vasodilation blockade. Given the growing use of these therapies in older populations, assessing their cardiovascular (CV) safety is of paramount importance.
    Methods: This multicentric observational prospective study focused on migraine sufferers aged ≥ 60 who began erenumab, galcanezumab, or fremanezumab for prevention. Baseline, three-month, and twelve-month BP measurements were collected. Changes in antihypertensive medication and "Newly or Worsened Hypertensive" patients (NWHP) were assessed.
    Results: Among 155 patients receiving anti-CGRP mAbs (40 Erenumab, 47 Galcanezumab, 68 Fremanezumab), 42.5% had hypertension history and 39% were on antihypertensive treatment. No significant systolic or diastolic BP changes occurred at any time point compared to baseline (all p > 0.05), with no differences between the three groups. After one year, 20/155 (12.9%) patients were considered NWHP; 11/20 had prior hypertension, and 5/11 adjusted antihypertensive therapy. Among 9/20 newly hypertensive patients, 5/9 had a single measurement above the normal threshold with no requirement for new pharmacological therapy. A higher baseline BP value was associated with increased BP (p = 0.002).
    Conclusions: The study concludes that treatment with anti-CGRP mAbs over one year does not significantly affect BP in patients aged ≥ 60, nor does it increase the incidence of hypertension compared to general population trends. Nonetheless, continuous monitoring and further long-term studies are necessary to fullya scertain the cardiovascular safety of these medications in the elderly.
    Language English
    Publishing date 2024-05-25
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2016546-8
    ISSN 1590-3478 ; 1590-1874
    ISSN (online) 1590-3478
    ISSN 1590-1874
    DOI 10.1007/s10072-024-07567-9
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  6. Article ; Online: Do anti-CGRP drugs have a role in migraine aura therapy?

    Matteo, Eleonora / Pensato, Umberto / Favoni, Valentina / Giannini, Giulia / Pierangeli, Giulia / Cevoli, Sabina

    Journal of neurology

    2021  Volume 268, Issue 6, Page(s) 2273–2274

    MeSH term(s) Calcitonin Gene-Related Peptide ; Epilepsy ; Humans ; Migraine with Aura/drug therapy ; Pharmaceutical Preparations
    Chemical Substances Pharmaceutical Preparations ; Calcitonin Gene-Related Peptide (JHB2QIZ69Z)
    Language English
    Publishing date 2021-04-15
    Publishing country Germany
    Document type Letter
    ZDB-ID 187050-6
    ISSN 1432-1459 ; 0340-5354 ; 0012-1037 ; 0939-1517 ; 1619-800X
    ISSN (online) 1432-1459
    ISSN 0340-5354 ; 0012-1037 ; 0939-1517 ; 1619-800X
    DOI 10.1007/s00415-021-10546-1
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  7. Article ; Online: Do catastrophizing and autonomic-reduced flexibility mediate pain outcomes in chronic headache?

    Rausa, Marialuisa / Spada, Gea Elena / Patron, Elisabetta / Pierangeli, Giulia / Palomba, Daniela

    Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology

    2021  Volume 43, Issue 5, Page(s) 3283–3295

    Abstract: Objectives: Maladaptive cognitive strategies and reduced autonomic flexibility have been reported in chronic pain conditions. No study to date addressed the effects of maladaptive coping and reduced autonomic flexibility, as indexed by heart rate ... ...

    Abstract Objectives: Maladaptive cognitive strategies and reduced autonomic flexibility have been reported in chronic pain conditions. No study to date addressed the effects of maladaptive coping and reduced autonomic flexibility, as indexed by heart rate variability (HRV), in chronic headaches. The present study aimed to assess the mediating role of pain catastrophizing and HRV on pain outcomes in patients with chronic headache.
    Methods: Thirty-two chronic headache patients and 28 healthy controls were recruited. Self-reported pain severity, pain interference on daily activity, and pain catastrophizing were assessed through the Multidimensional Pain Inventory and the Pain-Related Self Statements Scale. HRV was recorded at rest. Correlations and mediation analysis between self-report, HRV, and pain outcomes were run.
    Results: Patients with chronic headache reported significantly higher pain severity (p < .001; d =  - 1.98), pain interference on daily activity (p < .001; d =  - 1.81), and pain catastrophizing (p < .001; d =  - 0.96) compared to controls. They also presented significantly lower HRV (p < .05; d = 0.57). Both pain catastrophizing and HRV were associated with pain interference on daily activity. However, from mediation analysis, pain catastrophizing only emerged as the mediator for pain severity (p < .001; b = 0.30) and pain interference (p < .001; b = 0.14).
    Conclusion: Present results showed that chronic headache patients are characterized by high catastrophizing and lower physiological adaptability. Pain catastrophizing emerged as the only mediator of pain outcomes, suggesting that cognitive factors might have a major influence on the severity of pain and its interference on daily activities. Further studies are needed to evaluate these autonomic-cognitive interactions in chronic pain.
    MeSH term(s) Activities of Daily Living/psychology ; Catastrophization/psychology ; Chronic Disease ; Chronic Pain/psychology ; Headache Disorders/complications ; Humans ; Pain Measurement
    Language English
    Publishing date 2021-11-20
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2016546-8
    ISSN 1590-3478 ; 1590-1874
    ISSN (online) 1590-3478
    ISSN 1590-1874
    DOI 10.1007/s10072-021-05732-y
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  8. Article: Chronic Migraine and Medication Overuse Headache Worsening After OnabotulinumtoxinA Withdrawn Due to the Severe Acute Respiratory Syndrome-Coronavirus-2 Pandemic.

    Baraldi, Carlo / Ornello, Raffaele / Favoni, Valentina / Sacco, Simona / Caponnetto, Valeria / Pierangeli, Giulia / Pani, Luca / Cevoli, Sabina / Guerzoni, Simona

    Frontiers in neurology

    2021  Volume 12, Page(s) 647995

    Abstract: Introduction: ...

    Abstract Introduction:
    Language English
    Publishing date 2021-04-15
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2564214-5
    ISSN 1664-2295
    ISSN 1664-2295
    DOI 10.3389/fneur.2021.647995
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  9. Article ; Online: Great occipital nerve long-acting steroid injections in cluster headache therapy: an observational prospective study.

    Merli, Elena / Asioli, Gian Maria / Favoni, Valentina / Zenesini, Corrado / Mascarella, Davide / Sartori, Alex / Cortelli, Pietro / Cevoli, Sabina / Pierangeli, Giulia

    Journal of neurology

    2021  Volume 269, Issue 4, Page(s) 2193–2199

    Abstract: Background: Injections targeting the occipital nerve are used to reduce headache attacks and abort cluster bouts in cluster headache patients. There is no widely accepted agreement over the optimal technique of injection, type and doses of steroids and/ ... ...

    Abstract Background: Injections targeting the occipital nerve are used to reduce headache attacks and abort cluster bouts in cluster headache patients. There is no widely accepted agreement over the optimal technique of injection, type and doses of steroids and/or anesthetics to use, as well as injection regimens. The aim of this study was to verify the effectiveness and safety of greater occipital nerve long-acting steroid injections in the management of episodic and chronic cluster headache.
    Methods: We conducted a prospective observational cohort study on episodic (ECH) and chronic cluster headache patients (CCH). ECH were included in the study at the beginning of a cluster period. Three injections with 60 mg methylprednisolone were performed on alternate days. We registered the frequency and intensity of attacks three days before and 3, 7 and 30 days after the treatment, the latency of cluster relapse, adverse events, scores evaluating anxiety (Zung scale), depression (Beck's Depression Scale) and quality of life (Disability Assessment Schedule II, 12-Item Self-Administered Version). Primary outcome was the interruption of the cluster after the three injections. Responders conducted a follow-up period of 12 months.
    Results: We enrolled 60 patients, 47 with ECH and 13 with CCH. We observed a complete response in 47.8% (22/46) of episodic and 33.3% (4/12) of chronic patients. Moreover, a partial response (reduction of at least 50% of attacks) was obtained in further 10.8% (5/46) of episodic and in 33.3% (4/12) of chronic patients at 1 month. Median pain-free period was of 3 months for CCH responders. Only mild adverse events were reported in 38.3% (23/58) cases.
    Conclusions: We suggest three greater occipital nerve injections of 60 mg methylprednisolone on alternate days as useful therapy in episodic and chronic cluster headache. This leads to a long pain-free period in chronic forms. Adverse effects are mild and support its use as first choice.
    Trial registration: The study was inserted in AIFA observational studies register.
    MeSH term(s) Cluster Headache/drug therapy ; Humans ; Prospective Studies ; Quality of Life ; Steroids/therapeutic use ; Treatment Outcome
    Chemical Substances Steroids
    Language English
    Publishing date 2021-11-25
    Publishing country Germany
    Document type Journal Article ; Observational Study
    ZDB-ID 187050-6
    ISSN 1432-1459 ; 0340-5354 ; 0012-1037 ; 0939-1517 ; 1619-800X
    ISSN (online) 1432-1459
    ISSN 0340-5354 ; 0012-1037 ; 0939-1517 ; 1619-800X
    DOI 10.1007/s00415-021-10884-0
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  10. Article ; Online: Persistence of Facio-Skeletal Myorhythmia During Sleep in anti-IgLON5 Disease.

    Asioli, Gian Maria / Calandra-Buonaura, Giovanna / Mastrangelo, Vincenzo / Pierangeli, Giulia / Gaig, Carles / Santamaria, Joan / Cortelli, Pietro / Provini, Federica

    Movement disorders clinical practice

    2021  Volume 8, Issue 3, Page(s) 460–463

    Language English
    Publishing date 2021-02-25
    Publishing country United States
    Document type Case Reports
    ISSN 2330-1619
    ISSN (online) 2330-1619
    DOI 10.1002/mdc3.13159
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