This study, analyzed according to the more recent guidelines for controlled trials in migraine, showed that a fixed combination of indomethacin, prochlorperazine, and caffeine is significantly more effective than sumatriptan in the acute treatment of migraine attacks. It is notable that the combination is less expensive than sumatriptan per unit dose.
This validation study showed "ID Migraine" as a valid tool for migraine screening also in Italian patients referring to headache centers. If confirmed in a primary care setting, these results establish the "ID Migraine" as a valid screening instrument for migraine in Italian population.
Subtle clinical cerebellar alterations have been found in migraine. Moreover, abnormalities in visual and motor cortex excitability consistent with a lack of inhibitory efficiency have been described in migraine, and it is known that cerebellum exerts an inhibitory control on cerebral cortex. Here, we investigated if impairment of cerebellar activity on motor cortex, i.e. reduced inhibitory control, can be found in migraine. Ten migraineurs with aura and seven healthy controls underwent a transcranial magnetic stimulation (TMS) protocol to investigate the cerebellar inhibitory drive on motor cortex: a conditioning pulse on right cerebellar cortex was delivered 5, 7, 10, 15 ms before a test stimulus (TS) on contralateral motor cortex. The cerebellar conditioning stimulus inhibits the size of the motor-evoked potential (MEP) produced by the TS alone by approximately 30-50%. Amplitude of MEP to TS alone showed no significant difference between patients and controls. Cerebellar conditioning TMS showed a significant deficit of cerebellar inhibition in migraine patients as compared to controls at all interstimulus intervals (5-15 ms) tested. Cerebellar inhibition is reduced in migraineurs. This could account, at least in part, for the reduced inhibitory efficiency previously showed in cerebral cortex of these patients.
We showed reduced motor intracortical inhibition (ICI) and paradoxical increase of intracortical facilitation (ICF) to 1 Hz repetitive transcranial magnetic stimulation (rTMS) in patients affected by migraine with aura (MA). In conditions of enhanced excitability due to a reduced inhibition, high-frequency rTMS was found to potentiate intracortical inhibition. Here we explored the conditioning effects of high-frequency priming stimulation of motor cortex with the aim of normalizing excitability reverting paradoxical facilitation by 1 Hz rTMS in MA. Nine patients with MA and nine healthy controls underwent a paired-pulse TMS paradigm to evaluate motor intracortical excitability (ICI and ICF) before and after the following rTMS conditions: 1 Hz alone or preceded by a real or sham conditioning high-frequency (10 Hz) rTMS. Sham was used to control for rTMS specificity. In baseline, ICI was significantly lower in migraineurs with respect to controls. One hertz stimulation reduced motor evoked potential amplitude and ICF in healthy controls, while it caused a significant paradoxical ICF increase in migraineurs. High-frequency rTMS conditioning normalized excitability in migraine, increasing short ICI and so reversing the paradoxical effects of 1 Hz rTMS. These findings raise the possibility that the interictal reduced intracortical inhibition in migraine could be normalized by high-frequency rTMS. This would open perspectives for new treatment strategies in migraine prevention.
Migraine is a highly
prevalent and disabling disease that
is substantially undiagnosed in primary
care. Recently, the ID
Migraine, a self–administered questionnaire,
was shown to be a valid
and reliable screener for migraine
in primary care in the USA. To
validate an Italian version of the
ID Migraine, we planned a multicentric
study, evaluating at least
220 patients affected by various
form of headache. The responses to
the questionnaire were compared
with the diagnosis of headache
made by a headache specialist
blind to the result of the questionnaire.
Sensitivity, specificity, and
positive and negative predictive
values for migraine were calculated.
The statistical analysis on 140
patients now examined showed a
very good performance of the ID
Migraine with high sensitivity:
0.94 (95% CI: 0.89–0.95), specificity:
0.70 (95% CI: 0.54–0.86)
and positive predictive value: 0.89
(0.82–0.95). If confirmed, these
results would establish ID
Migraine as a valid screening
instrument for migraine in Italian
headache patients and warrant further
investigation in primary care
to assess the validity of this ID
screener in Italian population.
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