Tolerability is an important attribute of patient satisfaction with, and consequence adherence to, migraine acute treatment. Nevertheless, the determinants of tolerability are poorly explored. Accordingly, our objectives were: (i) in subjects receiving triptans, to contrast two methods of assessing adverse events (AEs); and (ii) to explore the relationship between migraine features and treatment attributes with tolerability. We surveyed 365 migraineurs who had been using the same triptan for at least 3 months. After prospectively treating an attack, headache characteristics and treatment response were assessed using headache calendars. Subjects also completed a standardized questionnaire, first asking about any AE and then prompting patients with a list of possible AEs. We contrasted both sets of answers and conducted logistic regression to assess if headache attributes or response to therapy influenced tolerability. Using the unprompted method, AEs occurred in 11.5-36.4% of patients, depending on the triptan used. Using the prompted method, they ranged from 26.9 to 64.3%. Chest and neck tightness were spontaneously reported by 3.5% of the sample, vs. 7.4% when prompted (P < 0.05). Chest pain was not spontaneously reported and was elicited in nine patients (2.5%, P = 0.002). Feeling groggy occurred in 5.7 and 17.5% (P < 0.001). AEs were not a function of headache severity, disability, efficacy of the drug, time to meaningful relief with the drug or recurrence of pain. The report of AEs varies dramatically with the methods of assessment. However, tolerability is not influenced by the severity of the attacks or by medication efficacy.

Triptans are the treatment of choice for migraine sufferers with disabling attacks. However,

The importance of the neuropsychological aspect in patients affected by tension headache is highlighted by different data in the literature as well as the results of a multicentric Italian study on comorbidity linked to consistent pathologies, from psychiatric to psychopathologies, in cephalalgic subjects. The need for an integrated approach to the treatment of migraine comes from the assumption, which has recently been confirmed by research, that cephalalgic patients, depending on their emotional condition, have difficulty in dealing with anxiety or other forms of stress in their everyday life. An integrated intervention is extremely useful both in the diagnostic and in the therapeutical approach. For 6 months, 64 patients with migraine without aura were subjected to an integrated therapeutical approach (the median age was 39 years). A number of exclusion criteria were used. The first group comprised 34 patients with migraine without aura having fewer than 4 attacks per month, while the second group comprised 30 patients with migraine without aura having more than four attacks per month. The psychological intervention involved clinical colloquia, such as Jacobson's muscle relaxation technique as well as tests and clinical questionnaires (follow-up and discussion). The follow-up assessed parameters relative to the attacks: frequency, length, and intensity. The reduction in the frequency and the length of migraine was more evident in the groups undergoing an integrated approach than in the group undergoing pharmacological therapy. This reduction was more significant in the group (8 patients) with more than four episodes per month, whose treatment involved an integrated approach and Jacobson's relaxation technique. The integrated approach yielded better results in patients with higher frequency, length, and elevated intensity of attacks (>4 attacks/month).

Lateral medullary syndrome encompasses a broad spectrum of symptoms and signs depending on the bulbar localization of the lesion. Body lateropulsion (BL) can occur without vestibular and cerebellar symptoms, as a unique manifestation of a lateral medullary infarction. However, it is relatively rare and challenging to diagnose. We report a case of a 72-year-old woman who presented with a tendency to fall to the right. She denied having vertigo, cerebellar signs, sensory loss, or motor weakness. No signs of vestibular dysfunction were found on the ENT examination. Neurological evaluation was unremarkable, except for mild ataxia of the right limbs along with BL to the right side when standing and walking. Brain magnetic resonance (MR) imaging showed an acute small infarct in the right lateral aspect of the medulla extending from the rostral to the caudal level. MR angiography found no stenosis or vascular occlusions. We believe that ipsilateral axial lateropulsion shown by our patient may be related to a selective ischemic lesion of the dorsal spinocerebellar tract in its medullary course. A lateral medullary infarction should be seriously considered in patients who present with isolated BL without further signs of bulbar involvement.