Clinically the presence or absence of prodromes has always been regarded as the only distinctive feature differentiating classic migraine from common migraine. As a preliminary step for identifying any other distinctive clinical features peculiar to these two conditions, we thought it useful to review the clinical picture of classic migraine by investigating 164 patients (113 females and 51 males) aged 7–75 years. The prodromal phase consisted of scintillating scotomas (with hemianopic distribution in over half of the cases) in 79.3%, of paraesthesias mostly with cheiro-oral distribution in 29.9%, and of aphasic disturbances in 17.1%. When several neurological symptoms were present in the prodromal phase, their occurrence followed a regular sequence in time. The prodromes lasted less than 30 min in 75.6% of the cases. Only in about half the patients was pain contralateral to the peripheral location of the prodrome. The headache was generally not severe and short lived.

The short- and long-term effects of administration of lithium carbonate in cluster headache (CH) have been investigated. Of the 90 patients treated (78 males and 12 females), 68 had episodic CH and 22 had the chronic form of the disease. The doses used were almost always 900 mg/day. Eleven of the 22 patients with chronic CH showed a definite, constant improvement both short and long term. In 7 of the 22 patients, lithium treatment provided excellent results initially but was later followed by some transient worsening; in the remaining 4 only partial benefits were observed initially and treatment proved still less effective after a few months. The effects of cessation of lithium administration after at least five months of continuous treatment were studied in 9 cases. In 6 of them the attacks re-appeared immediately, whereas in 3 the attacks occurred again only after free intervals of four to six months. Of the 68 patients with episodic CH, 26 proved highly responsive to treatment, 26 only partially responsive, and 16 refractory. In 3 cases, after one to three years of continuous treatment, euthyroid goitre developed, which disappeared after the drug was discontinued.

In this multicentric random double-blind study versus placebo, the therapeutic activity of timed-release dihydroergotamine preparation 10 mg/per os/day has been tested in 90 patients affected by common migraine. The drug presented a prophylactic effect on recurrent headache, mainly on night and awakening migraine. A low incidence of side-effects with no weight changes or other effects on physiologic events was registered.

In order to assess the effects of flunarizine in long-term prophylaxis of common migraine, 120 subjects (90 female and 30 male) were treated with 10 mg at bedtime and followed-up for two years. The effectiveness of the drug was assessed by investigating the variations of the Headache Index (HI) and of the intake of analgesics. The patients considered responders were those with an at least 60% reduction of the HI compared with the baseline value. To assess side effects, on each follow-up examination the patients were weighed and submitted to the Hamilton Rating Scale for Depression, Toulouse-Pieron test for attention, and arousal test. By the third month of therapy, the average monthly HI had decreased from a baseline value of 16.5 +/- 7.0 to 7.5 +/- 4.2. Also by the third month, 60 subjects had proved responders and 50 non-responders; 10 had dropped out of the study because of side effects or for other reasons. The only statistically significant differences between responders and non-responders were in the baseline HI, which was higher among responders, and in the baseline intake of analgesics, which was higher in non-responders.