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1.  Headache, anxiety and depressive disorders: the HADAS study 
The Journal of Headache and Pain  2010;11(2):141-150.
The objective of this paper was to assess prevalence and characteristics of anxiety and depression in migraine without aura and tension-type headache, either isolated or in combination. Although the association between headache and psychiatric disorders is undisputed, patients with migraine and/or tension-type headache have been frequently investigated in different settings and using different tests, which prevents meaningful comparisons. Psychiatric comorbidity was tested through structured interview and the MINI inventory in 158 adults with migraine without aura and in 216 persons with tension-type headache or migraine plus tension-type headache. 49 patients reported psychiatric disorders: migraine 10.9%, tension-type headache 12.8%, and migraine plus tension-type headache 21.4%. The MINI detected a depressive episode in 59.9, 67.0, and 69.6% of cases. Values were 18.4, 19.3, and 18.4% for anxiety, 12.7, 5.5, and 14.2%, for panic disorder and 2.3, 1.1 and 9.4% (p = 0.009) for obsessive–compulsive disorder. Multivariate analysis showed panic disorder prevailing in migraine compared with the other groups (OR 2.9; 95% CI 1.2–7.0). The association was higher (OR 6.3; 95% CI 1.4–28.5) when migraine (with or without tension-type headache) was compared to pure tension-type headache. This also applied to obsessive–compulsive disorder (OR 4.8; 95% CI 1.1–20.9) in migraine plus tension-type headache. Psychopathology of primary headache can reflect shared risk factors, pathophysiologic mechanisms, and disease burden.
doi:10.1007/s10194-010-0187-2
PMCID: PMC3452290  PMID: 20108021
Migraine; Tension-type headache; Depression; Anxiety; Prevalence
2.  Headache and sleep: clinical and therapeutical aspects 
The Journal of Headache and Pain  2004;5(Suppl 2):s123-s127.
Sleep disorders and headache are frequently comorbid. Anatomical, biochemical and physiologic common features and pathways could explain the bidirectional influence between sleep disorders and headache. One of the troubles often encountered in the evaluation of the comorbidity between sleep and headache disorders is that patients referring to tertiary headache centres are mainly concerned about their pain and generally do not tend to spontaneously report their possible sleep problems. But when they are specifically asked, very interesting data do emerge. The comorbidity headache-insomnia offers clinicians the opportunity to choose drugs able to control both disorders, avoiding molecules which could make insomnia worse while improving headache. A polysomnographic recording should be performed when a sleep apnoea headache is suspected and if diagnosis is confirmed, headache therapy should consist of the therapy of sleep apnoea itself. Morning headache in patients with periodic limb movements disorder during sleep is not responsive to standard headache therapy but needs to be treated with specific dopamine agonists which improve headache while relieving nocturnal movements.
doi:10.1007/s10194-004-0126-1
PMCID: PMC3451585
Sleep; Headache; Insomnia; Sleep apnoea headache; Hypnic headache; Therapy
3.  Disability in migraine patients: Italian experience 
The Journal of Headache and Pain  2001;2(Suppl 1):s29-s31.
Migraine is associated with functional impairment. The migraine disability assessment (MIDAS) scale is a scientific instrument which captures headache–related disability. The Italian version of MIDAS was developed through a multi–step standardized methodology. Studies on Italian clinical samples showed that migraine patients were disabled in all activity domains. Non–work activities were more affected than work activities. Among patients in paid work, most continued working with a headache attack, although productivity was significantly reduced. The Italian MIDAS was used also in patients with transformed migraine and drug overuse. These patients were markedly disabled. MIDAS scores were higher than those found in migraine patients. When disability was assessed after 6 months from withdrawal therapy, MIDAS scores were significantly lower than at baseline. Our results confirmed the negative impact of the lives of headache patients, and suggest the use of MIDAS as a sensitive outcome measure for monitoring patients’ progress.
doi:10.1007/s101940170006
PMCID: PMC3451815
Migraine; Disability; Transformed migraine; Migraine disability assessment (MIDAS); Outcome measure
4.  New strategies for the treatment of migraine attacks 
The Journal of Headache and Pain  2001;2(Suppl 1):s113-s115.
There is no consensus on which treatment strategy should be used in the acute therapy of migraine. A stratified care approach based on patient’s disabilty assessed by a valid instrument (the MIDAS questionnaire) has been proposed. An international controlled study, the DISC trial, showed that stratified care provided better clinical outcomes than step care across attacks or within attacks. An Italian study invited migraine patients with moderate– severe disability to treat 9 attacks according to one of two strategies: stratified care (i.e. triptans from the outset) or step care across attacks (i.e. with drug escalation from non–specific drugs to triptans, if the response was not satisfactory). This study should provide data useful for assessing the optimal treatment strategy in migraine.
doi:10.1007/s101940170022
PMCID: PMC3451825
Migraine;  Acute treatment; Step care; Stratified care; Triptans
5.  Chronic daily headache: biochemical and neurotransmitter abnormalities 
The Journal of Headache and Pain  2000;1(Suppl 1):S71-S79.
Although chronic daily headache (CDH) represents one of the most relevant complaints of patients in headache centers, the mechanisms underlying the chronicization of head pain are poorly understood. Experimental animal models of chronic pain suggest the involvement of a functional disturbance of several neuronal pathways. The disturbances include an abnormal excitability of nociceptive fibers supplying pain-sensitive structures in the brain responsible for peripheral sensitization (chronic neurogenic inflammation), an increased responsiveness of sensory neurons of the dorsal horns in the upper spinal cord and trigeminal nucleus caudalis (central sensitization), and a functional abnormality of facilitating and inhibitory supraspinal pathways. Moreover, based on the experimental chronic pain models, the concepts of hyperalgesia and allodynia, the phenomena of wind-up and kindling, and the suggestion of a long-term potentiation (LTP) inducing a “memory of pain” also in the head have been advocated to explain chronic head pain. However, these hypotheses have been only partially substantiated by robust findings in patients affected by CDH. In the last few years, investigation in patients with biochemical disturbances and neurotransmitter abnormalities in patients with CDH have been undertaken. Certain common mechanisms, but also discrepancies, have been identified between the two principal CDH forms, “ transformed migraine” and chronic tension-type headache. The biochemical and neurotransmitter alterations associated with analgesic and ergotamine abuse, which often is associated with CDH and the more recent triptan misuse, are at the moment only partially known. The most relevant results supporting the alteration of neurotransmitter pathways related to nociception in CDH are reviewed.
doi:10.1007/s101940070031
PMCID: PMC3611795
Key words Chronic headache; Central sensitization; Neurotransmitter abnormalities; Experimental evidence; Human studies
6.  Personality factors in chronic headache: evaluation with SCL-90R 
The Journal of Headache and Pain  2000;1(Suppl 1):S53-S56.
The psychopathological approach is fundamental in the study of chronic headache because it integrates the diagnosis of a pathology in which the symptom (headache) is the disease itself hiding in itself the deep message to decode. The Symptom Check List 90R(SCL-90R) is a scale of general evaluation of current psychopathology which can be self-administered by the patient. The scales of SCL-90R are correlated with those of the Minnesota Multiphasic Personality Inventory. Moreover the former test has the advantage of being shorter and more pratical so it was chosen to be used in this study on chronic headache. The results showed that the psychopathological profile of chronic headache patient is rather impaired in all the dimensions and indices measured by the test. No difference was found in the occurrence of psychopathological symptoms either between analgesic abusers and nonabusers, or among the three subtypes of chronic headache.
doi:10.1007/s101940070027
PMCID: PMC3611799
Key words SCL-90R; Psychopathological symptoms; Somatization; Chronic headache
7.  Stress and chronic headache 
The Journal of Headache and Pain  2000;1(Suppl 1):S49-S52.
The aims of this study were to assess how stress affects chronic headaches, and in particular to determine whether events play a role in the transformation of an episodic headache into a chronic form. A population of 267 Italian patients with chronic headache (headache present on average more than 15 days per month) was studied. Our results confirm a triggering role of stress on headache. We also found that episodic headache (migraine in most patients, 74.1%) preceded the development of a chronic form in about 90% cases. Among these patients, in 44.8% a stressful event correlated with the transformation. Analysis of these events revealed that minor events played a greater role than major life events, suggesting that patients with transformed headache are characterised by a different way of reacting to stress.
doi:10.1007/s101940070026
PMCID: PMC3611807
Key words Chronic headache; Stress; Life events; Trigger factor; Migraine; Transformation of headache

Results 1-7 (7)