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1.  Almotriptan 12.5 mg in menstrually related migraine: A randomized, double-blind, placebo-controlled study 
Cephalalgia  2011;31(2):144-151.
Background: Menstrually related migraine (MRM) affects more than half of female migraineurs. Because such migraines are often predictable, they provide a suitable target for treatment in the mild pain phase. The present study was designed to provide prospective data on the efficacy of almotriptan for treatment of MRM.
Methods: Premenopausal women with MRM were randomized to almotriptan (N = 74) or placebo (N = 73), taken at onset of the first perimenstrual migraine. Patients crossed over to the other treatment for the first perimenstrual migraine of their second cycle, followed by a two-month open-label almotriptan treatment period.
Results: Significantly more patients were pain-free at two hours (risk ratio [RR] = 1.81; p = .0008), pain-free from 2–24 hours with no rescue medication (RR = 1.99; p = .0022), and pain-free from 2–24 hours with no rescue medication or adverse events (RR = 1.94; p = .0061) with almotriptan versus placebo. Nausea (p = .0007) and photophobia (p = .0083) at two hours were significantly less frequent with almotriptan. Almotriptan efficacy was consistent between three attacks, with 56.2% of patients pain-free at two hours at least twice. Adverse events were similar with almotriptan and placebo.
Conclusion: Almotriptan was significantly more effective than placebo in women with MRM attacks, with consistent efficacy in longer-term follow-up.
doi:10.1177/0333102410378048
PMCID: PMC3057443  PMID: 20660540
Almotriptan; headache; menstrually related migraine; placebo; randomized controlled trial
2.  Evolution of migraine-associated symptoms in menstrually related migraine following symptomatic treatment with almotriptan 
Neurological Sciences  2010;31(Suppl 1):115-119.
In addition to headache, migraine is characterized by a series of symptoms that negatively affects the quality of life of patients. Generally, these are represented by nausea, vomiting, photophobia, phonophobia and osmophobia, with a cumulative percentage of the onset in about 90% of the patients. From this point of view, menstrually related migraine—a particularly difficult-to-treat form of primary headache—is no different from other forms of migraine. Symptomatic treatment should therefore be evaluated not only in terms of headache relief, but also by considering its effect on these migraine-associated symptoms (MAS). Starting from the data collected in a recently completed multicentre, randomized, double-blind, placebo-controlled, cross-over study with almotriptan in menstrually related migraine, an analysis of the effect of this drug on the evolution of MAS was performed. Data suggest that almotriptan shows excellent efficacy on MAS in comparison to the placebo, with a significant reduction in the percentages of suffering patients over a 2-h period of time.
doi:10.1007/s10072-010-0302-9
PMCID: PMC2869014  PMID: 20464599
Acute treatment; Almotriptan; Menstrual migraine; Migraine-associated symptoms
3.  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
4.  Menstrual migraine 
The Journal of Headache and Pain  2001;2(Suppl 1):s117-s119.
An association between migraine and menstruation can be ascertained by use of a diary for a minimum of three cycles. The pathophysiological and clinical peculiarities of menstrual migraine indicate that its management should differ from that of non–menstrual migraine. NSAIDS or migraine-specific medications (e.g. triptans) are often effective for the acute management of menstrual migraine. Preventive treatment is indicated when the attacks are long–lasting, severe and disabling and do not respond to acute treatments. Short–term prophylaxis (at the time of headache vulnerability) employs standard drugs such as magnesium, ergotamine or NSAIDs; triptans are currently being evaluated for short–term prophylaxis. If severe menstrual migraine attacks cannot be controlled by these, hormone therapy (percutaneous or transdermal estrogen) may be indicated. Antiestrogen agents (danazol, tamoxifen) are indicated only in rare resistant cases.
doi:10.1007/s101940170023
PMCID: PMC3451824
Menstruation; Migraine; Therapy; Sex hormones
5.  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
6.  Quality of life and illness behaviour in chronic daily headache patients 
The Journal of Headache and Pain  2000;1(Suppl 1):S61-S65.
Chronic pathologies, above all those in which is present pain, can induce a considerable impairment in quality of life. The concept of illness behaviour is closely related to that of quality of life. It can be defined as the way to estimate and to react to one's own health status. In this study on chronic headache patients, the sickness impact profile (SIP) was used as a measure of illness-related quality of life. The way of experiencing the disease was moreover quantified by means of the illness behaviour questionnaire (IBQ). Patients with chronic headache showed a remarkable impairment in most of their daily activities. At the same time, they lived their illnesses poorly. The longer was chronic headache duration, the more disability was marked. Fermale gender was associated with a more severe profile, both in SIP and in IBQ.
doi:10.1007/s101940070029
PMCID: PMC3611797
Key words Quality of life; SIP; IBQ Disability; Illness; Behaviour; Chronic daily headache; Drug abuse
7.  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

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