Search PubMed⌕ Search

Biomedical subjects

G Bussone

Publications and source records attributed to G Bussone.

At least 55 records · Page 3Linked to original sources
PubMed2004

Headache and intracranial hypotension: neuroradiological findings.

The cardinal and classic features of postural headache and low cerebrospinal fluid (CSF) pressure in intracranial hypotension may not dominate the clinical picture of the syndrome and may be associated with additional various neurological symptoms and signs. Reports of unusual clinical presentations continue to appear in the literature. Despite the considerable variability of the clinical spectrum, neuroradiological studies reveal more constant and characteristic features. Brain MRI findings include intracranial pachymeningeal thickening and post-contrast enhancement, subdural fluid collections and downward displacement or "sagging" of the brain. Spinal MRI findings include collapse of the dural sac with a festooned appearance, intense epidural enhancement owing to dilatation of the epidural venous plexus, and possible epidural fluid collections. In fact, spinal studies may demonstrate CSF leakage from spinal dural defects, which are considered the most common cause of the syndrome. Myelo-MR may suggest the possible point of CSF leakage, by demonstrating an irregular root sleeve; myelo-CT and radioisotope myelocisternography (RMC) are often needed to confirm the point of CSF leakage. Neuroimaging studies are, therefore, essential for suggesting and confirming the diagnosis.

Brain↗
PubMed2004

Strategies for the treatment of autonomic trigeminal cephalalgias.

Trigeminal autonomic cephalalgias (TACs) are a group of primary headache syndromes characterised by two main clinical characteristics: pain and oculofacial autonomic phenomena. Three headache forms are grouped as TACs: cluster headache (CH), paroxysmal hemicrania (PH) and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT). These are distinguished mainly on the basis of attack duration. It lasts from 15 to 180 min in CH, from 2 to 30 min in PH and from 5 to 240 s in SUNCT. The most effective drug preventative in PH is indomethacin even if in few cases other non-steroidal anti-inflammatory drugs have been reported to be effective. SUNCT is commonly described as drug resistant. Recent studies report that lamotrigin may be the drug of choice for SUNCT.

Adrenal Cortex Hormones↗
PubMed2004

Pathophysiology of migraine.

The exact pathogenesis of migraine remains to be determined. In particular there is increasing evidence for the neural basis of migraine. We now have a body of data supporting the concept of central neuronal hyperexcitability as a pivotal physiological disturbance predisposing to migraine. The reasons for increased neuronal excitability may be multifactorial. Most recently, abnormality of calcium channels has been introduced as a potential mechanism of interictal neuronal excitability. Mutant voltage gated P/Q type calcium channel genes likely influence presynaptic neurotransmitter release, possibly of excitatory amino-acid systems or inhibitory. It could therefore be hypothesised that genetic abnormalities result in a lowered threshold of response to trigger factors. There is also evidence from spectroscopic studies that magnesium is low in migraine. We currently conceive of a migraine attack as originating in the brain. Triggers of an attack initiate a depolarising neuroelectric and metabolic event likened to the spreading depression of Leao. This event activates the headache and associated features of the attack by mechanisms that remain to be determined, but appear to involve either peripheral trigeminovascular or brain stem pathways, or both. Excitability of cell membranes, perhaps in part genetically determined, is the brain's route of susceptibility to attacks. Factors that increase or decrease neuronal excitability constitute the threshold for triggering attacks.

Calcium Channels↗
PubMed2004

Measure of negative impact of migraine on daily activities, social relationships and therapeutic approach.

The study has been conducted in 9 European countries, interviewing 200 women in each country, aged 18-35, in fully working or studying period, to get a total of 1810 people. Migraine or severe headache was recognised and patients were studied to understand their behaviour. The features and severity of headache, the use of different drugs, the relationship between physicians and patients, the disability during attacks, the psychological aspects and the feeling of impotence that migraine patients experienced during their lives, are analysed and reported.

Activities of Daily Living↗
PubMed2004

Pharmacological behavioural treatment for children and adolescents with tension-type headache: preliminary data.

Recurrent headaches are a significant health problem for young patients. Most current investigations have employed limited modalities (either medication or behavioural) and few have included treatment comparisons. The purpose of this study was to compare relaxation training (provided in a limited contact format) and amitriptyline in the treatment of young tension-type headache (TTH) sufferers. Follow-up is planned for 3, 6 and 12 months, at which time patients complete headache logs and an Italian version of the Migraine Disability Assessment (MIDAS) Questionnaire that has been adapted for this age group. Two groups of TTH sufferers of similar age and characteristics were studied. Clinical results, MIDAS total score, and individual values for items A and B were collected at the first follow-up (3 months). The clinical improvement is significant for both groups. Although the clinical results are similar in both groups, relaxation therapy seems to be more accepted than pharmacological therapy. These data, however, are preliminary and the sample sizes are small, so these conclusions are tentative. We will continue our data collection for 12 months.

Adolescent↗
PubMed2004

Chronic migraine with medication overuse: treatment outcome and disability at 3 years follow-up.

Patients with chronic migraine and medication overuse are particularly difficult to treat. No clear consensus exists about treatment strategies to be used and little data exists about the functional impact of headache in these patients. The purpose of the study was to determine (1) the clinical course of a sample of chronic migraine patients with medication overuse 36 months following treatment intervention and (2) whether functional impairment, assessed by the Migraine Disability Assessment (MIDAS) questionnaire, improved upon treatment. Of 106 patients meeting the criteria for chronic migraine with medication overuse (according to Silberstein and Lipton), 71 went on to complete a structured inpatient treatment, consisting of medication withdrawal and then prophylactic treatment. As a group, the patients were significantly improved at 36-month follow-up, with respect to 2 headache parameters (days of headache per month and number of used medications per month assessed by the diary card) and 2 measures of functional impact extracted from the MIDAS questionnaire (MIDAS total score and frequency of headache). Chronic migraine accompanied with medication overuse led to considerable disability prior to treatment. However, notable improvement both in headache parameters and in disability measures occurred concurrently with treatment. This suggests that successful treatment has more wide-ranging positive benefits beyond mere symptom reduction. To our knowledge, this is the first investigation where the MIDAS questionnaire has been used as an outcome measure in patients with chronic headache to assess disability during such a long follow-up period.

Chronic Disease↗
PubMed2004

Elusive amines and cluster headache: mutational analysis of trace amine receptor cluster on chromosome 6q23.

Cluster headache (CH) is characterised by unilateral pain and ipsilateral autonomic features. To date, no molecular genetic evidence has been shown for CH. Small pedigrees and low penetrance render the identification of the CH-gene quite difficult. Nonetheless the association of CH and migraine to a new class of amine, namely trace or elusive amines such as tyramine, octopamine and synephrine, has recently been demonstrated. In particular, in comparison to healthy control subjects, all these neurotransmitters have been found to be greatly elevated in CH sufferers in plasma and platelets both in active and remission periods. A cluster of gene-encoding G-protein-coupled receptors that bind and are activated by trace amines was identified in the long arm of chromosome 6q23. We evaluated two families with CH by linkage analysis to 6q23 region and the mutation scanning of the TAR 1, TAR 3, TAR 4, TAR 5, PNR and GPR58 genes by denaturing high liquid chromatography is in progress in 16 familial cases.

Biogenic Amines↗
PubMed2004

Deep brain stimulation for intractable chronic cluster headache: proposals for patient selection.

Cluster headache is the most severe of the primary headaches. Positron emission tomography and functional MRI studies have shown that the ipsilateral posterior hypothalamus is activated during cluster headache attacks and is structurally asymmetric in these patients. These changes are highly specific for the condition and suggest that the cluster headache generator may be located in that brain area; they further suggest that electrical stimulation of that region might produce clinical improvement in chronic cluster headache sufferers refractory to medical therapy. In five patients with severe intractable chronic cluster headache, hypothalamic electrical stimulation produced complete and long-term pain relief with no relevant side-effects. We therefore consider it essential to propose criteria for selecting chronic cluster headache patients for hypothalamic deep brain stimulation before this procedure is undertaken at other academic medical centres.

Cluster Headache↗
PubMed2004

Selective vs. complete family interview for detecting those affected by familial cluster headache.

This study validates the method of interviewing only the first-degree relatives indicated by the proband as possible cluster headache sufferers. We interviewed essentially all the first-degree relatives (93%) of 87 probands with cluster headache. We found only one new first-degree relative with cluster headache (1/40 = 2.5%). The selective interview may be used with confidence as a means of investigating the hereditary component of cluster headache.

Adolescent↗
PubMed2004

Placebo-controlled comparison of effervescent acetylsalicylic acid, sumatriptan and ibuprofen in the treatment of migraine attacks.

Acetylsalicylic acid (ASA) in combination with metoclopramide has been frequently used in clinical trials in the acute treatment of migraine attacks. Recently the efficacy of a new high buffered formulation of 1000 mg effervescent ASA without metoclopramide compared to placebo has been shown. To further confirm the efficacy of this new formulation in comparison with a triptan and a nonsteroidal anti-inflammatory drug (ibuprofen) a three-fold crossover, double-blind, randomized trial with 312 patients was conducted in Germany, Italy and Spain. Effervescent ASA (1000 mg) was compared to encapsulated sumatriptan (50 mg), ibuprofen (400 mg) and placebo. The percentage of patients with reduction in headache severity from moderate or severe to mild or no pain (primary endpoint) was 52.5% for ASA, 60.2% for ibuprofen, 55.8% for sumatriptan and 30.6% for placebo. All active treatments were superior to placebo (P < 0.0001), whereas active treatments were not statistically different. The number of patients who were pain-free at 2 h was 27.1%, 33.2%, 37.1% and 12.6% for those treated with ASA, ibuprofen, sumatriptan or placebo, respectively. The difference between ASA and sumatriptan was statistically significant (P = 0.025). With respect to other secondary efficacy criteria and accompanying symptoms no statistically significant differences between ASA and ibuprofen or sumatriptan were found. Drug-related adverse events were reported in 4.1%, 5.7%, 6.6% and 4.5% of patients treated with ASA, ibuprofen sumatriptan or placebo. This study showed that 1000 mg effervescent ASA is as effective as 50 mg sumatriptan and 400 mg ibuprofen in the treatment of migraine attacks regarding headache relief from moderate/severe to mild/no pain at 2 h. Regarding pain-free at 2 h sumatriptan was most effective.

Adult↗
PubMed2004

Prevalence of primary headaches in people with multiple sclerosis.

The aim was to investigate the lifetime prevalence of headache and primary headache (diagnoses according to International Headache Society criteria) in multiple sclerosis (MS). The relationships between headache and clinical features of MS and MS therapy were also investigated. We studied 137 patients with clinically definite MS; 88 reported headache, 21 of whom developed headache after the initiation of interferon. The prevalence of all headaches in the remaining 116 patients was 57.7%. Migraine was found in 25.0%, tension-type headache in 31.9%, and cluster headache in one patient. A significant correlation (P = 0.007, Fisher's exact test) between migraine and relapsing-remitting MS was found. Primary headaches are common in MS patients. Further studies are needed to clarify the mechanisms underlying this association, particularly the association between migraine and relapsing-remitting MS, and the role of interferon in the development of new headache.

Adult↗
PubMed2003

Treatment of migraine with aura: comments and perspectives.

Migraine with aura (MwA) is a primary headache that affects about 30% of migraine sufferers. The main questions for the physician caring for the patient who has MwA are: when to use preventive medications, what medications to use in acute and preventive treatment, and whether the aura should be treated. The aim of this paper is to review the various therapeutic options for MwA proposed in the current literature and to evaluate their efficacy.

Adolescent↗
PubMed2003

Chronic migraine and chronic tension-type headache: different aspects of the chronic daily headache spectrum. Clinical and pathogenetic considerations.

Clinicians working in the field of headache face great difficulty in managing patients with daily headache. Many of these patients have a history of episodic migraine that over several years has transformed into a chronic headache. Others have a history of episodic tension-type headache that also has chronicized. Still others present clinical characteristics that resemble both headache forms. In this article, we review the clinical and pathophysiological aspects of chronic daily headache and discuss the problems associated with its diagnosis.

Chronic Disease↗
PubMed2003

Neurobiology of chronic migraine.

Chronic daily headache (CDH) is an important problem for clinicians. It is frequent in tertiary care structures, although at present there is no clear consensus about definitions and operational criteria. In fact, CDH is a group of headache disorders that includes chronic migraine (CM). CDH usually evolves from an episodic headache form, which was migraine in most cases. Several psychopathological factors (e.g. psychiatric comorbidity, personality traits or stressful life events) and some somatic disorders (e.g. like arterial hypertension, allergic condition, sleep disturbances) are frequent in CM patients. Caffeine consumption, alcohol overuse and medication overuse (abortive drugs for migraine) could favour chronicity. The possible role of these factors remains poorly understood. Prospective studies and research about the pathophysiology of chronic pain will lead to a better understanding of CM.

Chronic Disease↗
PubMed2003

Quality of life and disability in primary chronic daily headaches.

We assessed functional disability and health-related quality of life (HRQOL) in Italian patients suffering from chronic migraine and medication overuse (150 subjects) or chronic cluster headache (22 subjects). We used the validated Italian versions of the Migraine Disability Assessment Score (MIDAS) and of the Short Form 36 (SF-36). Patients with both conditions were characterised by significantly lower scores on most SF-36 scales than Italian normative data (Student's t test with Bonferroni correction). MIDAS scores revealed that patients had severe limitations in their ability to function, with high proportions forced to stop work and non-work activities, or experiencing significantly reduced productivity in all activity domains. These findings show that primary chronic headaches have a marked negative influence on patients' lives, compromising their sense of well being and their ability to function in different roles. We also found that MIDAS and SF-36 were sensitive to clinical changes in a group of 84 patients with chronic migraine and medication overuse who completed the both questionnaires before and after treatment.

Activities of Daily Living↗
PubMed2003

The patient with medication overuse: clinical management problems.

Patients with chronic headache arise many problems in clinical management, often strictly related to medication overuse. IHS classification did not clear the different clinical presentation and a chapter dedicated to this problem is lacking. This condition is very frequently associated with psychiatric illness, so that the clinical features become more complex over the years. Most of patients share a past clinical condition of episodic migraine; this aspect is very important facing the therapeutical phase, because after discontinuing medication overuse, if present, the treatment must be direct toward this disease. To treat a patient with analgesic, or ergotamine, or triptan abuse, require much caution because stopping the drug may arise new problems, such as different headache, abstinence syndrome, epileptic seizures etc. We review the different possibility that we have to manage the overuser patient.

Analgesics↗