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Gian Camillo Manzoni

Publications and source records attributed to Gian Camillo Manzoni.

11 recordsLinked to original sources
PubMed2006

Head trauma and cluster headache.

Post-traumatic cluster headache (CH) is a very rare occurrence. Only one such case has been verified in the literature thus far. On the other hand, a non-casual association is almost certain to exist between previous head trauma and future CH onset. Considering the generally long interval of time separating the two events, it is not easy to accurately explain the nature of the head trauma/CH relationship. Head trauma may damage extra- or intracranial peripheral or central nervous structures, hence predisposing to the future development of CH. However, there also is the possibility that previous head injuries may be more frequent among CH patients because of their lifestyle, which may leave them more exposed to the risk of traumatic events.

Cluster Headache↗
PubMed2006

Cluster headache prevalence: methodological considerations. A review of the literature.

Cluster headache (CH), also known as "suicide headache", is characterized by a distinctive periodic temporal pattern and by accompanying autonomic symptoms during the attacks. Epidemiological data for the general population are scarce: only five studies have been carried out until now on CH prevalence in the general population, with conflicting results (prevalence rates vary between 56 and 326 cases every 100,000 inhabitants). Recently, a study was performed to investigate a representative sample of the Italian general population aged over 14 years. Possible CH cases according to the diagnostic criteria of the 1988 International Headache Society (IHS) classification were screened out of a sample of 10,071 patients registered in the lists of seven general practitioners (GPs) in Parma, using a previously validated, specially designed self-administered questionnaire. The diagnosis of CH was confirmed in 21 subjects (nine women and 12 men). The estimated prevalence rate was 279/100,000 (95% CI: 173-427), 227/100,000 (95% CI: 104-431) in women and 338/100,000 (95% CI: 175-592) in men. Based on methodological considerations, we believe that a lifetime prevalence rate of 279/100,000 for a population aged over 14 years is a reliable figure and it is probably not much lower than in the whole general population, since some studies performed on large case series have shown that the onset of CH is not frequent under 14 years of age.

Cluster Headache↗
PubMed2005

Cluster headache prevalence in the Italian general population.

BACKGROUND: Prevalence of cluster headache (CH) is estimated at 56 to 69 per 100,000. OBJECTIVE: To calculate the CH lifetime prevalence in a sample representative of the Italian general population over age 14 years. METHODS: Possible CH cases according to the diagnostic criteria of the 1988 International Headache Society classification were screened from a sample of 10,071 patients (5,311 women and 4,760 men; mean age 50.4 years, SD 19.7 years) registered in the lists of seven Parma-based general practitioners (GPs), using a previously validated, specially designed, self-administered questionnaire. RESULTS: Seven thousand five hundred twenty-two subjects (74.7%; 3,971 women and 3,551 men; mean age 50.8 years, SD 19.0 years) responded to the questionnaire in their GP's office (n = 3,338; 1,885 women and 1,453 men) or at home by mail (n = 1,914; 1,030 women and 884 men) or by phone (n = 2,270; 1,056 women and 1,214 men). Of the 111 suspected cases (76 women and 35 men), 105 were seen by a neurologist and 6 were contacted on the phone. The diagnosis of CH was confirmed in 21 (9 women and 12 men), including 7 already followed at the authors' center for CH. Seventeen patients had episodic CH, and four (all men) had chronic CH. The estimated prevalence rate was 279 per 100,000 (95% CI 173 to 427), 227 per 100,000 (95% CI 104 to 431) in women, and 338 per 100,000 (95% CI 175 to 592) in men. CONCLUSION: These results point to a higher cluster headache lifetime prevalence than previous reports.

Adult↗
PubMed2005

Behavior during cluster headache.

Cluster headache (CH), also known as "suicide headache," is characterized by a distinctive behavior during attacks. In 80% to 90% of cases, patients are restless and constantly moving in a vain attempt to relieve pain. They often perform complex, stereotyped actions. During attacks, CH sufferers do not want to be touched, stroked, or comforted and frequently moan a great deal, cry, or even scream. They sometimes indulge in violent, self-hurting behavior. Restlessness is a highly sensitive and highly specific parameter for CH and has been included among the signs and symptoms accompanying pain of the disorder in the Second Edition of the International Classification of Headache Disorders. A few hypotheses on pathophysiology of restlessness are addressed in this paper.

Cluster Headache↗
PubMed2004

Evidence-based diagnosis of nontraumatic headache in the emergency department: a consensus statement on four clinical scenarios.

OBJECTIVE: To provide to emergency department (ED) physicians with guidelines for diagnosis of patients with nontraumatic headaches. BACKGROUND: Many patients present to an ED with the chief complaint of headache. Causes of nontraumatic headache include life-threatening illnesses, and distinguishing patients with such ominous headaches from those with a primary headache disorder can be challenging for the ED physician. CONCLUSION: We present a consensus statement aimed to be a useful tool for ED doctors in making evidence-based diagnostic decisions in the management of adult patients with nontraumatic headache. METHODS: A multidisciplinary work performed an extensive review of the medical literature and applied the information obtained to commonly encountered scenarios in the ED.

Adult↗
PubMed2003

An epidemiological study of migraine with aura in the San Severo general population: a pilot research project of cooperation between neurologists and general practitioners.

OBJECTIVES: (A) To define the lifetime prevalence of migraine with aura (MA) in patients recruited in general practices for an epidemiologic study by the University of Parma Headache Centre from the general population of San Severo, Italy, and (B) to assess the recognition of MA in general practice. METHODS: The study was conducted over a period of 5 consecutive months (January to May 2001) on patients aged 18-65, taken from the following general practice populations: (a) from the patient population of 4 general practitioners (GPs; 3,616 patients) and (b) from the patient population of 12 GPs (12,996 patients). The clinical diagnosis of MA was subsequently confirmed by a headache specialist. RESULTS: For objective A, 648 patients (420 women and 228 men) were interviewed; MA diagnosis was confirmed in 10 patients (7 women and 3 men), lifetime MA prevalence being 1.5%. For objective B, 150 'suspected' MA cases (96 women and 54 men) were reported by the 12 GPs; however, the diagnosis of MA was confirmed in only 3 cases (2 women and 1 man). CONCLUSION: The prevalence of MA observed in our small sample of the general practice patient population was comparable with that observed in the general population of San Severo, Italy. The results also suggest that GPs may be overestimating the number of cases of MA in their patient population.

Adolescent↗
PubMed2002

What predicts evolution from episodic to chronic cluster headache?

Over the last few years, attention has increasingly been focused on the evolution of cluster headache over time. Predictive factors have been identified that are correlated with an increased risk of unfavorable evolution from the episodic form to the chronic form of cluster headache. Late onset, the presence of sporadic attacks, a high frequency of cluster periods, and short-lived duration of remission periods when the headache is still in its episodic form all correlate with a possible worsening of the clinical picture over time. The reasons for evolution of episodic cluster headache to chronic are still unknown, but some factors, such as head trauma and other lifestyle factors--eg, cigarette smoking and alcohol intake--have been suggested as having a negative influence on the course of cluster headache over time.

Chronic Disease↗
PubMed1991

Impairment of corneal pain perception in cluster headache.

Despite many studies, the mechanisms underlying the pathogenesis of pain in cluster headache (CH) still remain obscure. An involvement of substance P (SP) containing neurons of the Gasserian ganglion and/or of the spinal trigeminal nucleus has recently been suggested, e.g., by impairment of inhibitory descending pathways on trigeminal nociceptive neurons. The electrically elicited corneal reflex was studied in 21 CH patients (15 in active phase, 6 in remission). This method allows simultaneous measurements of the trigemino-facial reflex and corneal pain perception. A significant reduction of pain thresholds (more evident on the pain side) was observed in CH during the active phase, while normal values were recorded during the remission phase. Ten out of 15 patients in the active phase showed a significantly reduced corneal pain threshold on the pain side, while tactile sensibility was normal. Moreover, latency, amplitude and duration of the corneal reflex were normal for both painful and painless stimulations during both phases. The threshold of the nociceptive muscular response in the active phase was significantly reduced, suggesting that the excitability of trigeminal nociceptive neurons or of the motor neurons is increased in CH. The results agree with the hypothesis that a reversible impairment of several integrative functions, including the activity of trigeminal pain control system, exists in CH during the active phase.

Adult↗
PubMedDate not supplied

Upper and lower cluster headache: clinical and pathogenetic observations in 608 patients.

UNLABELLED: OBJECTIVE, BACKGROUND, AND METHODS: Ever since it was proposed by Ekbom and Kugelberg back in 1968 on the basis of the different location of head pain during attacks, the differentiation of cluster headache into an upper syndrome (US) and a lower syndrome (LS) has been regarded as a purely academic distinction. To evaluate whether this differentiation is indeed well founded and to understand its possible significance in the light of current pathogenetic knowledge, we rigorously applied Ekbom and Kugelberg's classification criteria to a sample of 608 patients with cluster headache (CH; 440 men and 168 women), including 483 with episodic CH, 69 with chronic CH, and 56 with CH periodicity undetermined. RESULTS: Of these patients, 278 could be classified as US sufferers and 330 as LS sufferers. Our data analysis showed statistically significant clinical differences between the two syndromes: pain location was more common in the ocular, temporal, and nuchal regions among LS sufferers; in addition, patients with LS reported not only a higher rate of autonomic symptoms, but also a higher predominance of nasal congestion, ptosis, and forehead and facial sweating among these symptoms. CONCLUSIONS: Based on current anatomofunctional knowledge and on the most recent pathogenetic findings, we believe that changes in hypothalamic activity posteroinferiorly may lead to activation of the caudal part of the spinal trigeminal nucleus by way of the hypothalamus, midbrain, and trigeminal nerve fibers and consequently to activation of the trigeminovascular system with a different location in the two syndromes. More specifically, there seems to be a larger and more extensive involvement of the subnucleus caudalis in LS compared with US, where only its ventrocaudal portions are likely to be affected.

Adult↗
PubMedDate not supplied

Pain and behaviour in cluster headache. A prospective study and review of the literature.

Cluster headache (CH) has also been called "suicide headache" on account of the extremely severe pain that characterizes its attacks. It is indeed well known that CH sufferers exhibit peculiar behaviours during attacks. The purposes of our study were: i) to investigate prospectively prodromes and clinical pain features and behaviour of patients during typical, spontaneous attacks of CH defined according to the International Headache Society classification criteria; and ii) to investigate retrospectively the premonitory signs and symptoms preceding onset of the cluster period. Forty-two episodic CH patients consecutively referred to the University of Parma Headache Centre were asked to fill in a questionnaire soon after a "typical" CH attack. In the questionnaires, the patients were requested: a) to describe in their own words the type of pain experienced during the attack; b) to rate peak pain intensity on a visual analogue scale (VAS); c) to indicate the time elapsing between headache onset and peak pain intensity; d) to report the signs and symptoms preceding the attack (prodromes), choosing them from a 65-item list; and, e) to describe in their own words their behaviour during the attack. Each patient was also requested to report any signs and/or symptoms preceding onset of the cluster period (premonitory symptoms). Data analysis showed that the clinical features of pain were very complex and varied widely among patients. In 85.7% of cases, patients rated their peak pain intensity (reached on average within 8.9 minutes of attack onset) at between 8 and 10 on the VAS. Most (88.1%) exhibited typical signs of pyschomotor agitation (restlessness) during the attack. Prodromes were reported by almost all the patients in our sample (97.6%), and premonitory symptoms by only 40.5%. The results of our study suggest: i) that the pain in CH cannot be described either as vascular- or as neuralgic-type; ii) that a traditional three-item scale (mild, moderate, severe) does not allow adequate categorization of pain intensity, and should be replaced by the VAS in order to reflect a broader spectrum of pain intensity; iii) that restlessness during attacks is so frequent that it should become a CH diagnostic criterion; and, iv) that prompt and accurate reporting of prodromes and/or premonitory symptoms could be helpful in establishing early treatment.

Adult↗