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Background: Chronic migraine (CM) negatively impacts the quality of life of 2 to 4% of pediatric patients. In adults, CM is frequently linked to medication overuse headache (MOH), but there is a much lower prevalence of MOH in children. A suboptimal response to acute therapies may lead to their reduced use, thus preventing MOH development in children and adolescents. The frequency of patients with CM who do not respond to acute therapies was examined in the present study. We investigated whether the prevalence of MOH was different between responders and non-responders. We also examined whether patients receiving prophylactic therapy had an improved response to acute therapy. Finally, we investigated if there was a difference in the frequency of psychiatric comorbidities between responders and non-responders. Methods: We retrospectively analysed clinical data of all chronic pediatric migraineurs under the age of 18 referred to the Headache Centre at Bambino Gesù Children Hospital in June 2021 and February 2023. ICHD3 criteria were used to diagnose CM and MOH. We collected demographic data, including the age at onset of migraine and the age of the CM course. At baseline and after 3 months of preventive treatment, we evaluated the response to acute medications. Neuropsychiatric comorbidities were referred by the children's parents during the first attendance evaluation. Results: Seventy patients with CM were assessed during the chosen period. Paracetamol was tried by 41 patients (58.5%), NSAIDs by 56 patients (80.0%), and triptans by 1 patient (1.4%). Fifty-one participants (73%) were non-responder to the abortive treatment. The presence of MOH was detected in 27.1% of the whole populations. Regarding our primary aim, MOH was diagnosed in 29% of non-responder patients and 22% of responders (p > 0.05). All patients received preventative treatment. After 3 months of preventive pharmacological therapy, 65.4% of patients who did not respond to acute medications achieved a response, while 34.6% of patients who were non-responder remain non-responder (p < 0.05). Prophylactic therapy was also effective in 69% of patients who responded to acute medication (p < 0.05). Psychiatric comorbidities were detected in 68.6% of patients, with no difference between responders and non-responders (72.2% vs. 67.3%; p = 0.05). Conclusions: Despite the high prevalence of unresponsiveness to acute therapies in pediatric CM, it does not act as a protective factor for MOH. Moreover, responsiveness to acute drugs is improved by pharmacological preventive treatment and it is not affected by concomitant psychiatric comorbidities. [ABSTRACT FROM AUTHOR]

Background: In Italy, monoclonal antibodies targeting the CGRP pathway are subsidized for the preventive treatment of high frequency and chronic migraine (CM) in patients with a MIgraine Disability ASsessment (MIDAS) score ≥ 11. Eligibility to treatment continuation requires a ≥ 50% MIDAS score reduction at three months (T3). In this study, we evaluate whether a ≥ 50% MIDAS score reduction at T3 is a reliable predictor of response to one-year erenumab treatment. Methods: In this prospective, open-label, real-world study, 77 CM patients were treated with erenumab 70–140 mg s.c. every 28 days for one year (T13). We collected the following variables: monthly migraine days (MMDs), monthly headache days (MHDs), days of acute medication intake, MIDAS, HIT-6, anxiety, depression, quality of life and allodynia. Response to erenumab was evaluated as: i) average reduction in MMDs during the 1-year treatment period; and ii) percentage of patients with ≥ 50% reduction in MMDs during the last 4 weeks after the 13th injection (RespondersT13). Results: Erenumab induced a sustained reduction in MMDs, MHDs and intake of acute medications across the 12-month treatment period, with 64.9% of patients qualifying as RespondersT13. At T3, 55.8% of patients reported a ≥ 50% reduction in MIDAS score (MIDASRes) and 55.4% of patients reported a ≥ 50% reduction in MMDs (MMDRes). MIDASRes and MMDRes patients showed a more pronounced reduction in MMDs during the 1-year treatment as compared to NON-MIDASRes (MIDASRes: T0: 23.5 ± 4.9 vs. T13: 7.7 ± 6.2; NON- MIDASRes: T0: 21.6 ± 5.4 vs. T13: 11.3 ± 8.8, p = 0.045) and NON-MMDRes (MMDRes: T0: 23.0 ± 4.5 vs. T13: 6.6 ± 4.8; NON-MMDRes: T0: 22.3 ± 6.0 vs. T13: 12.7 ± 9.2, p < 0.001) groups. The percentage of RespondersT13 did not differ between MIDASRes (74.4%) and NON-MIDASRes (52.9%) patients (p = 0.058), while the percentage of RespondersT13 was higher in the MMDRes group (83.3%) when compared to NON-MMDRes (42.9%) (p = 0.001). MMDRes predicted the long-term outcome according to a multivariate analysis (Exp(B) = 7.128; p = 0.001), while MIDASRes did not. Treatment discontinuation based on MIDASRes would have early excluded 36.0% of RespondersT13. Discontinuation based on "either MIDASResor MMDRes" would have excluded a lower percentage (16%) of RespondersT13. Conclusion: MIDASRes only partly reflects the 12-month outcome of erenumab treatment in CM, as it excludes more than one third of responders. A criterion based on the alternative consideration of ≥ 50% reduction in MIDAS score or MMDs in the first three months of treatment represents a more precise and inclusive option. Trial registration: The trial was retrospectively registered at www.clinicaltrials.gov (NCT05442008). CGRP: Calcitonin Gene Related Peptide. MIDAS: MIgraine Disability Assessment. MMDs: monthly migraine days. MIDASRes: Patients with a MIDAS score reduction of at least 50% at T3. MMDRes: Patients with a MMDs reduction of at least 50% at T3. ResponderT13: Patients with a MMDs reduction from baseline of at least 50% in the last 4 weeks of observation period (after 13 erenumab administrations). T0: First erenumab administration. T3, T6, T9, T12: Follow-up visits at three, six, nine, and twelve months after first erenumab administration. T13: Last visit of the protocol. [ABSTRACT FROM AUTHOR]

Background: erenumab was safe and effective in clinical trials for the prevention of migraine. However, real-life data are still lacking. Here we report the clinical experience from an Italian real-world setting using erenumab in patients with chronic migraine experiencing previous unsuccessful preventive treatments. Methods: Seventy patients with chronic migraine and failure to ≥4 migraine preventive medication classes initially received monthly erenumab 70 mg s.c. Patients without a clinically meaningful improvement, considered as a > 30% reduction in headache days per month, after ≥3 months of therapy switched to monthly erenumab 140 mg. At the first administration and after 3 and 6 months, patients underwent extensive interviews to assess clinical parameters of disease severity and migraine-related disability and impact, and validated questionnaires to explore depression/anxiety, sleep, and quality of life (QoL). Finally, the Pain Catastrophizing Scale, Allodynia Symptom Checklist-12 and MIGraine attacks-Subjective COGnitive impairments scale (MIG-SCOG) were administered. Results: 70% of patients were "responders" after the third administration of erenumab 70 mg, whereas 30% switched to erenumab 140 mg; 29% (6 pts) responded after the sixth administration. The headache-day frequency was reduced from 21.1 ± 0.7 to 11.4 ± 0.9 days after the third administration (p < 0.001) and to 8.9 ± 0.7 days after the sixth administration (p < 0.001). 53% and 70% of patients, respectively, showed a reduction of ≥50% of headache days/month after the third and the sixth administrations. Also improved were headache pain severity, migraine-related disability, and impact on daily living, QoL, pain catastrophizing and allodynia (all p < 0.001), quality of sleep, symptoms of depression or anxiety (p < 0.05) but not MIG-SCOG. There were no new adverse event signals. Conclusion: These real-world data support monthly erenumab 70 or 140 mg s.c. as a safe and effective preventive treatment to reduce headache frequency and severity in chronic migraine patients experiencing previous unsuccessful preventive treatments. [ABSTRACT FROM AUTHOR]

Background: The MIG-SCOG is a questionnaire to assess self-reported subjective cognitive symptoms during migraine attacks, consisting of 9 items evaluating executive functions and language. The aim of the study was to evaluate the psychometric properties of the Italian version of the MIG-SCOG (I-MIG-SCOG) in patients with migraine without aura.Methods: The I-MIG-SCOG underwent 20 Italian healthy subjects to assess its comprehensibility. Reliability and divergent validity of the I-MIG-SCOG were evaluated in a sample of 153 migraines without aura patients. They also underwent Montreal Cognitive Assessment, Beck Depression Inventory and Apathy Evaluation Scale.Results: The final I-MIG-SCOG was easily comprehensible. There were no missing data, no floor and ceiling effects; mean I-MIG-SCOG score was 7.54 ± 3.98; Cronbach's alpha was 0.814. The I-MIG-SCOG score correlated poorly with Montreal Cognitive Assessment, Beck Depression Inventory and Apathy Evaluation Scale.Conclusion: The I-MIG-SCOG should represent a reliable and valid patient-centred and disease-related instrument to identify cognitive symptoms experienced during migraine attacks and to monitor the divergent effects of symptomatic treatments on cognitive functions also in Italian migraine patients. [ABSTRACT FROM AUTHOR]

Background There are only 2 small sample studies investigating allodynia in the pediatric population. The aim of this study was to evaluate the frequency of allodynia during cephalalgic attacks in a juvenile population with primary headaches and its association with other symptoms of migraine. Methods We reviewed all medical records of patients with primary headache consecutively seen during a 2-year period. Frequency of allodynia was evaluated, by means of a questionnaire, consisting of 6 questions (for example: Do you avoid touching your head when you have a migraine attack?). Results Two hundred thirty children suffering from primary headache were seen during the study period. Two hundred two children were affected by migraine, 28 (12.2%) by other primary headaches. Migraineurs significantly more frequently complained of allodynia compared to other primary headaches (37% vs 0%). At multivariate analysis, allodynia was significantly associated with pain aggravated by physical activity (adjusted odds ratio [ ORa ] 2.0, 95% confidence interval [ CI] 1.0, 3.8), phonophobia ( ORa 2.3, 95% CI 1.0, 5.1), and nausea ( ORa 1.9, 95% CI 1.0, 3.7). Conclusion According to our data, allodynia is common during pediatric migraine attacks. The association between allodynia and physical activity, nausea and phonophobia are supported by studies on adult population and suggests specific physiopathological mechanisms. [ABSTRACT FROM AUTHOR]

The article discusses the study on the prevalence of fatigue to patients with migraine. It states that 62 percent of patients reported fatigue compared to 5 percent of controlled patient. It cites that the number of fatigue in migraine patients was statistically significant. It also mentions that fatigue in migraine patients shows prodromal and postdromal symptoms.

The article discusses a study which examines the cognitive performance of migraine patients in context with demographic, clinical and psychopathological measures. Topics discussed include cognitive impairment in migraine patients, association between cognitive impairment and headache-induced disability, and psychological headache management.

The article discusses a study which investigates medication overuse headache patients (MOH) versus episodic migraine patients (MIG) in context with alexithymia scores, and also examines relationship between alexithymia and headache characteristics. Topics discussed include demographic characteristics of MIG and MOH patients, frequency of headache in MIG and MOH patients, and preventive measure to avoid drug-induced headache.

The article reports a common inflammatory pathogenesis for headache and hypovitaminosis D. The aim of the study was s to evaluate the relationship between vitamin D levels and headache frequency. Patients having a clinical history of episodic migraine and chronic migraine underwent d neurological and headache assessment, pharmacological evaluation, disability assessment and psychological evaluation. It was concluded that migraine patients have a high rate of hypovitaminosis D.