Headache in immigrant patients: similarities and differences with Italian population.

Headache is one of the most common neurological diseases. It is well known that there are differences in the perception and in the management of pain in various populations. Immigrants represent a growing portion between neurology outpatients. We analyzed the epidemiological characteristic of headache in immigrants come to our attention, in comparison with Italians. Data collected included age at immigration, age of onset of headache, headache's type (HIS criteria), and psychiatric comorbidities. There were not substantial differences in the incidence of headache subtypes: migraine was the most frequent diagnosis in both groups, followed by tension-type headache. The incidence of depression was similar, while anxiety was significantly less frequent in immigrants. Studies on neurological diseases in immigrants are few. The data available seem to show no differences in the incidence, but rather in treatment. Our study confirms the evenness of two populations, local and foreign, afferent in a Headache Unit, according to the single similar study, except for anxiety, maybe related to language difficulties or cultural background.

Condylar morphology in growing patients related to vertical dimension.

AIM: Aim of the study was to evaluate the mandibular morphology, especially the condylar one, in growing patients, according to the different vertical patterns. The objective was to analyze which condylar dimensions significantly vary in low, normal and high angle divergency growing patients with the use of the orthopantomogram (OPG). METHODS: From a database of randomly selected 514 patients, 96 subjects (48 males and 48 females) with skeletal Class I according to lateral cephalograms were selected and divided in three equal groups in relation to their vertical dimension (32 low FMA angle, 32 normal FMA angle and 32 high FMA angle). Each patient was examined with three OPGs at three different stages of dentition. OPGs were taken at the time of initial observation (T0 = first transitional phase of mixed dentition), after an average time of 12±1 months (T1=inter-transitional phase of mixed dentition) and after 36±3 months (T2=second transitional phase of mixed dentition). The radiological technician and the radiologic device were the same for each x-ray. On each OPG, condylar and mandibular ramus morphology of both sides was traced. Eleven linear and angular measurements were reported on each tracing. Data were analyzed by Wilcoxon's signed rank test and the Student's t-test. RESULTS: The study showed different condylar characteristics according to the vertical patterns. Differences were evident between males and females. CONCLUSION: The length of the mandibular ramus resulted longer in short-face patients respect to long-face subjects.

Cortical excitability and sleep deprivation: a transcranial magnetic stimulation study.

The objective was to assess the changes in cortical excitability after sleep deprivation in normal subjects. Sleep deprivation activates EEG epileptiform activity in an unknown way. Transcranial magnetic stimulation (TMS) can inform on the excitability of the primary motor cortex. Eight healthy subjects (four men and four women) were studied. Transcranial magnetic stimulation (single and paired) was performed by a focal coil over the primary motor cortex, at the "hot spot" for the right first dorsal interosseous muscle. The following motor evoked potential features were measured: (a) active and resting threshold to stimulation; (b) duration of the silent period; (c) amount of intracortical inhibition on paired TMS at the interstimulus intervals of 2 and 3 ms and amount of facilitation at interstimulus intervals of 14 and 16 ms. The whole TMS session was repeated after a sleep deprivation of at least 24 hours. After the sleep deprivation, the threshold to stimulation (in the active and resting muscle), as well as the silent period, did not change significantly. By contrast, the paired stimulus study showed a significant (p<0.05) reduction in both intracortical inhibition and facilitation. Thus, TMS showed that sleep deprivation is associated with changes in inhibition-facilitation balance in the primary motor cortex of normal subjects. These changes might have a link with the background factors of the "activating" effects of sleep deprivation.

Chronic post-traumatic headache associated with minor cranial trauma: a description of cephalalgic patterns.

We studied a group of 93 patients who had not previously suffered headache and who were consecutively admitted to the Emergency Department of the hospitals of Novara and Borgomanero, Italy because of a cranial trauma definable as minor according to the current International Headache Society (IHS) criteria. Two weeks after admission, all patients underwent a semi-structured interview which revealed that 24 (25.8%) had headache; 21 of these (22.5% of the original 93 patients) also had headache when they underwent a second interview eight weeks after the traumatic event. These 21 patients were diagnosed as having chronic post-traumatic headache associated with minor cranial trauma (5.2.2 of the IHS classification), and the prevalent clinical pattern of headache presentation was examined with the aim of attributing the fourth IHS classification code number. Eighteen of the 21 patients were found to have a tension-type pattern (5.2.2.2), and the remaining three had migraine (5.2.2.1); none had cluster headache (5.2.2.3). These data demonstrate a large prevalence of tension-type headache in patients with class 5.2.2 post-traumatic headache, and confirm the results of previously published studies that were not based on the diagnostic criteria of the current classification.