F Andrasik

Publications (60)138.87 Total impact

• Source

  Available from: sibelium.com.cn

  Article: Disability in chronic migraine with medication overuse: treatment effects through 5 years.

  F Andrasik, L Grazzi, S Usai, S Kass, G Bussone
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  ABSTRACT: Chronic migraine accompanied by medication overuse is particularly difficult to treat. The number of treatment investigations is limited, few have included follow-up beyond 6 months and almost none has examined whether treatment leads to concurrent improvements in disability and functional impairment. This open-label study addresses these limitations. We have been prospectively following an initial cohort of 84 chronic migraine patients with medication overuse, who at the time of this evaluation had been reduced to 58, for an extended period to assess longer-term maintenance of effects, using measurement procedures identical to those in the original investigation. Thus, the specific aim was to determine the clinical status, with respect to pain indices and disability level, of chronic migraine patients with medication overuse who were treated and followed prospectively for 5 years. All patients completed a brief inpatient treatment programme, in which they were withdrawn from their offending medications and subsequently placed on more appropriate preventive antimigraine medications. Both end-point, wherein missing data points were estimated, and continuer analyses, wherein data analysis was limited to the 58 individuals with complete datasets, revealed significant improvement on all measures studied-headache days per month, analgesic consumption and Migraine Disability Assessment (MIDAS) total score. The percentage reduction from baseline to 5 years for the MIDAS total score was 76.0%, while the percentage of individuals revealing improvements of clinically significant magnitude (≥ 50%) on the MIDAS was 91.9%. MIDAS total scores were lower at 5 years than at some of the intervening follow-up intervals. Comparisons of those who completed the 5-year follow-up (n = 58) with those who did not revealed no differences at baseline. This finding, coupled with the nearly identical results for the end-point and continuers analyses, suggests that attrition did not have a bearing on outcome. None of the patients completing the 5-year follow-up had relapsed since the prior 3-year follow-up assessment. High levels of maintenance were revealed at 5 years, with disability scores showing some continued improvement over time. The implications of these findings and the limitations of the study are discussed.
  Cephalalgia 07/2009; 30(5):610-4. · 3.43 Impact Factor
• Article: Functional-MRI evaluation of pain processing in chronic migraine with medication overuse.

  Luisa Chiapparini, L Grazzi, S Ferraro, M L Mandelli, S Usai, F Andrasik, M G Bruzzone, G Bussone
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  ABSTRACT: Withdrawal is the first step for treating patients with chronic migraine and medication overuse. Recent studies confirmed common elements in personality between these patients and subjects addicted; some neuroimaging researches showed that abnormalities revealed are related to a specific cerebral pattern and that they can return to the normal state after withdrawal. Aim of the study was to submit a group of patients suffering from chronic migraine and medication overuse (the diagnosis was made according to Silberstein-Lipton criteria) to a withdrawal, to evaluate by f-MRI the presence of specific cerebral patterns before treatment and their possible changes after withdrawal. f-MRI seems to be a useful technique to obtain information on particular neuronal changes of the pain network involved in this type of patients. The activated areas are congruent with some data of the literature and the data emerged are discussed according to preceding reports.
  Neurological Sciences 05/2009; 30 Suppl 1:S71-4. · 1.32 Impact Factor
• Article: Non-pharmacological approaches to treating chronic migraine with medication overuse.

  F Andrasik, L Grazzi, S Usai, D C Buse, G Bussone
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  ABSTRACT: Medication overuse headache (MOH) is now recognized as a biobehavioral disorder, a condition wherein emotion and pain are intermingled. This review discusses the steps to consider when treating this condition. The first step involves educating patients about MOH and the pathways to chronicity. The second step concerns working with patients to identify risk factors and behaviors that are present and contributing to the condition. The final step involves behavioral intervention. Examples for accomplishing each step are provided.
  Neurological Sciences 05/2009; 30 Suppl 1:S89-93. · 1.32 Impact Factor
• Article: Magnesium as a preventive treatment for paediatric episodic tension-type headache: results at 1-year follow-up.

  L Grazzi, F Andrasik, S Usai, G Bussone
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  ABSTRACT: The objective was to confirm the long-term utility of magnesium salts treatment on a group of young patients suffering from episodic tension-type headache (ETTH). The study was carried out at the Outpatient Headache Center at the National Neurological Institute "C. Besta," Milan, Italy, with 45 children/adolescents with ETTH reporting consecutively for treatment. Magnesium pidolate (2.25 g) was given twice per day for three months. Medication was not administered during the year of follow-up. No other treatment was provided at any time. Patients showed significant symptom reduction. Headache days decreased by 69.9%, whereas analgesics consumption was reduced by 65.4%. Overall disability levels improved by the greatest percent - 75.7%. MIDAS subscores improved as well (question A=58.0%; question B=22.5%). Although uncontrolled, these findings are encouraging and suggest that further, better controlled research investigations are warranted.
  Neurological Sciences 07/2007; 28(3):148-50. · 1.32 Impact Factor
• Article: Can behavioural therapy influence neuromodulation?

  F Andrasik, C Rime
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  ABSTRACT: This paper reviews non-invasive behavioural approaches - broadly construed as cognitive, affective, behavioural and psychophysiological interventions - and examines whether they can impact central, peripheral or autonomic nervous system components responsive to pain in general and headache in particular. It focuses on two developing bodies of literature - neurophysiology of migraine and fMRI studies of pain networks. The available literature suggests behavioural interventions can affect neuromodulation, although further research is clearly warranted.
  Neurological Sciences 06/2007; 28 Suppl 2:S124-9. · 1.32 Impact Factor
• Article: Pharmacological treatment compared to behavioural treatment for juvenile tension-type headache: results at two-year follow-up.

  F Andrasik, L Grazzi, S Usai, G Bussone
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  ABSTRACT: Recurrent headaches are common in children and adolescents. Most current investigations have employed limited modalities (either medication or behavioural) and few have included comparisons of different treatments. In this study relaxation training, administered in a limited contact format, and amitriptyline were compared for juvenile episodic tension-type headache. The clinical improvement was significant for both groups at 1- and 2-year follow-up; in particular for behavioural treatment, the patients came regularly for the sessions, practised routinely, and appeared to be compliant and accepting of treatment, although we did not assess this formally. In this group of patients the percentage of drop-outs was lower than in the pharmacological tratment. Although clinical results were similar in both groups, relaxation therapy seems to be more accepted than medication. The limited contact modality seems to be as useful as other behavioural approaches that require a greater investment of time (by patients and therapists), without unpleasant side effects. Because the sample sizes are small, these conclusions are tentative.
  Neurological Sciences 06/2007; 28 Suppl 2:S235-8. · 1.32 Impact Factor
• Source

  Available from: neurofeedbackclinic.ca

  Article: What does the evidence show? Efficacy of behavioural treatments for recurrent headaches in adults.

  F Andrasik
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  ABSTRACT: Behavioural treatments (predominantly biofeedback, relaxation and cognitive-behavioural) have been utilised in headache management for nearly 4 decades. This paper examines their clinical efficacy, drawing upon 2 primary sources of evidence: meta-analytic and evidenced-based reviews. Behavioural treatments have demonstrated efficacy and have been endorsed by various reviewing groups, such as the US Headache Consortium. Outcomes from behavioural treatments appear to endure over longer-term follow-up intervals as well. Meta-analyses comparing behavioural and pharmacological treatments have revealed similar levels of outcome. The article closes with a brief discussion of methods investigators are exploring to make behavioural treatments more available and affordable to headache patients.
  Neurological Sciences 06/2007; 28 Suppl 2:S70-7. · 1.32 Impact Factor
• Article: An expanded view of psychological aspects in head pain: the biopsychosocial model.

  F Andrasik, H Flor, D C Turk
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  ABSTRACT: Traditionally, headache has been viewed from a limited perspective, both medically and psychologically. The authors propose that a more expanded view of headache that considers each perspective as important, as embodied in the biopsychosocial model, will greatly enhance understanding and be more useful in treatment planning. This model views pain as emanating from a complex interaction of biological, psychological and social variables. This paper describes the key behavioural, affective and cognitive influences and provides pertinent supporting examples from the literature.
  Neurological Sciences 06/2005; 26 Suppl 2:s87-91. · 1.32 Impact Factor
• Article: Magnesium as a treatment for paediatric tension-type headache: a clinical replication series.

  L Grazzi, F Andrasik, S Usai, G Bussone
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  ABSTRACT: The objective was to determine the initial utility of magnesium salt as a treatment for paediatric episodic and chronic tension-type headache (TTH). The study took the form of a clinical replication series in the Outpatient Headache Center at the National Neurological Institute "C. Besta", Milan, Italy. The patients were five children/adolescents with episodic and four with chronic TTH reporting consecutively for treatment. Magnesium pidolate (2.25 g) was given twice per day for two months, with one year of follow-up. No other treatment was provided. Patients with episodic TTH revealed 76.0% symptom reduction, with 80% of the sample achieving reductions greater than 50%. The patients with chronic TTH revealed 87.5% symptom reduction, with 100% of the sample achieving reductions greater than 50%. Analgesic consumption decreased significantly for chronic TTH. Only one child took medication in the episodic TTH group. No significant changes occurred with respect to depression and anxiety, but these measures were not clinically elevated at the start of treatment. Although uncontrolled, the initial findings are encouraging and suggest that further, better controlled research is warranted.
  Neurological Sciences 03/2005; 25(6):338-41. · 1.32 Impact Factor
• Article: Pharmacological behavioural treatment for children and adolescents with tension-type headache: preliminary data.

  L Grazzi, F Andrasik, S Usai, D D'Amico, G Bussone
  [show abstract] [hide abstract]
  ABSTRACT: 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.
  Neurological Sciences 11/2004; 25 Suppl 3:S270-1. · 1.32 Impact Factor
• Article: Chronic migraine with medication overuse: treatment outcome and disability at 3 years follow-up.

  S Usai, L Grazzi, F Andrasik, D D'Amico, A Rigamonti, G Bussone
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  ABSTRACT: 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.
  Neurological Sciences 11/2004; 25 Suppl 3:S272-3. · 1.32 Impact Factor
• Article: Chronic migraine with medication overuse: treatment outcome and disability at 3 years follow-up

  S. Usai, L. Grazzi, F. Andrasik, D. D’Amico, A. Rigamonti, G. Bussone
  [show abstract] [hide abstract]
  ABSTRACT: 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 [1]), 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.
  Neurological Sciences 09/2004; 25:s272-s273. · 1.32 Impact Factor
• Article: Pharmacological behavioural treatment for children and adolescents with tension-type headache: preliminary data

  L. Grazzi, F. Andrasik, S. Usai, D. D’Amico, G. Bussone
  [show abstract] [hide abstract]
  ABSTRACT: 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.
  Neurological Sciences 09/2004; 25:s270-s271. · 1.32 Impact Factor
• Article: Treatment of chronic daily headache with medication overuse.

  L Grazzi, F Andrasik, D D'Amico, S Usai, A Rigamonti, M Leone, G Bussone
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  ABSTRACT: Clinicians long have suspected that symptomatic medications taken by those with headache can cause rebound or drug-induced headaches if overused. This problem has been considered in the classification of headache disorders made by the International Headache Society. Patients who overuse medication must be withdrawn before their headache can be treated effectively. Sustained improvement following treatment for drug-induced headache can be difficult to achieve and at the moment there is no consensus on what approach may be more effective, in particular regarding outpatient or inpatient treatment withdrawal strategy. Clinical aspects and different therapeutic strategies for chronic daily headache patients with medication overuse are considered.
  Neurological Sciences 06/2003; 24 Suppl 2:S125-7. · 1.32 Impact Factor
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  Available from: nbsempowers.com

  Article: Behavioral treatment approaches to chronic headache.

  F Andrasik
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  ABSTRACT: Over 3 decades of research have shown the utility of a number of behavioral treatments, chiefly relaxation, biofeedback, and cognitive behavior therapy, for uncomplicated forms of migraine and tension-type headache. However, the literature base is much less extensive for chronic, complicated, and refractory forms of headache. This paper reviews extant work on the usefulness of behavioral treatment for headache accompanied by medication overuse; chronic, daily, high intensity headache; refractory headaches; cluster headache; chronic tension-type headache; posttraumatic headache; and headache accompanied by psychiatric comorbidity. It concludes with a discussion of the role of environmental and familial factors in influencing chronic headaches. Suggestions for future research are pointed out along the way.
  Neurological Sciences 06/2003; 24 Suppl 2:S80-5. · 1.32 Impact Factor
• Article: Brief neurologist-administered behavioral treatment of pediatric episodic tension-type headache.

  F Andrasik, L Grazzi, S Usai, D D'Amico, M Leone, G Bussone
  Neurology 05/2003; 60(7):1215-6. · 8.31 Impact Factor
• Source

  Available from: neurofeedbackclinic.ca

  Article: Electromyographic biofeedback-assisted relaxation training in juvenile episodic tension-type headache: clinical outcome at three-year follow-up.

  L Grazzi, F Andrasik, D D'Amico, M Leone, F Moschiano, G Bussone
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  ABSTRACT: Although tension-type headaches are more common than migraine in children and adolescents, the limited studies that have been conducted with juveniles have focused chiefly on migraine treatment and its course. This report describes the clinical benefits for an electromyographic biofeedback-assisted relaxation treatment program for a group of children and adolescents experiencing episodic tension-type headache and examines whether the clinical presentation changed for headaches that remained. Of the 54 consecutive juveniles who began treatment, 38 completed and were available to participate in the 3-year follow-up. Headaches improved measurably immediately following treatment, with further gains being evident through 3 years. The few headaches that did occur at 3 years were nearly identical symptom-for-symptom to those that were experienced prior to treatment. This report suggests that behavioural treatment is a viable and durable intervention for juvenile episodic tension-type headache, but more definitive claims cannot be made due to the uncontrolled nature of the study. Further investigation is warranted.
  Cephalalgia 11/2001; 21(8):798-803. · 3.43 Impact Factor
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  Available from: bendcounseling.com

  Article: Biofeedback-assisted relaxation training for young adolescents with tension-type headache: a controlled study.

  G Bussone, L Grazzi, D D'Amico, M Leone, F Andrasik
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  ABSTRACT: Tension-type headache is common in children and adolescents and is generally treated with medication, but emerging literature suggests that various behavioral treatments may provide efficacious alternatives to medication. Juvenile tension-type headache sufferers were randomly assigned to biofeedback-assisted relaxation continued to improve and were superior to the control condition at a 6- and 12-month follow-up (86% versus 50%). Biofeedback-assisted relaxation appears to be an efficacious and durable treatment for juvenile tension-type headache and merits further exploration.
  Cephalalgia 10/1998; 18(7):463-7. · 3.43 Impact Factor
• Article: Behavioral management of migraine.

  F Andrasik
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  ABSTRACT: Behavioral treatments for migraine have received increased attention over the past 25 years. In general, research has focussed on the six following areas: 1) comparative efficacy of treatments, 2) interplay of behavioral and pharmacological approaches, 3) development of delivery models that are cost-effective, 4) identification of characteristics associated with varied levels of response to treatment, 5) maintenance of effects and factors associated with long-term outcome, and 6) mechanisms of treatment. This paper briefly and selectively reviews the available literature in an attempt to point out the status of current research.
  Biomedecine [?] Pharmacotherapy 02/1996; 50(2):52-7. · 2.00 Impact Factor
• Article: Temperature acquisition as a function of the computer-based biofeedback system utilized: an exploratory analysis.

  J D Otis, H W Rasey, S Vrochopoulos, J P Wincze, F Andrasik
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  ABSTRACT: Thermal biofeedback is widely used to treat various clinical disorders. Given its widespread utility, and the variability among the biofeedback systems currently on the market, it is important to investigate which systems are most effective for training various skills. This study compared the performance of normal subjects on two different computer-biofeedback systems. Results indicated a significant difference in subject performance between the two systems. Limitations and implications of these findings are discussed.
  Biofeedback and Self-Regulation 07/1995; 20(2):185-90.