Paola Torelli's research while affiliated with University Hospital of Parma and other places

Publications (170)

Article
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The identification of patients who can benefit the most from the available preventive treatments is important in chronic migraine. We explored the rate of excellent responders to onabotulinumtoxinA in a multicenter European study and explored the predictors of such response, according to different definitions. A pooled analysis on chronic migraineu...
Article
Understanding the importance of immigrant entrepreneurship in today's globalized world is crucial for economic, political, and social development. This study is one of the first in the field to explore one immigrant community's entrepreneurship experiences across three different countries. A typology of three different types of immigrant entreprene...
Article
Italian Migraine Registry (I-GRAINE) is a multicenter (n = 38), prospective, observational, non-interventional study aimed at providing big data on migraine to ensure proper clinical disease management, according to scientific, and sustainability criteria. We enrolled consecutive patients affected by episodic or chronic migraine according to the sy...
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Nutraceuticals might be defined as food or dietary supplements that provide medicinal or health benefits. Current preventive treatment of migraine includes nutraceuticals as well as conventional drugs. These non-pharmacological therapies, such as magnesium, coenzyme Q10, feverfew, riboflavin, and phycocyanins, are particularly useful in certain cat...
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The treatment of migraine now includes the possibility of using the anti CGRP monoclonal antibodies erenumab, fremanezumab and galcanezumab. Registration studies and real life studies have shown excellent efficacy and extraordinary tolerability of these treatments. Little is known about the possible differences between the three treatments and this...
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Objective To assess cervical musculoskeletal impairments during the 4 phases of a migraine cycle in episodic migraine patients, controlling for the presence of concomitant neck pain. Methods Differences in cervical musculoskeletal impairments were assessed during the 4 migraine phases in episodic migraine patients and compared with healthy control...
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Objective: Assessing mechanical pain thresholds from trigeminal, cervical, and distal pain-free areas during the four phases of a migraine cycle in patients with episodic migraine (EM). Methods: This multicenter, cross-sectional, observational study conducted in Parma and Genoa's Headache Centers assessed quantitative sensory tests during the fo...
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Background: Monoclonal antibodies anti-calcitonin gene-related peptide (mAbs anti-CGRP) pathway are effective and safe on migraine prevention. However, some drug agencies limited these treatments to one year due to their high costs. This study aimed at evaluating the effect of discontinuing mAbs anti-CGRP on monthly migraine days (MMDs) and disabi...
Preprint
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Background: The monoclonal antibodies anti-calcitonin gene-related peptide (mAbs anti-CGRP) pathway revolutionized migraine prevention. However, some drug agencies limited the treatment to one year due to their high costs. This study aimed at evaluating the effect of discontinuing mAbs anti-CGRP on monthly migraine days (MMDs) and disability in hig...
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Introduction: Migraine is mostly a female disorder because of its lower prevalence in men. Less than 20% of patients included in the available studies on migraine treatments are men; hence, the evidence on migraine treatments might not apply to men. The aims of the present study were to provide reliable information on the effectiveness of onabotul...
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Objective: To evaluate the long-term effectiveness, safety, and tolerability of erenumab in a real-world migraine population, looking for putative predictors of responsiveness. Background: Erenumab proved to be effective, safe, and well tolerated in the prevention of episodic migraine (EM) and chronic migraine (CM) in long-term extension studies...
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Objectives: This observational study aimed to assess the difference in disability, burden, and sensitization between migraine patients with low-frequency headache attack (1-8 headache days/month), high-frequency headache attack (9-14 headache days/months), and patients with chronic migraine (>14 headache days/months). Methods: Migraine patients...
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Objective To determine whether erenumab is effective and safe in refractory chronic migraine with medication overuse headache.Methods In this prospective, multicentric, real-life study, chronic migraine with medication overuse headache patients who received erenumab were recruited. Study inclusion was limited to patients who previously failed onabo...
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Objective: To develop a dedicated Italian chronic migraine (CM) database (IRON project) to overcome disease misconceptions, improve clinical administration, reduce patients' burden, and rationalize economic resource allotment. Background: Proper CM management requires a comprehensive appraisal of its full clinical, social, and economic complexit...
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Abstract Background: Migraine and depression are highly prevalent and partly overlapping disorders that cause strong limitations in daily life. Patients tend to respond poorly to the therapies available for these diseases. OnabotulinumtoxinA has been proven to be an effective treatment for both migraine and depression. While many studies have addre...
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IntroductionOnabotulinumtoxinA (BT-A) quarterly was the first treatment approved specifically for chronic migraine (CM). It is unclear whether three cycles are better than two to assess early BT-A response.Methods We performed a retrospective analysis on real-life prospectively collected data in 16 European headache centers. All the centers provide...
Article
Background: Rigidity is a key clinical feature of Parkinson's disease (PD), but in a very early phase of the disease, it may be absent and can be enhanced through active movements of the arm contralateral to the one being tested. Objective: To evaluate in a large cohort of neurologically and cognitively healthy (NCH) subjects aged 18-90 years if...
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Introduction: A large corpus of evidence has reported encouraging results for acupuncture as a prophylaxis therapy for migraine. However, trials that investigated the efficacy of acupuncture in comparison with pharmacological treatment in episodic migraine showed conflicting results. The study aimed to evaluate if acupuncture is as effective as evi...
Preprint
Full-text available
Background: Migraine and depression are highly prevalent and partly overlapping disorders that cause strong limitations in daily life. Patients tend to respond poorly to the therapies available for these diseases. OnabotulinumtoxinA has been proven to be an effective treatment for both migraine and depression. While many studies have addressed the...
Article
Objective To evaluate in 419 stroke-free cognitively normal subjects (CN) aged 45-82 years covering during a long prospective study (11.54 ± 1.47 years), the preclinical to dementia spectrum: 1) the distribution of small vessel disease (V) and brain atrophy (A) aggregated as following: V−/A−, V−/A+, V+/A−, V+/A+; 2) the relationship of these imagin...
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Objectives: The COVID-19 pandemic and the consequent lockdown came as a storm disrupting people's everyday life. This study aimed at observing whether the COVID-19 related lockdown influenced migraine frequency and disability in migraine patients on therapy with monoclonal antibodies inhibiting the CGRP pathway. Methods: In this longitudinal obs...
Preprint
Full-text available
Background A large corpus of evidence has reported encouraging results for acupuncture as a prophylaxis therapy of migraine. However, trails investigated the efficacy of acupuncture in comparison to pharmacological treatment in episodic migraine showed conflicting results. The aim of the study was to evaluate if acupuncture is as effective as evide...
Chapter
The earliest descriptions of cluster headache date back to the seventeenth century, but it was only from the twentieth century that knowledge of this disorder began to spread thanks to the publication of reports on large case series. Its present name was introduced in 1952, but not until the 1970s was it considered a separate clinical entity from m...
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Background: Isolated, subtle neurological abnormalities (ISNA) are commonly seen in aging and have been related to cerebral small vessel disease (SVD) and subcortical atrophy in neurologically and cognitively healthy aging subjects. Objective: To investigate the frequency of ISNA in different mild cognitive impairment (MCI) types and to evaluate...
Article
Background Mild parkinsonian signs (MPS) have been associated with mild cognitive impairment (MCI) types with conflicting results. Objective To investigate the association of individual MPS with different MCI types using logistic ridge regression analysis, and to evaluate for each MCI type the association of MPS with caudate atrophy, global cerebr...
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Objective: The objective of this study was to investigate differences in clinical, psychological, and psychophysical outcomes according to use of prophylactic medication (amitriptyline) in tension-type headache (TTH). Methods: In total, 173 individuals with TTH participated. Headache features and symptomatic medication intake were collected with...
Article
Cluster headache (CH) has always been considered a type of primary headache affecting predominantly male subjects in early and medium adulthood. However, recent studies carried out in large case series of patients with CH show that not infrequently it may set in also after age 50; by contrast, onset before adolescence is very rare. Additionally, wh...
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Background: To assess the prevalence of three nociceptive primitive reflexes (nPR), i.e., glabellar tap, snout reflex, and palmomental reflex, in neurologically and cognitively healthy (NCH) aging subjects. Objective: To investigate whether nPR are cross-sectionally associated with white matter hyperintensities (WMH), lacunes, atrophy of the cau...
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Background: Mild Parkinsonian signs (MPS) are commonly seen in aging, and have been related to cerebral small vessel diseases (SVD) with no univocal results. Objective: The aim of this study is to investigate the cross-sectional relation between MPS and white matter hyperintensities (WMH), lacunes, caudate atrophy, and global cerebral atrophy in...
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Migraine is a common neurological disorder characterized by episodic headaches with specific features, presenting familial aggregation. Migraine is associated with episodic vertigo, named Vestibular Migraine (VM) whose diagnosis mainly rely on clinical history showing a temporary association of symptoms. Some patient refers symptoms occurring in pe...
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To optimize chronic migraine (CM) ascertainment and phenotype definition, provide adequate clinical management and health care procedures, and rationalize economic resources allocation, we performed an exploratory multicenter pilot study aimed at establishing a CM database, the first step for developing a future Italian CM registry. We enrolled 63...
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Background/objectives: Puberty seems to be a turning point in cluster headache (CH) onset. To verify its influence on CH phenotype, we focused on cases with onset ≤13 years. A review of the literature follows. Method: We considered CH cases with age-of-onset ≤13 years evaluated at our center between 1975 and 2015; these cases were matched by sex...
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Objective: The aim of this work was to assess through a questionnaire the features of vertiginous episodes, accompanying symptoms, familial history, and migraine precursors in a sample of 252 subjects with a diagnosis of definite vestibular migraine. Background: Migraine is a common neurological disorder characterized by episodic headaches with...
Article
Objective The objective of this study was to analyse the prevalence and the clinical features of headache as a presenting symptom of glioma. Methods We interviewed 527 consecutive adult patients with histologically confirmed glioma, admitted to the Regina Elena National Cancer Institute between 2010 and 2015. We defined four headache phenotypes: T...
Article
The aim of the present study was to describe the characteristics of migraine with aura (MwA) in a case series of patients with headache onset before 12 years of age. We considered all consecutive patients referred to the Parma Headache Centre between 1975 and 2015 affected by MwA, diagnosed by our team of trained neurologists; the cases were subseq...
Article
In the past few years, research on chronicization of headache has focussed primarily on migraine, even though there are other types of primary headache that over time can turn into chronic forms. Only a minority of migraine sufferers will develop a chronic condition, with attacks that are likely to vary in their clinical features. As a result, in c...
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To investigate the differences in the presence of trigger points (TrPs) and their association with headache-related disability and mood disorders in people with frequent episodic tension-type headache (TTH) (FETTH) and chronic TTH (CTTH). One hundred twenty-two individuals with TTH participated. Clinical features of headache (i.e., intensity, durat...
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Headache is a widespread disorder and therefore it has a strong impact on quality of life. In the present work we focused on lifetime and past-year prevalence of headache in general and by gender, in a population-based sample in Parma. A total of 904 subjects representative of Parma’s adult general population were interviewed face-to-face by a phys...
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Background and objectives We describe a case of a female patient whose otherwise “typical” migraine attacks turned into episodes with a full spectrum of associated symptoms but without headache. Case report We evaluated a 53-year-old woman with a long history of migraine without aura. In concomitance with premenopausal menstrual dysregulation, she...
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Background There are limited literature data on migraine‐like accompanying features (MLF) in patients with cluster headache (CH). These symptoms are frequently reported by patients and may delay CH diagnosis. Objective The aim of the present study was to investigate the occurrence of migraine‐like symptoms in an Italian case series of CH patients...
Article
Objective: To investigate differences in widespread pressure pain hyperalgesia in the trigemino-cervical and extra-trigeminal (distant pain-free) regions in women with frequent episodic (FETTH) and chronic (CTTH) tension-type headache. Background: It seems that people with tension-type headache exhibit central sensitization. No study has investi...
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Background In the largest case series of cluster headache (CH) published in the literature, age of onset varies between 29.6 and 31.6 years. Differences in onset age based on gender and subtype diagnosis are reported, while there are only few data on patients with childhood and elderly onset. We therefore deemed it useful to review our own large ca...
Article
Chronic migraine is a debilitating headache, whose treatment is often complicated by the concomitant overuse of symptomatic medication and by the poor efficacy of standard prophylactic treatments. The PREEMPT studies have demonstrated the efficacy and tolerability of onabotulinum toxin A (Botox®) in the treatment of this headache type. Data about i...
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We identified 362 patients (250 men and 112 women) reporting MLF and 423 patients (319 men and 104 women) without MLF, with a significantly lower M:F ratio in the first group; furthermore these patients had a lower mean age of headache onset (27.2±12.1 yrs vs 32.3±14.3 yrs). There were no significant disproportions between the two groups regarding...
Article
The International Classification of Headache Disorders, 3rd edition (beta version) has significantly improved the categorization of chronic headaches. From a clinical standpoint, however, it still has a few limitations, both general and specific. Among the former is the fact that international headache classifications are aimed less at defining the...
Article
To investigate the familial occurrence of cluster headache (CH) in a series of Italian patients, we focused on possible differences in the mean age of onset between familial and non-familial CH cases. We considered all consecutive patients referred to the Parma Headache Centre between 1975 and 2013 affected by CH; we subsequently reviewed these cas...
Article
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The aim of this study is to describe the frequency of isolated, subtle, neurological abnormalities (ISNAs) in a large population of neurologically and cognitively healthy subjects and to compare ISNAs to various types of MRI-detected cerebrovascular lesions and subcortical brain atrophy in different age classes. 907 subjects were selected from a la...
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Background: There is only one small single-center study on the reliability of the diagnosis of focal dystonia. The aim of this study was to assess the inter-rater reliability of dystonia diagnosis among neurologists with different professional experience. Methods: Twenty-nine adults (18 with dystonia, 9 with other movement disorders, and 2 healt...
Article
The mean global prevalence of tension-type headache (TTH) in adult is 42 %. To date, there have been no Italian studies on TTH prevalence in the adult general population. Therefore, we conducted a cross-sectional study, called PACE, aimed at detecting the prevalence of primary headaches in the city of Parma's adult general population. 904 subjects...
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In the present paper, we focus on the age of onset for tension-type headache in a population-based sample in the Parma, distinguishing its different subtypes and considering definite and probable diagnoses. Age of headache onset is a useful clinical feature for differential diagnosis between primary headaches and between primary and secondary heada...
Article
All migraine patients need symptomatic treatment to stop individual attacks or, at least, significantly relieve pain. When attacks are very frequent (more than 3 days of headache per month on average), they will also need preventive treatment. The first physician the patient must address to for preventive treatment is the general practitioner (GP)....
Article
Full-text available
The mean global prevalence of tension-type headache (TTH) in adult is 42 %. To date, there have been no Italian studies on TTH prevalence in the adult general population. Therefore, we conducted a cross-sectional study, called PACE (PArma CEfalea, or "Headache in Parma"), aimed at detecting the prevalence and clinical features of primary headaches...
Article
Once migraine becomes chronic and has transformed into a form of headache that occurs daily or almost, the treatment options available are few and complex. This makes it important to take action before this point is reached, using all the measures that can be obtained from our current knowledge of chronic migraine (or transformed migraine) on the o...
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In the field of primary headaches, we have a very useful classification tool for the clinical characterization of individual attacks, but we lack a classification tool for the characterization of primary headache patients. Just because the reasons for this lack have been partially overcome by the knowledge that has been gained in the meantime and b...
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Chronic daily headache is a major problem due to severe disability and high socio-economic costs. In the last years, some trials have shown potential benefit from new therapeutic approach by occipital neurostimulation techniques, already applied with some success for the treatment of chronic cluster headache. Due to the extremely heterogeneous popu...
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In the field of so-called chronic daily headache, it is not easy for migraine that worsens progressively until it becomes daily or almost daily to find a precise and universally recognized place within the current international headache classification systems. A proposal is advanced to differentiate between a form of high-frequency migraine without...
Article
Data in the literature on cluster headache (CH) indicate a mean age at onset of about 29-30 years; recently, however, cases have been reported with onset in old age. A review of age at onset in all CH patients (n = 693) followed at the University of Parma Headache Centre between 1976 and 2011 shows that 73 (10.5 %) patients began to suffer from CH...
Article
In a minority of cases, the natural history of migraine without aura (MO) is characterised over time by its evolution into a form of chronic migraine (CM). In order to detect the possible factors predicting this negative evolution of MO, we searched in our Headache Centre files for all clinical records that met the following criteria: (a) first vis...
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Vera Osipova and her co-workers, on behalf of the Russian Headache Research Society, took one of our recent articles [1] as a starting point to express their opinion on the issue of chronic migraine (CM)/transformed migraine (TM) [2].
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In the literature there are few data about the prevalence of primary headaches, including migraine, in the Italian general population. The PACE study (PArma CEfalea, or 'Headache in Parma') is an observational study aimed at detecting the prevalence and clinical features of primary headaches in the city of Parma's adult general population. A total...
Article
Background.— In the absence of biological markers, the diagnosis of primary headache in epidemiological studies rests on clinical findings, as reported through ad-hoc interviews. Objectives.— The aim of this study was to validate a specially designed headache questionnaire to be administered by a physician for the diagnosis of primary headaches or...
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Full-text available
In the field of so-called chronic daily headache, it is not easy for migraine that worsens progressively until it becomes daily or almost daily to find a precise and universally recognized place within the current international headache classification systems. In line with the 2006 revision of the second edition of the International Classification...
Article
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Aims: We tested the usability and usefulness of the basic diagnostic headache diary (BDHD) for the diagnosis of migraine, tension-type headache and medication-overuse headache in European and Latin American countries. Methods: Patients were subdivided into two groups according to a 1:1 randomization list. Those in group 1 were sent the BDHD befo...