title: Neurological soft signs in primary headache patients.
abstract: Neurological soft signs (NSS) are semeiotic anomalies not assessed by the standard neurological examination, primarily developed in psychiatric settings and recently proposed as potential markers of minor brain circuit alterations, especially the cerebellar-thalamic-prefrontal network. Primary headache patients present with normal neurological examination and frequent psychiatric comorbidity. Aim of this exploratory study consisted in assessing NSS in 20 episodic frequent migraine (MH) and in 10 tension-type headache (ETTH) outpatients compared to 30 matched healthy controls. NSS were assessed by the Heidelberg scale; clinical characteristics and brain MRI were additionally obtained in all patients. NSS were increased by ∼70 and ∼90% in ETTH and MH, respectively, with respect to controls (p<0.001) and the difference remained significant even after controlling for age and education. Headache type and characteristics did not influence NSS presentation, while headache patients with white matter hyperintensities (WMH) at brain MRI had higher NSS scores compared both to normal controls and patients without WMH. NSS identify a subset of primary headache patients sharing the same comorbidities or minimal brain anomalies, suggesting that tailored prophylactic options might apply.
authors: Neurology Unit, San Gerardo Hospital, Department of Surgery and Translational Medicine (DCMT) and Milan Center for Neuroscience (Neuro-MI), University of Milano-Bicocca, Monza, Italy. Electronic address: lucio.tremolizzo@unimib.it.
authors: L
authors: L
authors: Tremolizzo
authors: Neurology Unit, San Gerardo Hospital, Department of Surgery and Translational Medicine (DCMT) and Milan Center for Neuroscience (Neuro-MI), University of Milano-Bicocca, Monza, Italy.
authors: S
authors: S
authors: Ferrario
authors: Neurology Unit, San Gerardo Hospital, Department of Surgery and Translational Medicine (DCMT) and Milan Center for Neuroscience (Neuro-MI), University of Milano-Bicocca, Monza, Italy.
authors: A
authors: A
authors: Pellegrini
authors: Neurology Unit, San Gerardo Hospital, Department of Surgery and Translational Medicine (DCMT) and Milan Center for Neuroscience (Neuro-MI), University of Milano-Bicocca, Monza, Italy.
authors: L
authors: L
authors: Fumagalli
authors: Neurology Unit, San Gerardo Hospital, Department of Surgery and Translational Medicine (DCMT) and Milan Center for Neuroscience (Neuro-MI), University of Milano-Bicocca, Monza, Italy.
authors: C
authors: C
authors: Ferrarese
authors: Neurology Unit, San Gerardo Hospital, Department of Surgery and Translational Medicine (DCMT) and Milan Center for Neuroscience (Neuro-MI), University of Milano-Bicocca, Monza, Italy.
authors: I
authors: I
authors: Appollonio
mesh_terms: D000328:Adult; D000368:Aged; D001931:Brain Mapping; D016022:Case-Control Studies; D005260:Female; D051270:Headache Disorders, Primary / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020326:Migraine without Aura / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D009460:Neurologic Examination; D010865:Pilot Projects; D018781:Tension-Type Headache / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D055815:Young Adult
keywords: Comorbidity; Endophenotypes; Episodic frequent tension-type headache; Migraine; Neurological soft signs; White matter hyperintensities