EFFETTI NEUROFISIOLOGICI E CLINICI Di TRATTAMENTI NON FARMACOLOGICI E FARMACOLOGICI PER L'EMICRANIA SU PARAMETRI DI ABITUAZIONE E SENSITIZAZIONE

Migraine represents a common neurologic condition that results in a considerable socioeconomic burden for many countries, especially for Italy. Concerning physiopathology, two opposing processes seems to be responsible of an alteration in both sensory processing and cortical excitability that characterized migraine people: lack of habituation and sensitization. The main aim of this project was to investigate the effects of two emerging pharmacological and non-pharmacological treatments with respect to neurophysiological clinical habituation and sensitization outcomes. In order to address this research question, three studies were conducted. Study 1 is a cross-sectional study that considered 30 people with episodic migraine compared to 30 healthy ones. Habituation and sensitization neurophysiological and clinical outcomes were assessed. The study reported that people with migraine were characterized by a significant alteration of all parameters taken into consideration with respect to healthy controls, suggesting an alteration in sensory processing. Study 2 is a randomized control trial that investigated the efficacy of an emerging non-pharmacological treatment in patients with episodic migraine, i.e., a dual task protocol of active exercise plus a concomitant cognitive task. This protocol compared active exercise-only and cognitive task-only treatments concerning some habituation and sensitization neurophysiological/clinical outcomes. This trial highlighted how active exercise seems to be more useful in sensitization outcomes, while cognitive training in habituation outcomes. As a consequence, a dual task protocol was more useful than the two monotherapies, i.e., active exercise and cognitive training, through a more evident effect on habituation and sensitization outcomes. Finally, Study 3 is an observational study, comparing two emerging pharmacological and non-pharmacological treatments in patients with migraine, concerning the same habituation and sensitization neurophysiological and clinical outcomes considered in Study. Study 3 detected similar peripheral and central effects of a dual task protocol and monoclonal antibody treatments. However, monoclonal antibody therapy seems to be more useful in sensitization outcomes, while a dual task protocol seems to be more useful in habituation outcomes. Based on this results, two main considerations could be made: 1. the strength of monoclonal antibody therapy represented the desensitization effect on trigemino-cervical complex that leads to peripherally and centrally modulation; 2. the strength of a dual task protocol represented the neuroplasticity activity-dependent that leads to peripherally and centrally modulations. Taken together, the findings from these three studies suggest the coexistence of both central and peripheral adaptive neurophysiological mechanisms in people with migraine that can be objectively measured with validated techniques. Such techniques can also be useful to evaluate the efficacy of different therapies: our preliminary results suggest that non-pharmacological interventions, such as physiotherapy, can significantly improve habituation and sensitization outcomes in this patients’ population.