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"Leone, Massimo"
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On insignificance : the loss of meaning in the post-material age
\"Focussing on the anthropological consequences of the disappearing of materiality and sensory embodiment, On Insignificance highlights some of the most perturbing patterns of insignificance that have seeped into our everyday lives. Seeking to explain the semiotic causes of feelings of meaningless, Leone posits that caring for the singularities of the world is the most viable way to resist the alienating effects of the digital bureaucratization of meaning. The book will be of interest to scholars of anthropology, cultural studies, semiotics, aesthetics, communication studies and social theory\"-- Provided by publisher.
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Technology and Sacrifice
This paper investigates the complex relationship between technology, religion, and sacrifice, positing this last term as a pivotal concept for understanding the evolution and impact of technological advancements. Through a detailed examination of various cultural and religious frameworks, it explores how artificial intelligence and other modern technologies both challenge and redefine traditional notions of the sacred and the profane. By analyzing historical and contemporary practices, the study highlights the paradoxical role of sacrifice in the digital age, serving as both a metaphor for the loss inherent in technological progress and a foundational principle that shapes the ethical landscapes of innovation.
Journal Article
Pathophysiology of trigeminal autonomic cephalalgias
Cluster headache, paroxysmal hemicrania, and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) are primary headaches recently classified together as trigeminal autonomic cephalalgias (TACs). The causes of these headaches have long been debated, with “peripheral” hypotheses in opposition to “central” hypotheses. The available information indicates that the pain originates from within the brain in cluster headache. The hypothalamic activation observed during TAC attacks by use of functional neuroimaging, and the success of hypothalamic stimulation as a treatment, confirm that the posterior hypothalamus is crucial in the pathophysiology of these headaches. The posterior hypothalamus is now known to modulate craniofacial pain, and hypothalamic activation occurs in other pain disorders, suggesting that this brain area is likely to have a more complex role in the pathophysiology of TACs than that of a mere trigger. Hypothalamic activation might play a part in terminating rather than triggering attacks, and might also give rise to a central permissive state, allowing attacks to take place.
Journal Article
Trial of Galcanezumab in Prevention of Episodic Cluster Headache
In a trial of galcanezumab, an antibody to calcitonin gene–related peptide, for the treatment of cluster headache, a subcutaneous dose reduced the mean weekly frequency of cluster attacks from 17.8 to 9.1, as compared with 17.3 to 12.1 in the placebo group. Injection-site reactions occurred in 8% of the patients receiving galcanezumab.
Journal Article
Globalisation of the pharmacological treatment of migraine
In 2021, about 3·4 billion individuals had disorders affecting the nervous system, with migraine accounting for the third greatest nervous-system-related loss of healthy life, assessed as number of disability-adjusted life-years.1 The International Headache Society (IHS) practical recommendations for the acute2 and preventive3 pharmacological treatment of migraine, published in August and September, 2024, are an important step towards improving management of migraine globally. The IHS recommendations2,3 aim to answer the questions most frequently encountered when treating patients with migraine: who is a candidate for preventive pharmacological treatment; how should effectiveness of therapies be rated; when should the effectiveness of a migraine preventive treatment be assessed; for how long should preventive therapies be used; how should comorbidities inform preventive treatment choices; what is the appropriate use of combination therapies; what approaches should be used for migraine prevention in children, in people older than 65 years, and during pregnancy and lactation; how should medication overuse be managed; and how should triptans and other acute pharmacological treatments be used. In low-resourced areas in sub-Saharan Africa, where migraine has the same prevalence as in high-income countries, more than 90% of patients with neurological disorders are managed in primary care by non-graduate health-care personnel.7 Regarding availability of anti-migraine drugs, only 12% of countries have a dedicated budget line for the treatment and care of people with neurological disorders.5 The WHO list of essential medicines includes only propranolol for migraine prevention;8 other drugs that are effective in migraine prophylaxis are listed for conditions other than migraine, such as valproic acid and lamotrigine (for epilepsy), amitriptyline (for psychiatric disorders), bisoprolol (for cardiovascular medicine), and some local anaesthetics and steroids.2,3,8 The mean total health spending per person in 2021 was US$103·6 in lower-middle-income and low-income countries,9 which together cover about half of the global population; such spending might be insufficient to cover treatments such as propranolol or the anti-seizure medications commonly used in migraine prophylaxis.
Journal Article
Current and emerging evidence-based treatment options in chronic migraine: a narrative review
BackgroundChronic migraine is a disabling condition that is currently underdiagnosed and undertreated. In this narrative review, we discuss the future of chronic migraine management in relation to recent progress in evidence-based pharmacological treatment.FindingsPatients with chronic migraine require prophylactic therapy to reduce the frequency of migraine attacks, but the only currently available evidence-based prophylactic treatment options for chronic migraine are topiramate and onabotulinumtoxinA. Improved prophylactic therapy is needed to reduce the high burden of chronic migraine in Italy. Monoclonal antibodies that target the calcitonin gene-related peptide (CGRP) pathway of migraine pathogenesis have been specifically developed for the prophylactic treatment of chronic migraine. These anti-CGRP/R monoclonal antibodies have demonstrated good efficacy and excellent tolerability in phase II and III clinical trials, and offer new hope to patients who are currently not taking any prophylactic therapy or not benefitting from their current treatment.ConclusionsTreatment of chronic migraine is a dynamic and rapidly advancing area of research. New developments in this field have the potential to improve the diagnosis and provide more individualised treatments for this condition. Establishing a culture of prevention is essential for reducing the personal, social and economic burden of chronic migraine.
Journal Article
The Regional Outreach Programme of the International Headache Society: A WHO IGAP-oriented initiative in partnership with DREAM to improve healthcare for people with headache in Sub-Saharan Africa
The WHO Intersectoral Global Action Plan (2022–2031) emphasises the importance of scaling up healthcare services to enhance access to care for patients with neurologic diseases. In Sub-Saharan Africa, most patients with neurological conditions, including headache, receive care in primary healthcare services. Here, they are often underdiagnosed and poorly managed, primarily due to the inadequate training of healthcare providers. Through its Regional Outreach Programme (ROPE), the International Headache Society (IHS) partnered with a local primary healthcare programme – the Disease Relief through Excellent and Advanced Means (DREAM) programme – to deliver two structured, in-person training courses to local clinicians in Blantyre, Malawi (in 2022 and 2025). These courses provided primary care providers with practical skills in diagnosing and managing primary and secondary headaches. The programme also included local field-based mentorship periods and a ‘train-the-trainer’ model. The training output indicates that partnerships between international scientific societies, such as the IHS, and established local healthcare programmes, like DREAM, facilitate effective task shifting among primary healthcare providers. This helps to bridge the huge diagnostic and treatment gap for headaches in Sub-Saharan Africa. ROPE represents a successful, replicable model for improving access to care for people with headaches in underserved regions.
Journal Article
Dysfunctional mesocorticolimbic circuitry in cluster headache
Background
This study aimed to identify mesocorticolimbic functional abnormalities in cluster headache (CH) patients, disentangling the roles of chronification and affective symptoms.
Methods
Using the monetary incentive delay fMRI task to directly engage these pathways, we investigated functional alterations in key regions of this network in chronic (
n
= 23) and episodic CH patients (
n
= 49) compared to a control group (
n
= 32). After processing the fMRI data, we extracted beta values from selected regions and for contrasts of interest and entered them into logistic regression models adjusted for potential confounders (such as depressive and anxiety symptoms and smoking habit) to test their association with the diagnoses (chronic CH and control subjects, episodic CH and control subjects).
Results
Results showed that chronic CH patients exhibited reduced ventral tegmental area (VTA) activity and a tendency towards significance (
p
= 0.056) for an increased medial prefrontal cortex (mPFC) responsiveness during reward anticipation, alongside a significant decrease in mPFC activity during reward outcomes. Episodic patients displayed abnormal mPFC activity across both reward phases, but coupled with intact VTA responses. Importantly, these functional abnormalities were not correlated to depressive and anxiety symptoms and smoking habits.
Conclusions
These findings suggest that chronic CH patients experience an imbalance in the VTA-mPFC pathway, while episodic patients may show early signs of this emerging dysfunction. Moreover, the observed reward processing alterations seem distinct from those associated with affective disorders, possibly highlighting unique mechanisms underlying the pathophysiology of CH.
Journal Article
Involvement of the ipsilateral-to-the-pain anterior–superior hypothalamic subunit in chronic cluster headache
Background
Despite hypothalamus has long being considered to be involved in the pathophysiology of cluster headache, the inconsistencies of previous neuroimaging studies and a limited understanding of the hypothalamic areas involved, impede a comprehensive interpretation of its involvement in this condition.
Methods
We used an automated algorithm to extract hypothalamic subunit volumes from 105 cluster headache patients (57 chronic and 48 episodic) and 59 healthy individuals; after correcting the measures for the respective intracranial volumes, we performed the relevant comparisons employing logist regression models.
Only for subunits that emerged as abnormal, we calculated their correlation with the years of illness and the number of headache attacks per day, and the effects of lithium treatment. As a post-hoc approach, using the 7 T resting-state fMRI dataset from the Human Connectome Project, we investigated whether the observed abnormal subunit, comprising the paraventricular nucleus and preoptic area, shows robust functional connectivity with the mesocorticolimbic system, which is known to be modulated by oxytocin neurons in the paraventricular nucleus and that is is abnormal in chronic cluster headache patients.
Results
Patients with chronic (but not episodic) cluster headache, compared to control participants, present an increased volume of the anterior–superior hypothalamic subunit ipsilateral to the pain, which, remarkably, also correlates significantly with the number of daily attacks. The post-hoc approach showed that this hypothalamic area presents robust functional connectivity with the mesocorticolimbic system under physiological conditions. No evidence of the effects of lithium treatment on this abnormal subunit was found.
Conclusions
We identified the ipsilateral-to-the-pain antero-superior subunit, where the paraventricular nucleus and preoptic area are located, as the key hypothalamic region of the pathophysiology of chronic cluster headache. The significant correlation between the volume of this area and the number of daily attacks crucially reinforces this interpretation. The well-known roles of the paraventricular nucleus in coordinating autonomic and neuroendocrine flow in stress adaptation and modulation of trigeminovascular mechanisms offer important insights into the understanding of the pathophysiology of cluster headache.
Journal Article