Objective: To assess the feasibility of a novel ACT model for patients with HFEM and its effectiveness respect to a standard treatment. Background: Patients with High Frequency Episodic Migraine without Aura (HFEM) are particularly exposed to the risk of chronification and medication overuse. The “cephalalgiophobia”, is a common trait in these patients and induces anxiety, depression and increased medication intake and headache frequency. These patients need a multidisciplinary approach to manage their problem before chronification. Recently, non pharmacological approaches as Mindfulness, Acceptance Commitment Therapy (ACT) , showed encouraging results for pain conditions & migraine, comparable to pharmacological prophylaxis at long-term. The goal is the psychological flexibility by cultivating positive psychological capacities which can improve mental & physical states, disability, and impact in pain conditions. Design/Methods: Twenty four Patients with HFEM were included and randomized for the study (9/14 episodes per month). Two treatment conditions. 1) TaU: pharmacological prophylaxis (topiramate, amitriptyline, beta blocker, Ca channel blockers) (11 patients); 2) TaU + ACT (13 patients). The ACT consisted of six weekly 90 minutes sessions and two booster sessions, one every 15 days; small groups of patients. Sessions involve: psycho-education, discussions, experiential exercises and home assignments Results: Results showed decrease in days of headache /month in the ACT-group (10+2.0 vs 6.5+3.5 at 3 months), not in the TaU-group (9.27+3.43 vs 11.5+4.71) , and of medication intake /month in the ACT-group ( 9.4+2.75 vs 5.75+3.3) not in the TaU-group (9.9+3.6 vs 10.5 +5.8). Patients of the ACT group were actively involved and participated regularly at the sessions. Conclusions: Although preliminary, results show that ACT seems suitable for this category of patients. An integrated and flexible treatment combining different approaches may be more effective than drugs alone to alleviate pain, to reinforce clinical improvement. Disclosure: Dr. Grazzi has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Allergan, Inc. and ElectroCore, LLC. Dr. Bernstein has nothing to disclose. Dr. Raggi has nothing to disclose. Dr. Sansone has nothing to disclose. Dr. Grignani has nothing to disclose. Dr. Searl has nothing to disclose. Dr. Rizzoli has nothing to disclose.

Background and purposeThe cost of medication overuse headache (MOH) is underestimated. Our aim was to address the cost‐effectiveness of a structured treatment protocol and to present annual cost estimates.MethodsPatients were enrolled on the occasion of a structured treatment protocol, were administered a research protocol addressing direct and indirect costs and were followed up for 3 months.ResultsOf 176 enrolled patients, 138 completed the study. The 3‐month cost per patient fell from €2989 to €1160: the difference was €696 per month for patients treated in the ward and €466 for those treated in day‐hospital; thus it takes 2–3 months to compensate for the protocol's cost. The per‐person annual costs of MOH were €10 533 (95% confidence interval €8700–12 406): direct healthcare costs accounted for 44.8% and indirect costs for 51.5% of the total MOH cost. The annual MOH cost for Italy is estimated at €13.5 billion (95% confidence interval €11.1–15.9 billion).ConclusionThe cost of MOH around the period of a structured treatment protocol is much higher compared to previous estimates. Our protocol is cost‐effective for reducing the economic burden of MOH.

We evaluated 44 old patients (mean age 84 years) in order to study the frequency of hedaches. The frequency found in our sample is higher in comparison to other studies. Further studies including a larger number of patients are needed to obtain more incisive results.

Objective To describe the atypical symptoms of withdrawal syndrome from short-acting barbiturate utilized in the self-medication of migraine.Design: The patients are evaluated with CT scan and EEG.Setting: Patients admitted to the Neurological Department of S. Paolo Hospital, Milan, Italy.Results: Three patients with acute barbiturate withdrawal showed atypical psychiatric features not associated with epileptic seizures.Conclusion: We stressed the importance of pharmacological history taking in patients presenting with atypical confusional symptoms.