BACKGROUND:Headache disorders are highly prevalent, and have a substantial and negative impact on health worldwide. They are largely treatable, but differences in structure, objectives, organization and delivery affect the quality of headache care. In order to recognize and remedy deficiencies in care, the Global Campaign against Headache, in collaboration with the European Headache Federation, recently developed a set of quality indicators for headache services. These require further assessment to demonstrate fitness for purpose. This is their first implementation to evaluate quality in headache care as a multicentre national study.METHODS:Between September and December 2016, we applied the quality indicators in six Italian specialist headache centres (Bologna, Firenze, Modena, Padova, Roma Campus Bio-Medico and Roma Sapienza). We used five previously developed assessment instruments, translated into Italian according to Lifting The Burden's translation protocol for hybrid documents. We took data from 360 consecutive patients (60 per centre) by questionnaire and from their medical records, and by different questionnaires from their health-care providers (HCPs), including physicians, nurses, psychologists and nursing assistants.RESULTS:The findings, comparable between centres, confirmed the feasibility and practicability of using the quality indicators in Italian specialist headache centres. The questionnaires were easily understood by HCPs and patients, and were not unduly time-consuming. Diagnoses were almost all (> 97%) according to ICHD criteria, and routinely (100%) reviewed during follow-up. Diagnostic diaries were regularly used by 96% of physicians. Referral pathways from primary to specialist care existed in five of the six clinics, as did urgent referral pathways. Instruments to assess disability and quality of life were not used regularly, a deficiency that needs to be addressed.CONCLUSION:This Italy-wide survey confirmed in six specialist centres that the headache service quality indicators are fit for purpose. By establishing majority practice, identifying commonalities and detecting deficits as a guide to quality improvement, the quality indicators may be used to set benchmarks for quality assessment. The next step is extend use and evaluation of the indicators into non-specialist care.

• Dengue may involve CNS with a wide spectrum of clinical manifestations. • We report the first case of dengue presenting with nonconvulsive status epilepticus . • Dengue diagnosis could very challenging even in case of direct CNS involvement.

We thank Madias JE for his comments and the appreciation of our report. Entacapone, Parkinson's disease, “functional adrenergic denervation”, and Takotsubo syndromeParkinsonism & Related DisordersVol. 21Issue 4PreviewThe fascinating report by Baldacci et al. [1], published ahead of print, on September 16, 2014 in the Journal, about the 68-year-old woman with Parkinson's disease (PD) who suffered Takotsubo syndrome (TTS), 4 days after starting entacapone (ENTA), a catecholamine augmenting inhibitor of c-COMT activity, provides plenty of food for thought. The case for TTS is herein well documented, such brief episodes, manifesting by rapid normalization of the left ventricular function, have been previously reported, and the absence of electrocardiographic abnormalities may be due to the non-development of myocardial edema [2], due to the brief duration of the illness. Full-Text PDF

Takotsubo syndrome (TTS) or apical ballooning/stress cardiomyopathy is characterized by clinical suspicion of an acute myocardial infarction without significant coronary stenosis, and its pathophysiology may involve a sudden catecholamine surge leading to a usually reversible myocardial dysfunction.

Background: Allodynia is a phenomenon of central sensitization that may lead to migraine transformation. Allodynia is associated with more functional disability and severity of migraine. It is well known that allodynia is positively related to headache frequency, attack duration, illness duration, and /INS;unilateral pain. On the contrary, little is known if some of the common accompanying symptoms of the migraine pain are more present in allodynic migraineurs.

Paroxysmal dyskinesias (PxDs) are involuntary, episodic moveents including any combination of dystonia, ballism, chorea, r athetosis [1]. The events may be precipitated by sudden volntary movements (paroxysmal kinesigenic dyskinesias) or may ccur spontaneously at rest (paroxysmal non-kinesigenic dyskineias precipitated by caffeine, alcohol, fatigue and emotional stress). n uncommon type of PxD is precipitated by exertion and is called aroxysmal exertion-induced dyskinesia (PED) [1]. Although most ases of PxD are primary, specific cause could be recognized such as ultiple sclerosis, vascular lesions, trauma, or acquired metabolic bnormalities [1].