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Despite those limitations, available data pointed toward an increased risk of ischemic stroke associated with the use of HCs in women with migraine. Furthermore, present funding arrangements for health care sometimes fail to provide incentives for nutrition counselling and other sorts of preventative care Bipartisan Policy Center Pope Innocent XI. Simply said, obesity, chronic diseases, and medicine spending have grown as the percentage of income spent on food has declined. Strange are the vicissitudes of human affairs! The demolition of temples was the usual consequence p. His words were only burning when he censured his hearers for not remaining faithful to their Church and to their God. Hence the large increase in the emigration from all parts of France immediately after the Act of Revocation had been proclaimed. Afifi, H.❿
THE HUGUENOTS IN FRANCE – Windows 10 1703 download iso italianos humble – windows 10 1703 download iso italianos humble
He takes a much more patriotic view of the French people. He cannot believe them to have been wilfully guilty of the barbarities which the French Government committed upon the Huguenots. It was the King, the priests, and the courtiers only! But he forgets that these upper barbarians were supported by the soldiers and the people everywhere. He adds, however, that if the Revocation were popular, “it would be the most overwhelming accusation against the Church of Rome, that it had thus educated and fashioned France.
To give an account in detail of the varieties of cruelty inflicted on the Huguenots, and of the agonies to which they were subjected for many years before and after the passing of the Act of Revocation, would occupy too much space, besides being tedious through the mere repetition of like horrors. But in order to condense such an account, we think it will be more interesting if we endeavour to give a brief history of the state of France at that time, in connection with the biography of one of the most celebrated Huguenots of his period, both in his life, his piety, his trials, and his endurance—that of Claude Brousson, the advocate, the pastor, and the martyr of Languedoc.
Claude Brousson was born at Nismes in He was designed by his parents for the profession of the law, and prosecuted his studies at the college of his native town, where he graduated as Doctor of Laws. He commenced his professional career about the time when Louis XIV. Protestant advocates were not yet forbidden to practise, but they already laboured under many disabilities. He continued, however, for some time to exercise his profession, with much ability, at p. He was frequently employed in defending Protestant pastors, and in contesting the measures for suppressing their congregations and levelling their churches under existing edicts, some time before the Revocation of the Edict of Nantes had been finally resolved upon.
Thus, in , he was engaged in disputing the process instituted against the ministers and elders of the church at Nismes, with the view of obtaining an order for the demolition of the remaining Protestant temple of that city. Peyrol, one of the ministers. Brousson defended the case, observing, at the conclusion of his speech, that the number of Protestants was very great at Nismes; that the ministers could not be personally acquainted with all the people, and especially with occasional visitors and strangers; that the ministers were quite unacquainted with the girl, or that she professed the Roman Catholic religion: “facts which rendered it probable that she was sent to the temple for the purpose of furnishing an occasion for the prosecution.
Another process was instituted during the same year p. The pretext for destroying the latter was of a singular character. A Protestant pastor, M. Paulet, had been bribed into embracing the Roman Catholic religion, in reward for which he was appointed counsellor to the Presidial Court of Montpellier.
But his wife and one of his daughters refused to apostatize with him. The daughter, though only between ten and eleven years old, was sent to a convent at Teirargues, where, after enduring considerable persecution, she persisted in her steadfastness, and was released after a twelvemonth’s confinement. Five years later she was again seized and sent to another convent; but, continuing immovable against the entreaties and threats of the abbess and confessor, she was again set at liberty.
An apostate priest, however, who had many years before renounced the Protestant faith, and become director and confessor of the nuns at Teirargues, forged two documents; the one to show that while at the convent, Mdlle. Paulet had consented to embrace the Catholic religion, and the other containing her formal abjuration. It was alleged that her abjuration had been signified to Isaac Dubourdieu, of Montpellier, one of the most distinguished pastors of the French Church; but that, nevertheless, he had admitted her to the sacrament.
This, if true, was contrary to law; upon which the Catholic clergy laid information against the pastor and the young lady before the Parliament of Toulouse, when they obtained sentence of imprisonment against the former, and the penance of amende honorable against the latter. The demolition of temples was the usual consequence p. The Duc de Noailles, lieutenant-general of the province, entered the city on the 16th of October, , accompanied by a strong military force; and at a sitting of the Assembly of the States which shortly followed, the question of demolishing the Protestant temple at Montpellier was brought under consideration.
Four of the Protestant pastors and several of the elders had before waited upon De Noailles to claim a respite until they should have submitted their cause to the King in Council. The request having been refused, one of the deputation protested against the illegality of the proceedings, and had the temerity to ask his excellency whether he was aware that there were eighteen hundred thousand Protestant families in France? Upon which the Duke, turning to the officer of his guard, said, “Whilst we wait to see what will become of these eighteen hundred thousand Protestant families, will you please conduct these gentlemen to the citadel?
The great temple of Montpellier was destroyed immediately on receipt of the King’s royal mandate. It required the destruction of the place within twenty-four hours; “but you will give me pleasure,” added the King, in a letter to De Noailles, “if you accomplish it in two. It was, perhaps, scarcely necessary, after the temple had been destroyed, to make any effort to justify these high-handed proceedings.
But Mdlle. Paulet, on whose pretended conversion to Catholicism the proceedings had been instituted, was now requested to admit the authenticity of the documents. She was still p. Of course the documents were forged; but they had answered their purpose. The Protestant temple of Montpellier lay in ruins, and Isabeau de Paulet was recommitted to prison.
On hearing of this incident, Brousson remarked, “This is what is called instituting a process against persons after they have been condemned”—a sort of “Jedwood justice.
The repetition of these cases of persecution—the demolition of their churches, and the suppression of their worship—led the Protestants of the Cevennes, Viverais, and Dauphiny to combine for the purpose of endeavouring to stem the torrent of injustice.
With this object, a meeting of twenty-eight deputies took place in the house of Brousson, at Toulouse, in the month of May, As the Assembly of the States were about to take steps to demolish the Protestant temple at Montauban and other towns in the south, and as Brousson was the well-known advocate of the persecuted, the deputies were able to meet at his house to conduct their deliberations, without exciting the jealousy of the priests and the vigilance of the police.
What the meeting of Protestant deputies recommended to their brethren was embodied in a measure, which was afterwards known as “The Project. At the same time, Brousson drew up a petition to the Sovereign, humbly requesting him to grant permission to the Huguenots to worship God in peace after their consciences, copies of which were sent to Louvois and the other ministers of State. On this and other petitions, Brousson observes, “Surely all the world and posterity will be surprised, that so many respectful petitions, so many complaints of injuries, and so many solid reasons urged for their removal, produced no good result whatever in favour of the Protestants.
The members of the churches which had been interdicted, and whose temples had been demolished, were accordingly invited to assemble in private, in the neighbouring fields or woods—not in public places, nor around the ruins of their ancient temples—for the purpose of worshipping God, exciting each other to piety by prayer and singing, receiving instruction, and celebrating the Lord’s Supper.
Various meetings were accordingly held, in the following month of July, in the Cevennes and Viverais. At St. The dragoons were at once sent to St. Hypolite to put an end to these meetings, and to “convert” the Protestants. The town was almost wholly Protestant. The troops were quartered in numbers in every house; and the people soon became “new converts. Germain, Vigan, and Ganges were as full of them as St.
Hypolite—may be inferred from the items charged upon the inhabitants of St. Hypolite alone  :—. Meetings of the persecuted were also held, under the terms of “The Project,” in Viverais and Dauphiny.
These meetings having been repeated for several weeks, the priests of the respective districts called upon their bishops for help to put down this heretical display. The p. On their arrival, the troops were scattered over the country, to watch and suppress any meetings that might be held. The first took place on the 8th of August, at Chateaudouble, a manufacturing village in Drome.
The assembly was surprised by a troop of dragoons; but most of the congregation contrived to escape. Those who were taken were hung upon the nearest trees. Another meeting was held about a fortnight later at Bezaudun, which was attended by many persons from Bourdeaux, a village about half a league distant.
While the meeting was at prayer, intelligence was brought that the dragoons had entered Bourdeaux, and that it was a scene of general pillage. The Bourdeaux villagers at once set out for the protection of their families.
The troopers met them, and suddenly fell upon them. A few of the villagers were armed, but the principal part defended themselves with stones. Of course they were overpowered; many were killed by the sword, and those taken prisoners were immediately hanged. A few, who took to flight, sheltered themselves in a barn, where the soldiers found them, set fire to the place, and murdered them as they endeavoured to escape from the flames.
One young man was taken prisoner, David Chamier,  son of an advocate, and p. He was taken to the neighbouring town of Montelimar, and, after a summary trial, he was condemned to be broken to death upon the wheel.
The sentence was executed before his father’s door; but the young man bore his frightful tortures with astonishing courage. He appointed Marshal Saint-Ruth commander of the district—a man who was a stranger to mercy, who breathed only carnage, and who, because of his ferocity, was known as “The Scourge of the Heretics.
The instructions Saint-Ruth received from Louvois were these: “Amnesty has no longer any place for the Viverais, who continue in rebellion after having been informed of the King’s gracious designs. In one word, you are to cause such a desolation in that country that its example may restrain all other Huguenots, and may teach them how dangerous it is to rebel against the King.
This was a work quite congenial to Saint-Ruth  —rushing p. Tracking the Protestants in this way was like “a hunt in a great enclosure. If they were unable to fly, they met death upon their knees. Antoine Court recounts meetings in which as many as between three and four hundred persons, old men, women, and children, were shot dead on the spot.
De Cosmac, the bishop, was very active in the midst of these massacres. When he went out to convert the people, he first began by sending out Saint-Ruth with the dragoons. Afterwards he himself followed to give instructions for their “conversion,” partly through favours, partly by money.
The same course was followed throughout the Cevennes. It would be a simple record of cruelty to describe in detail the military proceedings there: the dispersion of meetings; the hanging of persons p. But let us take the single instance of Homel, formerly pastor of the church at Soyon.
Homel was taken prisoner, and found guilty of preaching to his flock after his temple had been destroyed. For this offence he was sentenced to be broken to death upon the wheel. To receive this punishment he was conducted to Tournon, in Viverais, where the Jesuits had a college. He first received forty blows of the iron bar, after which he was left to languish with his bones broken, for forty hours, until he died.
During his torments, he said: “I count myself happy that I can die in my Master’s service. Though you witness my bones broken to shivers, yet is my soul filled with inexpressible joy. De Noailles, the governor, when referring in one of his dispatches to the heroism displayed by the tortured prisoners, said: “These wretches go to the wheel with the firm assurance of dying martyrs, and ask no other favour than that of dying quickly.
They request pardon of the soldiers, but there is not one of them that will ask pardon of the King. To return to Claude Brousson. After his eloquent p. Brousson was repeatedly offered the office of counsellor of Parliament, equivalent to the office of judge, if he would prove an apostate; but the conscience of Brousson was not one that could be bought. He also found that his office of defender of the doomed Huguenots could not be maintained without personal danger, whilst as events proved his defence was of no avail to them; and he resolved, with much regret, to give up his profession for a time, and retire for safety and rest to his native town of Nismes.
He resided there, however, only about four months. The Protestants of Nismes had taken no part in “The Project;” their remaining temple was still open. But they got up a respectful petition to the King, imploring his consideration of their case.
Roman Catholics and Protestants, they said, had so many interests in common, that the ruin of the one must have the effect of ruining the other,—the flourishing manufactures of the province, which were mostly followed by the Protestants, being now rapidly proceeding to ruin.
They, therefore, implored his Majesty to grant them permission to prosecute their employments unmolested on account of their religious profession; and lastly, they conjured the King, by his piety, by his paternal clemency, and by every law of equity, to grant them freedom of religious worship. The hearts of the King, his clergy, and his ministers, were all hardened against them.
A copy of the above petition was presented by two ministers of Nismes and several influential gentlemen of Lower Languedoc to the Duke de Noailles, the governor of the province.
He treated the deputation with contempt, and their petition with scorn. Writing to Louvois, the King’s prime minister, De Noailles said: “Astonished at the effrontery of these wretched persons, I did not hesitate to send them all prisoners to the Citadel of St. Esprit in the Cevennes , telling them that if there had been petites maisons  enough in Languedoc I should not have sent them there.
Nismes was now placed under the same ban as Vivarais, and denounced as “insurrectionary. One of those to be apprehended was Claude Brousson. Hundreds of persons knew of his abode in the city, but notwithstanding the public proclamation which he himself heard from the window of the house where he was staying , and the reward offered for his apprehension, no one attempted to betray him.
After remaining in the city for three days, he adopted a disguised dress, passed out of the Crown Gate, and in the course of a few days found a safe retreat in Switzerland.
Peyrol and Icard, two of the Protestant ministers whom the dragoons were ordered to apprehend, also escaped into Switzerland, Peyrol settling at p. But although the ministers had escaped, all the property they had left behind them was confiscated to the Crown.
Hideous effigies of them were prepared and hung on gibbets in the market-place of Nismes by the public executioner, the magistrates and dragoons attending the sham proceeding with the usual ceremony. At Lausanne, where Claude Brousson settled for a time, he first attempted to occupy himself as a lawyer; but this he shortly gave up to devote himself to the help of the persecuted Huguenots.
But expostulation was of no use. With each succeeding year the persecution became more bitter, until at length, in , the Edict was revoked. In September of that year Brousson learnt that the Protestant church of his native city had been suppressed, and their temple given over to a society of female converters; that the wives and daughters of the Protestants who refused to abjure their faith had been seized and imprisoned in nunneries and religious seminaries; and that three hundred of their husbands and fathers were chained together and sent off in one day for confinement in the galleys at Marseilles.
The number of Huguenots resorting to Switzerland p. Brousson was from the first an energetic member of this committee. Part of their work was to visit the Protestant states of the north, and find out places to which the emigrants might be forwarded, as well as to collect subscriptions for their conveyance. La Porte was one of the ministers of the Cevennes, who had fled before a sentence of death pronounced against him for having been concerned in “The Project.
Brousson and La Porte here met the Rev. David Ancillon, who had been for thirty-three years pastor at Metz,  and p. The Elector suggested to Brousson that while at Berlin he should compose a summary account of the condition of the French Protestants, such as should excite the interest and evoke the help of the Protestant rulers and people of the northern States.
This was done by Brousson, and the volume was published, entitled “Letters of the Protestants of France who have abandoned all for the cause of the Gospel, to other Protestants; with a particular Letter addressed to Protestant Kings, Electors, Rulers, and Magistrates. Brousson remained nearly five months at Berlin, after which he departed for Holland to note the progress of the emigration in that country, and there he met a large number of his countrymen.
Nearly two hundred and fifty Huguenot ministers had taken refuge in p. While in Holland, Brousson resided principally with his brother, a banished Huguenot, who had settled at Amsterdam as a merchant. Having accomplished all that he could for his Huguenot brethren in exile, Brousson returned to Lausanne, where he continued his former labours.
He bethought him very much of the Protestants still remaining in France, wandering like sheep without shepherds, deprived of guidance, books, and worship—the prey of ravenous wolves,—and it occurred to him whether the Protestant pastors had done right in leaving their flocks, even though by so doing they had secured the safety of their own lives.
Accordingly, in , he wrote and published a “Letter to the Pastors of France at present in Protestant States, concerning the Desolation of their own Churches, and their own Exile. In this letter he says:—”If, instead of retiring before your persecutors, you had remained in the country; if you had taken refuge in forests and caverns; if you had gone from place to place, risking your lives to instruct and rally the people, until the first shock of the enemy was past; and had you even courageously exposed yourselves to martyrdom—as in fact those have done who have endeavoured to perform your duties in your absence—perhaps the examples of constancy, or zeal, or of piety you had discovered, might have animated your flocks, revived their courage, and arrested the fury of your enemies.
Brousson was not a pastor. Would he like to return to France at the daily risk of the rack and the gibbet? The Protestant ministers in exile defended themselves. Brousson was as brave as his words. He was not a pastor, but he might return to the deserted flocks, and encourage and comfort them.
He could no longer be happy in his exile at Lausanne. He heard by night the groans of the prisoners in the Tower of Constance, and the noise of the chains borne by the galley slaves at Toulon and Marseilles. He reproached himself as if it were a crime with the repose which he enjoyed.
Life became insupportable to him and he fell ill. His health was even despaired of; but one day he suddenly rose up and said to his wife, “I must set out; I will go to console, to relieve, to strengthen my brethren, groaning under their oppressions.
His wife threw herself at his feet. He loved his wife and children, but he thought a higher duty called him away from them. When his friends told him that he would be taken prisoner and hung, he said, “When God permits his servants to die for the Gospel, they preach louder from the grave than they did during life. He would go to the help of the oppressed with the love of a brother, the faith of an apostle, and the courage of a martyr.
Brousson knew the danger of the office he was about to undertake. There had, as we have seen, been numerous attempts made to gather the Protestant people together, and to administer consolation to them by public prayers and preaching. The persons who conducted these services were not regular pastors, but only private members of their former churches.
Some of them were very young men, and they were nearly all uneducated as regards clerical instruction. One of the most successful was Isaac Vidal, a lame young man, a mechanic of Colognac, near St.
Hypolite, in the Cevennes. His self-imposed ministrations were attended by large numbers of people. He preached for only six months and then died—a natural death, for nearly all who followed him were first tortured and then hung. We have already referred to Fulcran Rey, who preached for about nine months, and was then executed.
In the same year were executed Meyrueis, by trade a wool-carder, and Rocher, who had been a reader in one of the Protestant churches. Emanuel Dalgues, a respectable inhabitant of Salle, in the Cevennes, also received the crown of martyrdom. Ever since the Revocation of the Edict, he had proclaimed the Gospel o’er hill and dale, in woods and caverns, to assemblies of the people wherever he could collect them.
He was executed in Three other persons—Gransille, Mercier, and Esclopier—who devoted themselves to preaching, were transported as slaves to America; and David Mazel, a boy twelve years of age, who had a wonderful memory, and preached sermons which he had learned by heart, was transported, with his father p.
At length Brousson collected about him a number of Huguenots willing to return with him into France, in order to collect the Protestant people together again, to pray with them, and even to preach to them if the opportunity occurred. Brousson’s companions were these: Francis Vivens, formerly a schoolmaster in the Cevennes; Anthony Bertezene, a carpenter, brother of a preacher who had recently been condemned to death; and seven other persons named Papus, La Pierre, Serein, Dombres, Poutant, Boisson, and M.
They prepared to enter France in four distinct companies, in the month of July, Brousson left Lausanne on the 22nd of July, accompanied by his dear friend, the Rev. The other members of the party had preceded them, crossing the frontier at different places. They all arrived in safety at their destination, which was in the mountain district of the Cevennes. They resorted to the neighbourhood of the Aigoual, the centre of a very inaccessible region—wild, cold, but full of recesses for hiding and worship.
It was also a district surrounded by villages, the inhabitants of which were for the most part Protestant. The party soon became diminished in number. The old pastor, De Bruc, found himself unequal to the fatigue and privations attending the work. He was ill and unable to travel, and was accordingly advised by his companions to quit the service and withdraw from the country.
Persecution also destroyed some of them. When it became known that assemblies for religious observances were again on foot, an increased force of soldiers was sent into the district, and a high price was set on the heads of all the preachers that could be apprehended. The soldiers scoured the country, and, helped by the p. Paul’s, north of Anduze, in the Cevennes.
They were both executed at Nismes, being first subjected to torture on the rack, by which their limbs were entirely dislocated. They were then conveyed to the place of execution, praying and singing psalms on the way, and finished their course with courage and joy.
When Brousson first went into the Cevennes, he did not undertake to preach to the people. He was too modest to assume the position of a pastor; he merely undertook, as occasion required, to read the Scriptures in Protestant families and in small companies, making his remarks and exhortations thereupon.
He also transcribed portions of his own meditations on the Scriptures, and gave them away for distribution from hand to hand amongst the people. When it was found that his instructions were much appreciated, and that numbers of people assembled to hear him read and exhort, he was strongly urged to undertake the office of public instructor amongst them, especially as their ministers were being constantly diminished by execution.
He had been about five months in the Cevennes, and was detained by a fall of snow on one of the mountains, where his abode was a sheepcote, when the proposal that he should become a preacher was first made to him.
Vivens was one of those who most strongly supported the appeal made to Brousson. He spent many hours in private prayer, seeking the approval of God for the course he was about to undertake. Vivens also prayed in the several assemblies that Brousson might be confirmed, and that God would be pleased to pour upon him his Holy Spirit, and strengthen him so that he p.
Brousson at length consented, believing that duty and conscience alike called upon him to give the best of his help to the oppressed and persecuted Protestants of the mountains.
By the grace of God I will comply with your pious desires; dedicate and devote myself to the work of the ministry, and spend the remainder of my life in unwearied pains and endeavours for promoting God’s glory, and the consolation of precious souls. Brousson received his call to the ministry in the Cevennes amidst the sound of musketry and grapeshot which spread death among the ranks of his brethren.
He was continuously tracked by the spies of the Jesuits, who sought his apprehension and death; and he was hunted from place to place by the troops of the King, who followed him in his wanderings into the most wild and inaccessible places. The perilous character of his new profession was exhibited only a few days after his ordination, by the apprehension of Olivier Souverain at St.
Jean de Gardonenque, for preaching the Gospel to the assemblies. He was at once conducted to Montpellier and executed on the 15th of January, During the same year, Dumas, another preacher in the Cevennes, was apprehended and fastened by the troopers across a horse in order to be carried to Montpellier. His bowels were so injured and his body so p. Then followed the execution of David Quoite, a wandering and hunted pastor in the Cevennes for several years.
He was broken on the wheel at Montpellier, and then hanged. All these persons were taken, executed, destroyed, or imprisoned, during the first year that Brousson commenced his perilous ministry in the Cevennes. About the same time three women, who had gone about instructing the families of the destitute Protestants, reading the Scriptures and praying with them, were apprehended by Baville, the King’s intendant, and punished.
She was condemned to be imprisoned for life in the Tower of Constance, a place echoing with the groans of women, most of whom were in chains, perpetually imprisoned there for worshipping God according to conscience. Nothing, however, is known of the time when she died. When a woman was taken and imprisoned in one of the King’s torture-houses, she was given up by her friends as lost. A third woman, taken at the same time, was more mercifully dealt with. Anne Montjoye was found assisting at one of the secret assemblies.
She was solicited in vain to abjure her faith, and being condemned to death, was publicly executed. Shortly after his ordination, Brousson descended from the Upper Cevennes, where the hunt for Protestants was becoming very hot, into the adjacent valleys and plains. There it was necessary for him to be exceedingly cautious. The number of dragoons in Languedoc had been increased so as to enable them regularly to patrol the entire province, and a price had been set upon Brousson’s head, which was calculated to quicken their search for the flying pastor.
Brousson was usually kept informed by his Huguenot friends of the direction taken by the dragoons in their patrols, and hasty assemblies were summoned in their absence. The meetings were held in some secret place—some cavern or recess in the rocks. Often they were held at night, when a few lanterns were hung on the adjacent trees to give light. Sentinels were set in the neighbourhood, and all the adjoining roads were p. After the meeting was over the assemblage dispersed in different directions, and Brousson immediately left for another district, travelling mostly by night, so as to avoid detection.
In this manner he usually presided at three or four assemblies each week, besides two on the Sabbath day—one early in the morning and another at night. At one of his meetings, held at Boucoiran on the Gardon, about half way between Nismes and Anduze, a Protestant nobleman—a nouveau convertis , who had abjured his religion to retain his estates—was present, and stood near the preacher during the service. One of the Government spies was present, and gave information.
The name of the Protestant nobleman was not known. But the Intendant, to strike terror into others, seized six of the principal landed proprietors in the neighbourhood—though some of them had never attended any of the assemblies since the Revocation—and sent two of them to the galleys, and the four others to imprisonment for life at Lyons, besides confiscating the estates of the whole to the Crown. Brousson now felt that he was bringing his friends into very great trouble, and, out of consideration for them, he began to think of again leaving France.
The dragoons were practising much cruelty on the Protestant population, being quartered in their houses, and at liberty to plunder and extort money to any extent. They were also incessantly on the look out for the assemblies, being often led by mounted priests and spies to places where they had been informed that meetings were about to be held.
Their principal object, besides hanging the persons found attending, was to seize the preachers, more especially Brousson and Vivens, believing that the country would be more effectually p. Brousson, knowing that he might be seized and taken prisoner at any moment, had long considered whether he ought to resist the attempts made to capture him.
He had at first carried a sword, but at length ceased to wear it, being resolved entirely to cast himself on Providence; and he also instructed all who resorted to his meetings to come to them unarmed. In this respect Brousson differed from Vivens, who thought it right to resist force by force; and in the event of any attempt being made to capture him, he considered it expedient to be constantly provided with arms.
Yet he had only once occasion to use them, and it was the first and last time. The reward of ten thousand livres being now offered for the apprehension of Brousson and Vivens, or five thousand for either, an active search was made throughout the province. At length the Government found themselves on the track of Vivens. One of his known followers, Valderon, having been apprehended and put upon the rack, was driven by torture to reveal his place of concealment.
A party of soldiers went in pursuit, and found Vivens with three other persons, concealed in a cave in the neighbourhood of Alais. Vivens was engaged in prayer when the soldiers came upon him.
His hand was on his gun in a moment. When asked to surrender he replied with a shot, not knowing the number of his opponents. He followed up with two other shots, killing a man each time, and then exposing himself, he was struck by a volley, and fell dead. The three other persons in the cave being in a position to hold the soldiers at defiance for some time, were promised their lives if they would surrender.
Vivens’ body was taken to the same place. The Intendant sat in judgment upon it, and condemned it to be drawn through the streets upon a hurdle and then burnt to ashes. Brousson was becoming exhausted by the fatigues and privations he had encountered during his two years’ wanderings and preachings in the Cevennes; and he not only desired to give the people a relaxation from their persecution, but to give himself some absolutely necessary rest.
He accordingly proceeded to Nismes, his birthplace, where many people knew him; and where, if they betrayed him, they might easily have earned five thousand livres. But so much faith was kept by the Protestants amongst one another, that Brousson felt that his life was quite as safe amongst his townspeople as it had been during the last two years amongst the mountaineers of the Cevennes. It soon became known to the priests, and then to the Intendant, that Brousson was resident in concealment at Nismes; and great efforts were accordingly made for his apprehension.
During the search, a letter of Brousson’s was found in the possession of M. Guion, an aged minister, who had returned from Switzerland to resume his ministry, according as he might find it practicable. The result of this discovery was, that Guion was apprehended, taken before the Intendant, condemned to be executed, and sent to Montpellier, where he gave up his life at seventy years old—the drums beating, as usual, that nobody might hear his last words.
The house in which Guion had been taken at Nismes was ordered p. After spending about a month at Nismes, Brousson was urged by his friends to quit the city.
He accordingly succeeded in passing through the gates, and went to resume his former work. His first assembly was held in a commodious place on the Gardon, between Valence, Brignon, and St. Maurice, about ten miles distant from Nismes. Although he had requested that only the Protestants in the immediate neighbourhood should attend the meeting, so as not to excite the apprehensions of the authorities, yet a multitude of persons came from Uzes and Nismes, augmented by accessions from upwards of thirty villages.
The service was commenced about ten o’clock, and was not completed until midnight. The concourse of persons from all quarters had been so great that the soldiers could not fail to be informed of it.
Accordingly they rode towards the place of assemblage late at night, but they did not arrive until the meeting had been dissolved. One troop of soldiers took ambush in a wood through which the worshippers would return on their way back to Uzes. The command had been given to “draw blood from the conventicles. About forty others wore taken prisoners. The men were sent to the galleys for life, and the women were thrown into gaol at Carcassone—the Tower of Constance being then too full of prisoners.
After this event, the Government became more anxious in their desire to capture Brousson. They published far and wide their renewed offer of reward for his apprehension.
The role of attachment insecurity in the emergence of anxiety symptoms in children and adolescents with migraine: an empirical study. J Headache Pain In Press. Metabolic syndrome and overweight are highly prevalent among migraineurs and the weight-loss was suggested as a useful strategy to improve both migraine and metabolic syndrome. Recently, we have observed that a particular version of VLCD characterized by very low-carbohydrate intake and Ketone bodies KBs production, named very low-calorie ketogenic diet VLCKD , was able to induce a rapid improvement of headache in migraineurs.
To assess if the favorable outcome on migraine was due to the caloric restriction, instead of KBs, we performed a double blind crossover study to compare headache modifications during a VLCD and a VLCKD in a population of overweighed and obese migraineurs. Among patients referred to the Sapienza University Obesity Clinic, a neurologist specializing in headache recruited 35 migraineurs. To verify variations in headache frequency, we used as baseline the month before the first VLCD and the first transition diet.
Headaches are one of the most disabling disorders . Moreover, recent knowledge have suggested that physical examination for provocative procedures should be done on each patient with side- locked headaches as many of these headaches may closely mimic primary headaches . There have been identified eleven physical tests to properly assess cervical disorders.
When these dysfunctions are present, they support a reciprocal interaction between the trigeminal and the cervical systems as a trait symptom in migraine [6, 7]. In this presentation, an evidence based physical protocol of specific tests it will be provided by a physiotherapist to assess musculoskeletal disorders in the most common primary headaches as Migraine and Tension Type Headache.
Moreover, the integration of this examination in a multidisciplinary team it will be discussed. Stovner LJ. Migraine prophylaxis with drugs influencing the renin- angiotensin system. Eur J Neurol. Prevalence of neck pain in migraine and tension-type headache: a population study. Temporomandibular disorders is more prevalent among patients with primary headaches in a tertiary outpatient clinic.
Arq Neuropsiquiatr. Prakash S, Rathore C. Side-locked headache: an algorithm based approach. The Journal of Headache and Pain ; doi International consensus on the most useful physical examination tests used by physiotherapists for patients with headache: A Delphi study.
Man Ther. Musculoskeletal dysfunction in migraine patients. The International Classification of Headache Disorders, 3rd edition beta version Jul;33 9 Headache represents the most common neurological symptom in pediatric age.
Among the primary headaches, migraine is far more prevalent than tension-type headache and cluster headache. Though extremely rare at this age, also trigeminal autonomic cephalgias have been reported. The most frequent causes of pediatric secondary headaches are represented by respiratory tract infections, while potentially life-threatening diseases, such as brain tumors, are less common.
However, especially in the emergency setting, the possibility that a headache attack is due to a brain tumor must be always considered. To avoid missing these cases, some headache characteristics red flags have been identified .
However, while the most recent ICHD criteria improved the possibility to classify some patients, such as children with migraine with aura , they turned out to be unsuitable for others, such as young patients with primary headache.
Several studies have shown the primary role played by psychological factors in determining the severity of migraine in children . Therefore, a psychological examination is often mandatory, as part of the initial assessment of the patient. Lastly, when assessing a child with primary headache, possible comorbidities should be never forgotten, since addressing them can represent a crucial point for the treatment .
Headache as an emergency in children and adolescents. Curr Pain Headache Rep ; Cephalalgia, submitted. Diagnosis of primary headache in children younger than 6 years: A clinical challenge. Cephalalgia ; Chronic Migraine in Children and Adolescents. Headache and comorbidities in childhood and adolescence. Springer, Whether medication-overuse headache MOH represents a distinct biological entity within the concept of chronic daily headache with specific neurobiological and genetic background is still a matter of debate.
A great deal of interest has been directed at understanding the neurophysiological mechanisms that underlie MOH pathogenesis. Currently, two main, non-mutually exclusive hypotheses have been proposed.
The first, stems from the apparent compulsive use of headache medications by MOH patients, and considers this disorder a sort of addiction to symptomatic remedies. The second shifts the focus from drug addiction to neural sensitization, claiming that triptan overuse triggers adaptations of the trigeminovascular system, thereby facilitating pain transmission and leading to a state of latent sensitization.
Answering these questions might be relevant to better understand the neurochemical mechanisms prompted by acute headache medications that underlie the pathophysiology of MOH and of chronic headache in general. In this presentation, preclinical data will be presented showing that chronic exposure to eletriptan or indomethacin alter trigeminal ganglion gene expression patterns broadly and to a similar extend. Remarkably, qualitative transcriptomic analysis reveals that prolonged exposure to the two different symptomatic drugs triggers almost identical, increased expression of various genes coding for proteins involved in headache pathogenesis such as neuropeptides, their cognate receptors, TRP channels, prostanoid and NO synthesizing enzymes.
These findings will be correlated with the clinical aspects of MOH. The dramatic caloric restriction promotes the fat metabolism, mimicking the starvation, even if meals replacements ad hoc developed accounts for essential nutrients, avoiding the malnutrition.
Because of the extreme caloric restriction, this type of diet is very effective in weight loss, however, that characteristic also is the main limit of VLCD, since it is possible to follow this kind of dietetic regimen for a very limited period usually weeks.
Salads are allowed ad libitum dressed with a spoonful of olive oil. Also in this kind of diet, there are meals per day, mainly consisting in meal replacement products. There is a growing interest in the ketogenic form of the VLCD because several studies have shown a higher compliance of patients with this diet.
The reason of this higher adherence to the diet is still under scrutiny but several reasons are called in cause: an appetite suppression induced by proteins and maybe by ketone bodies KBs , or a modification in hormone secretion insulin, glucagon, ghrelin, adipokines.
The real impact of ketogenic diets in weight loss is still disputed; in fact, on the long period there are not differences between low-carb and low-fat diets in terms of weight reduction and regain of lost weight after the diet. However, thanks to the higher compliance and the drastic caloric restriction, the VLCKDs seem to be a promising approach in the early management of obesity and in the preparation phase for patients that must undergo to bariatric or other types of surgical procedures.
Temporomandibular disorders TMD represent the main cause of orofacial pain of non-dental origin and comprehend several disturbances of the masticatory system characterized by myofascial pain of masticatory muscles or articular pain localized in the pre-auricular area.
Moreover, TMD patients show temporomandibular joint sounds and deviation or limitation of the opening of the mouth. Myofascial pain is a probable consequence of central nervous system mechanisms of convergence and activation of second order neurons with enlargement of the receptive field, reduced pain threshold and allodinia. Often there are accompanying symptoms like facial pain and headaches.
Headache is the most prevalent neurologic disorder, third most diffused health disturbance and the seventh cause of disability in the world. It can be primary, without apparent organic cause, or secondary to other pathologies.
Some epidemiological studies indicates that headache is more prevalent in TMD patients and TMD is more prevalent in subjects affected by headache. A stronger association exists between TMD and chronic migraine in comparison with other types of headache.
Nevertheless the methodological quality of the available studies is not optimal and many of them classify patients with anamnestic questionnaire that tend to overestimate the values of prevalence.
A growing body of literature suggests that the association between headache and TMD may be a manifestation of a central sensitization mechanism. Temporomandibular joint and muscles receive the sensitive innervation of the trigeminal nerve that supply also the cranial vascular structures likely involved in the etiology of the headache. The sensitization of the trigeminal caudate nucleus by the TMD symptoms can favor the triggering of migraine episode. Beside the epidemiological studies and the neurophysiologic hypothesis, there are some initial clinical evidence that show how severity of TMD symptoms parallels an increase of frequency and intensity of migraine and the simultaneous treatment of both conditions results in better outcomes.
From a clinical perspective, a comprehensive assessment based on a biopsychosocial approach can provide relevant information to plan a contemporaneous treatment of TMD and headache, together with an intervention targeted to the reduction of psychosocial conditions that can elicit and maintain mechanisms of central sensitization likely responsible of the comorbidity of TMD and headache.
The exact pathophysiology is still unknown, but evidence supporting both peripheral and central mechanisms i. In fact, the frequency of headache attacks has found to be related to the level of central sensitization . However, not all TTH patients present with the same level of central sensitization and clinical presentation, but subgroups need to be identified in order to offer specific therapeutic programs .
Prolonged peripheral nociceptive input from the pericranial, neck, and shoulder regions e. In fact, it has been found that sustained stimulation of TrPs may induce central sensitization in healthy participants . The number of TrPs seems to be associated with the degree of widespread pressure pain hypersensitivity in TTH patients, supporting the role of TrPs on central sensitization: however the cross-sectional nature of the study does not allow to establish a cause and effect relationship between TrPs and central sensitization, as other variables may influence this association .
Physical therapy may be helpful for the management of TTH patients [10,11], as it may decrese the peripheral nociceptive input. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia ;— Tension type headache. Curr Rheumatol Rev ; — Pressure pain thresholds assessed over temporalis, masseter, and frontalis muscles in healthy individuals, patients with tension- type headache, and those with migraine: A systematic review.
Pain ; — Frequency of headache is related to sensitization: a population study. Pain ; Identification of subgroups of patients with tension type headache with higher widespread pressure pain hyperalgesia.
J Headache Pain ; 18 1 The role of muscles in tension-type headache. Curr Pain Headache Rep. Sustained nociceptive mechanical stimulation of latent myofascial trigger point induces central sensitization in healthy subjects. J Pain. Myofascial trigger points and sensitization: An updated pain model for tension-type headache. Trigger Points are associated with widespread pressure pain sensitivity in people with tension-type headache. Cephalalgia [Epub ahead of print].
Muscle trigger point therapy in tension-type headache. Expert Rev Neurother ; 12 3 Effectiveneess of physical therapy in patients with tension-type headache: literature review. J Jpn Phys Ther Assoc ; 17 1 Migraine is related to the highest disability among headaches. Great efforts are faced to improve the outcome of forthcoming treatments. However, still now, many patients regard as unsatisfactory the low responder rate about the half of patients and adverse effects that current treatments account.
Therefore, waiting for innovative, more tolerated and effective treatments, there is a large request for non-pharmacological approaches that in many cases have specific pathophysiological targets. Among these treatments, nutraceuticals has a leading role. Several nutraceutical products are proposed for migraine and sold around the world, but researchers adequately study only few compounds.
Among studied nutraceuticals compounds, only few of them have studies of good quality in support. Moreover, also interactions among different molecules are not studied. We have reviewed literature data in order to find researches that support the use of nutraceutical molecules in migraine management. Available good quality data support the use of certain nutraceuticals, in particular riboflavin, coenzyme Q10, magnesium, butterbur, feverfew, and omega-3 polyunsaturated fatty acids.
Even if not supported by double blind studies, recently some prospective observational studies about fixed combination of nutraceuticals were performed. For instance, it is the case of a combination of coenzyme Q10, feverfew and magnesium for migraine prophylaxis: a prospective observational study.
A double blind versus placebo study about the effect of a fixed combination of riboflavin, coenzyme Q10, feverfew, andrographis and magnesium for migraine prophylaxis is currently in progress. Usually patients appreciate nutraceuticals more than traditional drugs, since they are regarded as safe and of efficacy not inferior to other pharmacological products.
Available data seem to support this widespread belief, but some concerns about the regulation of nutraceuticals and quality of some products, still remain.
Contrary to what is generally thought of, headaches and algology pain therapy share many aspects. Headaches and chronic non-oncological pain are two paradigms of chronic illness capable of generating enormous individual and social impact by disabling the sick person not only in the biological, but also in the psychological, professional, social and relational spheres.
Both cause alterations in psychological equilibrium, secondary depression, loss of social and professional roles, which, in the most serious cases, can cause loss of work. Literature documents in both cases, headaches and chronic pain, a rise in direct costs but above all of the indirect ones with a huge burden of disease. Both are capable of generating a marked drop in the quality of life associated with a serious bio-psycho-social disability.
Headaches and chronic pain, although distinct according to a topographical criterion, share many mechanisms and physiopathogenetic steps. One of the most current fields in which neurologists and pain therapists converge is the focus on neuroinflammation  and central sensitization, two key mechanism for triggering, maintaining, and subsequent perpetuation of pain: the pain as a symptom, filogenetically responsible for maintaining homeostasis of the organism against actual or potential damage, becomes unnecessary illness without any protective meaning.
Another important shared pathogenetic passage is that of neuroimmune mechanisms, which interlink the immune system with the central nervous system. Furthermore, numerous contribution to the scientific international literature highlight the need to modify the therapeutic approach, directing it towards a semeiotic criterion pain phenothype: specific sign and symptoms of a certain type of pain in a specific moment , which is an epiphenomenon of underlyng pathogenetic mechanism, instead of basing it on a etiologic criterion.
This would enable a more appropriate prescription and greater efficiency, taking into primary consideration the possibility of getting back to everyday life rather than obtaining complete analgesia. All the above mentioned aspects are equally important but one of them can prevail over the others depending on patient characteristics and background.
In conclusion it can be stated that the aspects of sharing between headaches and chronic non-oncological pain are significantly greater than those that clearly divide them. World Health Organization. International classification of functioning, disability and health ICF.
Geneva, World Health Organization, Steiner T. J Lifting the burden: The global campaign against headache. Ru-Rong Ji Emerging targets in neuroinflammation-driven chronic pain. Nat Rev Drug Discov.
Baron R Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment. Lancet Neurol. Headache is a common clinical feature in neurological patients. Usually, neuroimaging is unnecessary in patients with episodic migraine or tension type headache with typical headache features and with a normal neurological examination. These patients do not have a higher probability of a relevant brain pathology compared to the general population.
A recent study, however, reported that neuroimaging is routinely ordered in outpatient headache even if guidelines specifically recommend against their use. Brain MRI with detailed study of the pituitary area and cavernous sinus, is recommended for all trigeminal autonomic cephalalgias TACs.
Neuroimaging should be considered in patients presenting with atypical headache features, a new onset headache, change in previously headache pattern, headache abruptly reaching the peak level, headache changing with posture, headache awakening the patient, or precipitated by physical activity or Valsalva manoeuvre and abnormal neurological examination.
A recent consensus recommends brain MRI for the case of migraine with aura that persists on one side or in brainstem aura.
According the same consensus, fFor primary cough headache, exercise headache, headache associated with sexual activity, thunderclap headache and hypnic headache apart from brain MRI additional tests may be required .
Particularly in emergency room it is mandatory to exclude a secondary headache that requires special attention and further diagnostic workup.
CT scan is the first line neuroimaging examination. MRI offers a greater resolution and discrimination and might therefore be the preferred method of choice in non acute headache. In addition, radiation due to CT scanning may be avoided. Neuroimaging non conventional techniques are of little or no value in the clinical setting. Headache neuroimaging: Routine testing when guidelines recommend against them. European Headache Federation consensus on technical investigation for primary headachedisorders.
Migraine frequency fluctuates over time. In the literature, the most important recognized factors associated to chronic migraine are overuse of acute migraine medication, ineffective acute treatment, obesity, depression, presence of allodynia and stressful life events. Other factors reported in studies are age, female sex and low educational status. Very recently, a large population study suggested that the presence of additional noncephalic pain site is a risk factor for migraine chronification.
For many of these factors the relationship with migraine chronification may however be bi-directional. For instance, in the case of depression, it is possible that depression may negatively affect the response of migraine to acute and prophylactic treatments, but it is also true the opposite: i.
In the case of obesity, the association with chronic migraine may simply be ascribed to the effect of fat tissue in drug distribution. Beside and beyond the putative biological factors that may cause a worsening of disease, several lines of evidence suggest that the progression from episodic to chronic migraine is associated to a progressive increase and stabilization of functional and anatomical changes associated to chronic sensitization. In this frame, it appears obvious that an additional cause for chronic migraine is quite likely represented by the low rate of prescription of preventive medications.
The underutilization of preventive drugs has several explanations ranging from drug-associated issues limited efficacy, poor tolerability profile to education of practitioners, pharmacists and patients, and it also involve the limited access to qualified care.
Underutilization of preventative drugs also translate into a higher recourse to acute drugs, thus feeding on a vicious cycle that leads to negative consequences. CT has participated in advisory boards for Allergan and electroCore; she has lectured at symposia sponsored by Allergan; she is PI or collaborator in clinical trials sponsored by Alder, electroCore, Eli-Lilly and Teva.
Prevalence of migraine sufferers who are candidates for preventive therapy: results from the American migraine study AMPP study. Headache ; — The added value of an electronic monitoring and alerting system in the management of medication-overuse headache: A controlled multicentre study.
To date, the majority of clinical studies concerning primary headaches and their comorbidities are focused on migraine. Comorbidities of migraine may include neurological and psychiatric conditions, as mood disorders depression, mania, anxiety, panic attacks , epilepsy, essential tremor, stroke, and the presence of white matter abnormalities .
Particularly, a complex and bidirectional relation between migraine and stroke has been described, including migraine as a risk factor for cerebral ischemia, migraine caused by cerebral ischemia, migraine mimicking cerebral ischemia, migraine and cerebral ischemia sharing a common cause, and migraine associated with subclinical vascular brain lesions .
A recent meta-analysis pointed out that migraine is associated with increased ischemic stroke risk , and according to a systematic review and meta-analysis  the risk of hemorrhagic stroke in migraineurs is increased with respect to non-migraineurs. Besides, the risk of transient ischemic attack seems to be increased in migraineurs, although this issue has not been extensively investigated .
A recent systematic review and meta-analysis also describes an increased risk of myocardial infarction and angina in migraineurs compared to non-migraineurs . Concerning the association between migraine and vascular risk factors arterial hypertension, diabetes mellitus, dyslipidemia, obesity, alcohol consumption, family history of cardiovascular disease , a recent review  showed no solid evidence of an increased burden of conventional vascular risk factors in migraineurs, with the only exceptions of dyslipidemia and cigarette smoking, while a systematic review and meta-analysis regarding migraine and body mass index categories  found an increased risk of having migraine in underweight subjects and in obese women as compared with normal-weight subjects.
Few studies investigated the comorbidities of tension-type headache TTH , despite the fact that tension-type headache TTH is highly prevalent, and may be as debilitating as migraine . It is noteworthy that, according to a review, TTH is associated with increased rate of affective distress . Furthermore, some medical disorders may worsen a preexisting TTH, and it has been described the comorbidity of TTH with psychiatric disorders and fibromyalgia .
The International Classification of Headache Disorders, 3 rd edition beta version. Comorbid neuropathologies in migraine. Migraine headache and ischemic stroke risk: an updated meta-analysis.
Am J Med. Migraine and hemorrhagic stroke: a meta-analysis. Sacco S, Kurth T. Migraine and the risk for stroke and cardiovascular disease. Curr Cardiol Rep. Migraine and risk of ischaemic heart disease: a systematic review and meta-analysis of observational studies. Conventional vascular risk factors: Their role in the association between migraine and cardiovascular diseases. Migraine and body mass index categories: a systematic review and meta-analysis of observational studies.
Tension-type headache and psychiatric comorbidity. Tension-type headache and systemic medical disorders. Differentiating patients with life-threatening headaches from the overwhelming majority with primary headaches eg migraine, tension or cluster headache is an important issue in emergency department ED.
Patients with non-traumatic headaches are up to 4. These numbers seem to remain constant in Western countries Ramirez-Lassepas, ; Kowalski, ; Cvetkovic, ; Gaughran, Primary headaches still pose an open challenge in the ED because the failure to recognize a secondary headache could cause potentially fatal consequences. Unfortunately, to date, there is still no a standard diagnostic procedure for headache in emergency conditions; although according to the diagnostic guidelines there are red flags that could help in the process, the positive predictive value of each severity indicator is not yet determined.
The problem of poor diagnostic sensitivity was attributed to IHCD-3 criteria rigidity in relation to primary headache diagnosis in emergency setting Dutto, , Swadron, Alternatively, a different standardized work-up has been proposed for the most frequent headache scenarios in ED Cortelli, ; Dutto, A careful history and physical examination remain the most important part of the assessment of the headache patient; they enable the clinician to determine whether the patient is at significant risk for a dangerous cause of their symptoms and what additional workup is necessary.
This presentation will discuss how to approach adults with headache in ED with an emphasis on those features that characterize high-risk headaches. Thus, the muscolokeletal contribution in Primary Headaches is still debate in the literature . Moreover, recent knowledge suggests that different clinical headache phenotypes arising from a common pathophysiology rather than an independent disorder . That is, in the most prevalent headaches disorders i. In this presentation, the role of the musculoskeletal inputs in primary headaches it will be provided.
Moreover, evidences of the effectiveness of a manual therapy management provided by a physiotherapist and its integration in a multidisciplinary team it will be discussed. Migraine prophylaxis with drugs influencing the renin-angiotensin system. The impact of headache in Europe: principal results of the Eurolight project.
Pietrobon D, Striessnig J. Neurobiology of migraine. Nat Rev Neurosci. Cady RK. The convergence hypothesis. Noseda R, Burstein R. Migraine pathophysiology: anatomy of the trigeminovascular pathway and associated neurological symptoms, CSD, sensitization and modulation of pain. Migraine pathophysiology: anatomy of the trigeminovascular pathway and associated neurological symptoms, cortical spreading depression, sensitization, and modulation of pain.
The European Headache Federation recognized the value of OnabotulinumtoxinA suggesting that, before labeling a patient as affected by refractory CM, a proper treatment with this drug needs to be completed . In the last years several real-life prospective studies provided further evidence in clinical setting of OnabotulinumtoxinA U efficacy for the headache prophylaxis in CM complicated by medication overuse headache MOH . Recently we published the results of a prospective study on the long-term 2 years efficacy and safety of a single dose of OnabotulinumtoxinA or U in patients with CM plus MOH had failed previous preventative drugs and detoxification attempts .
Both the doses were effective and equally safe, but U was more effective than U in reducing headache days, migraine days, pain medication intake days and Headache Impact Test HIT -6 score.
Even more, the U dose superior efficacy was evident since the first injection and maintained over all the study period of 24 months. Interestingly we observed a progressive improvement in all the efficacy measures during the 2 years of follow-up with both the doses and significantly more with U. Sometime a response appears only after the second or third injections.
For this reason in selected cases can be useful to temporarily continue an oral preventative agent. The NICE guidelines recommend OnabotulinumtoxinA only for patients who have already tried at least three different preventative drug treatments that have not worked. The chance to use it as first-line preventative treatment may shorten the period of chronicity and eventually prevent the developing of MOH. Several studies conducted before OnabotulinumtoxinA approval shown that it is ineffective in patients with episodic migraine .
Those studies had important limitations as range doses and injection paradigm. Furthermore, the population enrolled was represented in the majority by patients with low frequency episodic migraine an average of attacks per month.
Refractory chronic migraine: a consensus statement on clinical definition from the European headache federation. J Headache Pain ;28; A critical evaluation on MOH current treatments. Curr Treat Options Neurol. A two years open-label prospective study of OnabotulinumtoxinA U in medication overuse headache: a real-world experience.
J Headache Pain ; Efficacy of botulinum toxin type A for the prophylaxis of episodic migraine headaches: a meta-analysis of randomized, double-blind, placebo-controlled trials. Pharmacotherapy ;— Trigeminal autonomic cephalalgias TACs are a group of primary headaches comprehending the following syndromes: episodic and chronic cluster headache CH , episodic and chronic paroxysmal hemicrania PH , short-lasting unilateral neuralgiform headache attacks, and hemicrania continua HC .
Their phenotypes are similar and attack duration is the main feature distinguishing the first three TACs. An accurate diagnosis is important because of their different response to treatments. CH typically occurs at the same time of the day, from once to eight times per day, and in the same period of the year. Trigger factors can include alcohol, volatile chemicals or a warm environment 3. Controlled trials have investigated the efficacy of subcutaneous sumatriptan, nasal sumatriptan, and nasal zolmitriptan.
When a preventive medication is required, verapamil is the reference treatment. PH attack features are characterized by unilateral, often stabbing, headaches, shorter and more frequent than in cluster headaches. PH is responsive to treatment with indomethacin. Indomethacin dosages ranges from 25 to 75 mg, three times a day. SUNCT-SUNA attacks are very short in duration seconds to minutes , triggered by touching the face or chewing, with associated autonomic features and occur up to hundreds of times per day.
In HC, clinical attack features have been reported as unilateral, side-locked continuous pain although interrupted by frequent severe exacerbations , associated with autonomic symptoms and responsive to indomethacin. Therapeutic options in TACs are limited. In many patients the preventive treatment does not help to control attack frequency, or the acute drugs are not well tolerated or are contraindicated.
For these reasons, after the discovery of the central role of the hypothalamus in TACs pathogenesis, neuromodulation techniques started. Graves, in St. James’s Street; and T. Morphew, near Stationers-Hall. Price 1s. Saturday, March 24, 1. Dorinda of nothing afraid, She’s sprightly and gay, a valiant Maid, And as bright as the Day.
Tuesday, March 27, 1. That’s his sign. And here’s now mystery and hieroglyphic. Wednesday, April 4, 1. Cartwright, prithee speak that a little louder, and with a hoarse voice. I am the bold Thunder: pshaw! Speak it me in a voice that thunders it out indeed: I am the bold Thunder.