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But this and many other things in this business we must refer to your good considerations and fruitful endeavors in opening a work begun here out of pity, and tending so much to the benefitt of the plantation, shall not miscarry for any want of good will or care on your part.
In a monopoly of the importation of tobacco was granted to the Virginia and Somers Island, companies. But notwithstanding this terrible massacre in which nearly four hundred persons were slain the colony increased in wealth and numbers as plantations were laid out and the colonists developed the various resources of the country.
From the first planting of tobacco in Virginia by the colony it seemed to meet the royal displeasure of King James the First who falsely and frivolously sought to establish a connection between the balmy plant, and the influences of the Evil One. In King James still opposing the cultivation of tobacco sought by every means in his power to discourage its growth and culture. He urged the growing of mulberry trees and the propagation of silk worms, as being of more value than tobacco.
In a letter dated 10th June , addressed to the Governor and Council of Virginia by the London Company we find this reproof for neglecting the cultivation of "mulberrie trees":. In a letter was prepared for the colony by order of privy council of the king and addressed to Sir Francis Wyatt Knight and Captain General of Virginia and to the p.
The following is a portion of the proclamation:—. Thus King James by Proclamation and Prohibition set his face sternly against the growth and traffic in the plant, which opposition knew no alteration and continued till his death, which occurred in James was succeeded by his son Charles I. On ascending the throne Charles manifested the same hostility towards the plant which his father had.
He prohibited the importation of all tobacco excepting that grown by the colony, and throughout his reign made no change in the restrictive laws against its growth and sale. He continued its sale, however, as a kingly monopoly, allowing only those to engage in it who paid him for the privilege. The Company had now raised a capital of two hundred thousand pounds, but falling into dispute and disagreeing one with another, Charles thought best to establish a royal government.
And at our charge we will maintain those public officers and ministers and that strength of men, munition, and fortification, which shall be necessary for the defence of that plantation. And we will also settle and assure the particular rights and interests of every planter and adventurer. Lastly, whereas the tobacco of those plantations the only present means of their subsisting cannot be managed for the good of the plantations, unless it be brought into one hand, whereby the foreign tobacco of those plantations may yield a certain and ready price to the owners thereof: to avoid all differences between the planters and adventurers themselves, we resolve to take the same into our own hands, and to give such prices for the same as may give reasonable satisfaction, whereof we will determine at better leisure.
From this time forward the Plantation seemed to prosper, Charles granted lands to all the planters and adventurers who would till them, upon paying the annual sum of two shillings payable to the crown for each hundred acres.
Arthur and Carpenter, in their History of Virginia, give a graphic and truthful picture of its cultivation during the reign of King James:—. Distance, however, and a want of the proper facilities to enable them to manufacture cheaply, rendered the cost of these commodities so great, that exports of a similar character from Russia and Sweden were still enabled to maintain their old ascendency in the markets of Europe. After many fruitless and costly experiments in the cultivation of the vine, the growing demand for tobacco enabled the planters to turn their labor into a profitable channel.
As the demand increased the profits became correspondingly great, and every other species of labor was abandoned for the cultivation of tobacco.
The townspeople, more greedy of gain than mindful of their own security, scattered abroad into the wilderness, where they broke up small pieces of rich ground and made their crop regardless of their proximity to the Indians, in whose good faith so little reliance could be placed.
During the reign of Charles I. King Charles, to use the language of another, had now commenced "as a tobacco merchant and monopolist," and in issued a proclamation renewing his already strong monopoly more effectually, by appointing certain officers of London. Again in King Charles issued another proclamation, and among other restrictions limited the importation of it from the colony. Quickly following this the King issued in another proclamation regulating the retailing of tobacco.
In he also prohibited the landing of tobacco any where except at the quay near the custom house in London. In parliament laid a tax for the year , calling it Excise, and also laid a duty of four shillings per pound on foreign, and two shillings per pound on English tobacco. From what has already been written, it will be seen that both King James and his son p. But the Scottish Solomon who was on the alert, added another law restraining its cultivation 'to misuse and misemploy the soil of this fruitful Kingdom.
By this means the trade was monopolized, the consumers oppressed, importation diminished, and the London Company of Virginia traders ultimately ruined. Those who are fond of excusing the evil acts of one of the worst of English Kings, pretend to see James' care for his subjects' health and wealth in these restrictions, totally regardless of the fact that James cared for neither when the monopoly brought large sums into his own pocket.
In Charles I. The next year he sailed from England with two hundred persons and settled in his new possessions. The colony from the first, prospered far better than the colony of Virginia and soon laid the foundation of a strong and substantial government.
Like the Virginians they soon engaged in the cultivation of tobacco which seemed as well adapted to the soil as the other products, corn and English wheat. The Indians were found here as in the Plantation of Virginia planting tobacco p. From this time forward both colonies developed into strong and flourishing plantations and with each succeeding year increased the cultivation of tobacco which had now become more extensively cultivated than all the other products combined.
Its culture however was looked upon with the same disapproval by Charles II. But notwithstanding the remonstrances of the Stuarts the plant grew in use and favor and could not be uprooted even by a kingly hand. The early cultivators of the plant received a fresh impetus from the importation of a new species of labor in the form of Negro slaves brought from the West India islands. Rolfe in alluding to the importation of Negroes says:. Most writers are of the opinion that this was in , one of whom says "in the same year that the Pilgrims landed at Plymouth, slaves landed in Virginia.
If twenty negroes came in , as alleged, their increase was very slow, for according to a census of 16th of February, , there were but twenty-two then in the colony, distributed as follows: eleven at Flourdiew Hundred, three at James City, one at James Island, one at the plantation opposite James City, four at Warisquoyok, and two at Elizabeth City.
About the same time that "negars" landed in the colony, commenced the arrival of starving boys and girls picked up out of the streets of London. The "negars" are described as follows by an early writer of the colony. The negroes are very numerous, some gentlemen having hundreds of them of all sorts, to whom they bring great profit; for the sake of which they are obliged to keep them well, and not overwork, starve, or famish them, besides other inducements to favor them, which is done in a great degree, to such especially that are laborious, careful, and honest; though indeed some Masters, careless of their own interest and reputation, are too cruel and negligent.
Their work or chimerical hard slavery is not very laborious; their greatest hardship consisting in that they and their posterity are not at their own liberty or disposal, but are the property of their owners; and when they are free they know not how to provide so well for themselves generally; neither did they live so plentifully nor many of them so easily in their own country where they are made slaves to one another, or taken captive by their enemies.
Their work is to take care of the stock, and plant Corn, Tobacco, Fruits and which is not harder than thrashing, hedging, or ditching; besides, though they are out in the violent heat, wherein they delight, yet in wet or cold weather there is little occasion for their working in the fields, in which few will let them be abroad, lest by this means they might get sick or die, which would prove a great loss to their owners, a good Negroe being sometimes worth three nay four score pounds sterling, if he be a tradesmen; so that upon this if upon no other account they are obliged not to overwork them, but to clooth and feed them sufficiently, and take care of their health.
The planters, supplied with greater facilities for the work, now increased the size of their tobacco plantations, "taking up new ground" clearing the land and planting a much larger area.
The first exportation of the colony's tobacco was brought into competition with that of much finer flavor, which had acquired an established reputation long before the English began the culture of the plant in the New World.
The Spanish, Dutch and Portuguese had long monopolized its culture and trade, and brought from St. Domingo, Jamaica, St. Thomas, the Philippine Islands, West Florida, and various parts of South America, several varieties of tobacco of excellent quality, and which sold at an exorbitant price. On testing the tobacco grown by the London and Plymouth companies it was found to be sweet and mild in flavor, of a light color, and well adapted for smoking.
The planters, who at first cultivated small patches, now planted large fields of tobacco, and such was the greed for gain that some planters gathered a second crop upon the same field from the suckers left growing upon the parent stalk. Tatham [16] says in regard to it:—. The practice of cultivating suckers is on these accounts not only discountenanced as fraudulent, but the constables are strictly enjoyned ex officio to make diligent search, and to employ the posse commitatus in destroying such crops; a law indeed for which, to the credit of the Virginians, there is seldom occasion; yet some few instances have occurred, within my day, where the constables have very honorably carried it into execution in a p.
Fairholt makes a mistake in speaking of the planter as re-setting the suckers, and his statement shows him to be entirely unacquainted with the habits of the plant. As soon as the plants are harvested, the stump of the plant remaining in the ground puts forth one or more vigorous suckers or shoots, which often in a good season grow almost as high as the parent stalk. In some tobacco-growing sections one or two crops of suckers are gathered besides the first crop. The Creole planters in Louisiana are said to grow three crops in this manner, the first or parent crop and two growths of suckers.
The quality of leaf, however, is greatly inferior, as it is small and thin and lacking in all the qualities necessary for a fine leaf. The planters now adopted new methods of culture, and cultivated several species of the plant known as Oronoko and little Frederick, although they did not fertilize the fields, even when the soil became impoverished, but simply took new fields for its culture. The gentlemen's seats are of late built for the most part of good brick, and many of timber very handsome, commodious, and capacious; and likewise the common planters live in pretty timber houses, neater than the farm houses are generally in England: With timber also are built houses for the overseers and out-houses; among which is the kitchen apart from the dwelling house, because of the smell of hot victuals, offensive in hot weather.
Upon this account they think it folly to take off their hands or negroes and p. So that though they are apt to learn, yet they are fond of and will follow their own ways, humors and notions, being not easily brought to new projects and schemes; so that I question if they would have been improved upon by the Mississippi or South sea, or any other such monstrous bubbles.
The common planters leading easy lives without much labor, or any manly exercise, except horse-racing, nor diversion, except cock-fighting, in which some greatly delight. They are such lovers of riding, that almost every ordinary person keeps a horse; and I have known some spend the morning in ranging several miles in the woods to find and catch their horses to ride only two or three miles to the Church, to the Court-House or to a Horse-Race, where they generally appoint to meet upon business; and are more certain of finding those that they want to speak or deal with, than at their home.
No people can entertain their friends with better cheer and welcome; and stranger and traveler is here treated in the most free, plentiful, and hospitable manner; so that a few Inns or Ordinaries on the road are sufficient. This is no doubt a correct picture of the early planters of Virginia. Many of them became the owners of large plantations and all those who were successful growers of tobacco became wealthy in proportion to the quality of leaf produced.
The merchants, factors or store-keepers bought up the tobacco of the planters paying in goods or "current Spanish money, or with sterling bills payable in Great Britain. Necessity that very prolific mother of invention , first suggested the idea of rolling by hand; time and experience have led to the introduction of horses, and have ripened human skill, in this kind of carriage, to a decree of perfection which merits the adoption of the mother country, but which will be better explained under the next head of this subject.
Two hickory saplings are affixed to the hogshead, for shafts by boring an auger-hole through them to receive the gudgeons or pivots, in the manner of a field rolling-stone; and these receive pins of wood, square tapered points, which are admitted through square mortises made central in the heading, and driven a considerable depth into the solid tobacco. Upon the hind part of these shafts, between the horses and the hogshead, a few light planks are nailed, and a kind of little cart body is constructed of a sufficient size to contain a bag or two of p.
In this manner they set out to the inspection in companies, very often joining society with the wagons, and always pursuing the same method of encamping. The methods of making the plant bed, cultivating and harvesting, by the early planters may be interesting to all growers of the plant and are here described as showing the progress made in cutting tobacco from that time until now. They are then sown in a hot-bed. When the young plants have grown to a finger's length, they are taken up between the fifteenth and twenty-second of May, and planted in ground that has been previously well manured with the dung of doves or swine.
They are placed at square distances of one and a half-foot from one another. In dry weather, they are now to be watered with lukewarm water softly showered upon them, between sunset and twilight. When these plants are full two feet high, the top of the stems are broken off, to make the leaves grow thicker and broader. Here and there are left a few plants without having their tops broken off, in order that they may afford seeds for another year. Throughout the summer the other plants are from time to time, pruned at the top, and the whole field is carefully weeded to make the growth of the leaf so much the more vigorous.
It is more advantageous to pluck the leaves when they are dry than when they are moist. When plucked they are to be immediately brought home, and hung upon cords within the house to dry, in as full exposure as is possible to the influence of the sun and air; but so as to receive no rain.
In this exposure they remain till the months of March and April following; when they are to be put up in bundles, and conveyed to the store-house, in which they may be kept, that they may be there till more perfectly dried by a moderate heat. Within eight days they must be removed to a different place, where they are to be sparingly sprinkled with salt water, and left till the leaves shall be no longer warm to the p. A barrel of water with six handfuls of salt are the proportions.
After all this the tobacco leaves may be laid aside for commercial exportation. They will remain fresh for three years. In Maryland they formerly prepared the land for a plant-bed by burning upon it a great quantity of brush-wood, afterwards raking the surface fine; the seed was then sowed broadcast. The young plants were kept free from weeds, and were transplanted when about two inches high.
The cultivation of tobacco gradually spread from one State to another. From Virginia it was introduced into North Carolina and Maryland and finally Kentucky which is now the largest producing tobacco State in the Union. The demand for Virginia tobacco continued to increase and long before the Revolutionary war, Virginia exported annually thousands of hogsheads of leaf tobacco. Half a century ago the plant began to be cultivated in Ohio and from the first grew remarkably well, producing a leaf adapted for both cutting and cigar purposes.
Tobacco was planted in New Netherland New York by p. Soon after its cultivation began it was subjected to Excise; and regulations were published to check the abuses which injured "the high name" it had gained in foreign countries.
Tobacco thus became the first marketable staple production of Mississippi. An English writer has the following account of the culture of tobacco in Louisiana by the French:.
There is one advantage in this culture here which ought not to be forgotten; in Louisiana the French planters after the tobacco is cut, weeded and cleaned the ground on which it grew the roots, push forth fresh shoots, which are managed in the same manner as the first crop. By this means a second crop is made on the same ground, and sometimes a third.
These seconds indeed, as they are called, do not usually grow so high as the first plant, but notwithstanding they make very good tobacco. During the reign of the Stuarts, the plant was first cultivated in New England but only in small quantities [19] and p.
About the plant received more attention from the farmers living in the Connecticut valley containing some of the finest tobacco land in the country. They found by repeated trials that the soil was well adapted to the production of a finer leaf tobacco than any they had ever seen.
At this time Kentucky and Havana tobacco were used in the manufacture of cigars, but on testing American tobacco or as it is now known "Connecticut seed leaf" it was found to make the finest wrappers yet produced, and consequently the best looking cigars.
From that time its reputation has kept pace with its cultivation, until it now enjoys a world wide popularity. As a wrapping tobacco it towers far above the seed products of other states and can never have a successful competitor in the other varieties now cultivated in the Middle and Western States. Doubtless America furnishes the finest varieties of the plant now cultivated, suited for all kinds of manufacturing, and adapted to all the various forms in which it is used. The great diversity of soil and climate renders this probable while actual experiments and improved methods of culture have demonstrated it to a certainty.
Thousands of hogsheads, cases, and bales are annually shipped to all parts of the world and the demand for American tobacco is greater than for the varieties grown in the Old World. More than two hundred and fifty years have passed since the London and Plymouth Companies began its cultivation in the Old Dominion, and on the same soil where the red man grew his "uppowac. From a small beginning, like the plant itself it has developed into a great and increasing industry and its culture become a source of wealth unprecedented in agricultural history.
Could the sapient James I. Saint Pierre alluding to the beneficence of nature and of the folly and cruelty of man as contrasted says:. The descendants of those princes took possession of America, and transmitted to us by this conquest, an inexhaustible succession of wars and maladies. While they were exterminating the inhabitants of America with cannon, a Carib invited sailors to smoke his Calumet as a signal of peace.
The perfume of the tobacco vanquished their torments and their troubles, and the use of tobacco was spread all over the earth. While the afflictions of the two worlds came from artillery, which kings call their last resort, the consolations of civilized nations flowed from the pipe of a savage. It seems hardly possible to draw a more graphic picture of the blessings diffused by the balmy plant, than that just given.
Its peculiar charms and soothing influence are well calculated p. The pipe of a king burns not more freely the shreds of the plant, than it does the last remnant of hostile feelings and the recollections of bitter wrongs; while the snuff-box of the diplomat contains the precious dust that has soothed the fierce hatred of rival houses and cemented the divided factions of a tottering throne.
The discovery of the tobacco plant in America by European voyagers aroused their cupidity no less than their curiosity. They saw in its use by the Indians a custom which, if engrafted upon the civilization of the Old World, would prove a source of revenue commensurate with their wildest visions of power and wealth. This was particularly the case with the Spanish and Portuguese conquerors, whose thirst for gold was gratified by its discovery. The finding by the Spaniards of gold, silver, and the balmy plant, and by the Portuguese of valuable and glittering gems, opened up to Spain and Portugal three great sources of wealth and power.
But while the Spaniards were the first discoverers of the plant there seems to be conflicting opinions as to which nation first began its culture, and whether the plant was cultivated first in the Old World or in the New.
Humboldt says:—. Unlike in their nature, both have been received as extensive blessings—the one by its nutritive powers tends to support, the other by its narcotic virtues to soothe and comfort the human frame—the potato and tobacco; but very different was the favor with which these plants were viewed.
The one long rejected, by the slow operation of time, and, perhaps, of necessity, was at length cherished, and has become the support of millions, but nearly one hundred and twenty years passed away before even a trial of its merits was attempted; whereas, the tobacco from Yucatan, in less than seventy years after the discovery, appears to have been extensively cultivated in Portugal, and is, perhaps, the most generally adopted superfluous vegetable product known; for sugar and opium are not in such common use.
The potato by the starch satisfies the hunger; the tobacco by its morphia calms its turbulence of the mind. The former becomes a necessity required, the latter a gratification sought for. It would appear then that the year was about the period of the introduction of tobacco into Europe.
Phillip II. In the following year it was introduced into France and Italy. As the history of Nicot is so intimately connected with that of the plant, a short sketch of this original importer will doubtless be interesting to all lovers of the weed:—.
He was the son of a notary at Nismes, and started in life with a good education, but with no fortune. Finding that his native town offered no suitable or sufficient field for his energies, he went to Paris and strove hard to extend his studies as a scholar and his connections as an adventurer.
He made the acquaintance of some courtiers, who felt or affected an interest in learning and in learned men. His manners were insinuating; his character was pliable.
When presented at court he succeeded in gaining the esteem and confidence of Henry II. Francis II. He was successful in his mission. But it was neither his talents as a diplomatist, nor his remarkable mind, nor his solid erudition, which made Nicot immortal. It was by popularizing tobacco in France that he gained a lasting fame.
But it is likewise stated with quite as much confidence, that a Flemish merchant, who had just returned from America, offered Nicot at Bordeaux, where they met, some seeds of the tobacco, telling him of their value. The seeds Nicot sent to Catherine de Medicis, and on arriving in Paris he gave her some leaves of tobacco. Nicot published two works. The first was an edition of the History of France or of the Franks, in Latin, written by a Monk called Aimonious, who lived in the tenth century.
Stevens and Liebault in the "Country Farm" [27] give the following account of its early introduction into France and the wonderful cures produced by its use:. This herbe is called Nicotiana of the name of an ambassador which brought the first knowledge of it into this realme, in like manner as many plants do as yet retaine the names of certaine Greekes and Romans, who being strangers in divers countries, for their common-wealth's service, have from thence indowed their own countree with many plants, whereof there was no knowledge before.
Some call it the herbe of Queen mother, because the said ambassador Lord Nicot did first send the same unto the Queen mother, [28] as you shall understand by and by and for being afterwards by her given to divers others to plant and make to grow in this country. Others call it by the name of the herbe of the great Prior, because the said Lord a while after sailing into these western seas, and happening to lodge neere unto the said Lord ambassador of Lisbone, gathered divers plants thereof out of his garden, and set them to increase here in France, and there in greater quantitie, and with p.
From this time forward this herbe began to become famous in Lisbon, where the king of Portiugal's court was at that time, and the vertues thereof much spoken of, and the common people began to call it the ambassador's herbe. Now upon this occasion there came certain days after, a p.
After this yet the herbe grewe still in greater reputation, inasmuch as that many hasted out of all corners to get some of this herbe. And among the rest, there was one woman which had a great ring worme, covering all her face like a mask, and having taken deepe roote, to whom the said Lord caused this Petum to be given, and withall the manner of using it to be told her, and at the end of eight or ten daies, this woman being thoroughly cured, came to shewe herself unto the said Lord, and how that she was cured.
There came likewise a captain bringing with him his son diseased with the king's evill, unto the said Lord Ambassador, for to send him into France, upon whom there was some triall made of the said herbe, whereupon within four daies he began to show great signs and tokens of healing, and in the end was thoroughly cured of his king's evil.
Italy received the first plant from Santa Croce, [29] who, like Nicot, obtained the seed in Lisbon. In first appeared a figure of the plant in Andre Theret's "Cosmographie," which was but an imperfect representation of the plant.
It was supposed by many on its discovery to grow like the engraving given—in form resembling a tree or shrub rather than an herb. One account of its introduction into England is as follows:. To deprive it of its acidity, some of the natives were wont to pass the smoke through bulbs containing water, in which aromatic and medicinal herbs had been infused.
Neander ascribes this invention to the Persians; but Magnenus rather attributes it to the Dutch and English, to the latter of whom attaches the credit of having invented the clay pipes of modern times. Some writers have concluded that the plant served as a narcotic in some parts of Asia. Liebault thinks it was known in Europe [32] many years before the discovery of the New World, and asserts that the plant had been found in the Ardennes.
Magnenus, however, claims its origin as transatlantic and affirms as his belief that the winds had doubtless carried the seeds from one continent to the other. Pallos says that among the Chinese, and among the Mongol tribes who had the most intercourse with them, the custom of smoking is so general, so frequent, and has become so indispensable a luxury; the tobacco purse affixed to their belt so necessary an article of dress; the form of the pipes, from which the Dutch seem to have taken the p.
Meyen also states that the consumption of tobacco in the Chinese empire is of immense extent, and the practice seems to be of great antiquity, "for on very old sculptures I have observed the very same tobacco pipes which are still used. How shall those empty brains be filled but with air, Nature's immediate instrument to that purpose?
If with air, what so proper as your fume; what fume so healthful as your perfume, what perfume so sovereign as tobacco. Besides the excellent edge it gives a man's wit, as they but judge that have been present at a feast of tobacco, where commonly all good wits are consoled; what variety of discourse it begets, what sparks of wit it yields?
The name of Sir Walter is intimately connected with the history of tobacco, and is associated with many of the brilliant exploits and explorations during the reign of the illustrious Elizabeth.
Dixon has given us the following vivid picture of the great Elizabethan navigator:. That splendid Durham House, in which the nine-days queen had been married to Guilford Dudley, and which had afterwards been the town-house of Elizabeth, belonged to Sir Walter Raleigh, by whom it was held on leave from the queen. Raleigh, a friend of William Shakespeare and the players, was also a friend of Francis Bacon and the philosophers. Raleigh is said to have founded the Mermaid Club; and it is certain that he numbered friends among the poets and players.
The proofs of his having known Shakespeare, though indirect, are strong. Of his long intercourse with Bacon every one is aware. Thus it requires no effort of the fancy to picture these three men as lounging in a window of Durham House, puffing the new Indian weed from silver bowls, discussing the highest themes in poetry and science, while gazing on the flower-beds and the river, the darting barges of dames and cavalier, and the distant pavilions of Paris Garden and the Globe. Its use by so distinguished a person as Raleigh was equivalent to its general introduction.
In our part—Malmsbury Hundred—it came p. They had first silver pipes. The ordinary sort made use of a walnut shell and a strawe. I have heard my grandfather Lyte say that one pipe was handed from man to man round the table. Sir Walter Raleigh standing in a stand at Sir Ro. Poyntz parke at Acton tooke a pipe of tobacco, which made the ladies quitte it till he had donne.
A writer has truthfully said in regard to associating the name and use of the plant with the primitive users of it. Kings now rushed into the tobacco trade. Those of Spain took the lead, and became the largest manufacturers of snuff p.
Other monarchs monopolized the business in their dominions, and all began to reap enormous profits from it, as most do at this day. In the year tobacco was first planted in Holland; and in Switzerland in As soon as its cultivation became general in Spain and Portugal the tobacco trade was "farmed out," bringing an enormous revenue to those kingdoms.
About the beginning of the Seventeenth Century the Portuguese introduced into Hindostan and Persia [37] two things, pine-apples and tobacco. To the pine-apples no objection seems to have been made; but to the tobacco the most strenuous resistance was offered by the sovereigns of the two countries. Spite, however, of punishments and prohibitions the use of tobacco spread with the rapidity of lightning. In England, tobacco taking soon became a favorite custom not only with the loiterers about taverns and other public places, but among the courtiers of Elizabeth.
Smoking was called drinking tobacco, as the fashionable method was to "put it through the nose" or exhale it through the nostrils. At this period tobacco seemed to have nearly the same effect as it did upon the Indian, producing a sort of intoxication; thus in "The Perfuming of Tobacco" it is said:. The term "drinking tobacco" was not confined to England, but was used in Holland, France, Spain and Portugal, as the same method of blowing the smoke through the nostrils, seemed to be everywhere in vogue.
The use of tobacco increased very rapidly soon after its importation from Virginia. The Spaniards and Portuguese had hitherto monopolized the trade, so that it brought enormous prices, some kinds selling for its weight in silver. As soon as its culture commenced in Virginia the demand for West India tobacco lessened and Virginia leaf soon came p.
It had now become a prime favorite and was used by nearly all classes. Poets and dramatists sung its praises, while others wrote of its wonderful medicinal qualities. To wear a pair of velvet breeches, with panes or slashes of silk, an enormous starched ruff, a gilt handled sword, and a Spanish dagger; to play at cards or dice in the chambers of the groom-porter, and smoke tobacco in the tilt-yard or at the play-house, were then the grand characteristics of a man of fashion.
Powell, as sometimes raising himself Applause from the ill Taste of an Audience; I must do him the Justice to own, that he is excellently formed for a Tragoedian, and, when he pleases, deserves the Admiration of the best Judges; as I doubt not but he will in the Conquest of Mexico, which is acted for his own Benefit To-morrow Night.
She is also well-skilled in the Drapery-part, and puts on Hoods and mixes Ribbons so as to suit the Colours of the Face with great Art and Success. This Day is publish'd An Essay on Criticism. Printed for W.
Osborn, in Gray's Inn near the Walks; T. 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. Genetic and environmental influences on migraine: a twin study across six countries. Twin Res. Pain and emotion: a biopsychological review of recent research. J Clin Psychol ; 67 9 : Attachment styles in children affected by migraine without aura. Neuropsychiatr Dis Treat. Behavioural problems in children with headache and maternal stress: is children's attachment security a protective factor?
Dev ; DOI: 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 [1]. 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 [4].
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 [1]. However, while the most recent ICHD criteria improved the possibility to classify some patients, such as children with migraine with aura [2], 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 [4]. 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 [5]. 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 [4].
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 [5]. 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 [7].
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 [9].
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 [3] and central sensitization[4], 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[4]. 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[5].
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 [3]. 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 [2]. 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 [2].
A recent meta-analysis pointed out that migraine is associated with increased ischemic stroke risk [3], and according to a systematic review and meta-analysis [4] 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 [5]. A recent systematic review and meta-analysis also describes an increased risk of myocardial infarction and angina in migraineurs compared to non-migraineurs [6].
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 [7] 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 [8] 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 [9]. It is noteworthy that, according to a review, TTH is associated with increased rate of affective distress [9]. Furthermore, some medical disorders may worsen a preexisting TTH, and it has been described the comorbidity of TTH with psychiatric disorders and fibromyalgia [10].
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 [5]. Moreover, recent knowledge suggests that different clinical headache phenotypes arising from a common pathophysiology rather than an independent disorder [6].
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 [1]. 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 [2]. 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 [3].
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 [4].
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 [1].
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.
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