Impulse control disorders (ICDs) encompass a wide spectrum of abnormal behaviour frequently found in cases of Parkinson's disease (PD) treated with dopamine agonists (DAs). The main aim of this study was to analyse ICD prevalence with different DAs. We carried out a multicentre transversal study to evaluate the presence of ICDs in patients with PD chronically treated (>6 months) with a single non-ergolinic DA (pramipexole, ropinirole, or rotigotine). Clinical assessment of ICD was performed using the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's disease. Thirty-nine per cent of patients (91/233) fulfilled the clinical criteria for ICD. The group of patients with ICD symptoms (ICD+) differed from those without ICD symptoms (ICD-) in younger age and type of DA intake. Oral DA treatment (pramipexole and ropinirole) was associated with higher risk of ICDs compared with transdermal DA (rotigotine): 84/197 (42%) patients treated with oral DA developed ICD, versus 7/36 (19%) patients treated with transdermal DA (Fisher's exact text <0.01). In univariate analysis, a younger age (p<0.01), treatment with rasagiline (p<0.05), and especially treatment with an oral DA (pramipexole or ropinirole) (p<0.01) were significantly associated with ICD. Multivariate analysis confirmed that oral DA remained significantly associated with ICD (p: 0.014, OR: 3.14; 1.26-7.83). ICD was significantly associated with the use of the non-ergolinic oral DA (pramipexole and ropinirole) when compared with transdermal non-ergolinic DA (rotigotine). Since pramipexole, ropinirole and rotigotine are non-ergolinic DAs with very similar pharmacodynamic profiles, it is likely that other factors including route of administration (transdermal vs oral) explain the difference in risk of ICD development.

Parkinson's disease (PD) is a degenerative neurological disease presenting with motor and non-motor signs and symptoms. Approximately 30-50% of the patients experience pain. There is no consensus regarding the mechanisms and classification of pain in PD. This paper reviews current data on the possible mechanisms, classifications, evaluation and potential risk factors for pain in PD. Literature searches were performed to identify clinical trials and reviews covering patho-physiology, classification, type, evaluation and risk factors associated with pain in PD. Pain in PD could be related to pathologic changes in the anatomic structures involved in nociceptive mechanisms. Studies on pain mechanisms have been mostly conducted in animals. The mechanism of pain is complicated and influenced by different factors. There are several methodological differences between the studies trying to classify pain and to characterize its subtypes. Potential risk factors for pain in PD include: age, gender, and duration of the disease. Although pain is one of the non-motor symptoms most frequency experienced by patients, it is often under recognized and inadequately treated in contrast to motor symptoms Multicenter studies are needed that include a large cohort of subjects evaluated in multiple dimensions including pain in order to obtain more data and to allow improved management of pain in patients with PD.

Numular headache is a chronic, mild to moderate, pressurelike pain in a circumscribed cranial area of approximately 2 to 6 cm in diameter. Pain usually is limited to the parietal region, although it may appear in any cranial site. It is a benign process of usually unknown origin.