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Headache is the most common cause of referral to neurologists. You would find this difficult to believe on reading most neurological journals—an observation that has been recently quantified.1 However, there have been exciting advances in headache in classification, diagnosis, pathophysiology, and treatment. This supplement aims to provide a practical perspective on this common and occasionally difficult problem.
The supplement starts with common presentations. The first two articles by Peter Goadsby and Christopher Boes tackle the two frequent presentations of chronic daily headache and new persistent daily headache. They demonstrate the benefits of approaching patients with this particular categorisation in mind. Next, Giles Elrington provides a pragmatic approach to the assessment and management of migraine. Cathy Sudlow reviews the sometimes difficult issue of when patients should be imaged by analysing the evidence based guidelines on imaging in non-acute headache.
Following considerations of the common presentations of headaches, Manjit Matharu and Peter Goadsby explore the developing field of trigeminal autonomic cephalagias. These are rarer syndromes that are likely to be referred to neurologists, who will need to recognise and treat these often disabling headache syndromes. Facial pain syndromes are not always neurological in origin. Joanna Zakrzewska provides the perspective from oral medicine on evaluating facial pain and discusses the evidence behind the management of these conditions. Headaches also present as emergencies where the differential diagnosis and management may be quite different. Richard Davenport discusses how to approach a patient with headache in the emergency room. Nicola Giffin explores where doctors and patients can access useful information about headache on the web. And finally, Donald Hadley provides descriptions with diagnostic imaging of some of the much rarer causes of “structural” headache.
Headache is a feature of a wide range of neurological diseases that are covered in other supplements. We have not included detailed discussion of the link of migraine with stroke or of the evolving understanding of rare conditions such as CADASIL or familial hemiplegic migraine, as these are covered elsewhere.
The mechanism and management of headache, 6th ed. Lance JW, Goadsby PJ. Butterworth-Heinemann, London 2000.
A useful overview of practical management of headache.
Effects of drug treatments of acute migraine headache. Morillo L. Neurological disorders. Migraine headache (search date May 2001). Clinical Evidence 2001; Issue 6.
This useful article reviews the methodology and results of RCTs of acute treatments including salicylates, NSAIDs, ergot derivatives and the many triptans.
Classification and diagnostic criteria for headache disorders, cranial neuralgias, and facial pain. Headache Classification Committee of the International Headache Society. Cephalalgia 1988;8(suppl 7):1–96.
The current standard classification of headache syndromes.
Guidelines for all doctors in the management of migraine and tension-type headache. Steiner TJ, MacGregor EA, Davies PTG. 2001. Available at: http://www.bash.org.uk.
British guidelines on the management of the most common headache syndromes from the British Association for the study of headache.
Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review). Silberstein SD. Neurology 2000;55:754–62.
Evidence-based guidelines in the primary care setting: neuroimaging in patients with nonacute headache. Frishberg BM, Rosenberg JH, Matchar DB, et al. Available at: http://www.aan.com/public/practiceguidelines