Dr Dodick has created a wonderfully organized and thorough set of topics and enlisted the most expert authors to shine their knowledge and expertise on us as we diagnose and manage our many patients with headache disorders.
Diagnosis and management of headache disorders, whether acute or chronic, primary or secondary, are ubiquitous aspects of neurologic practice. For this issue of CONTINUUM, Guest Editor Dr David W. Dodick from the Mayo Clinic, Phoenix, Arizona, has created a wonderfully organized and extremely thorough set of topics and enlisted the most expert authors to shine their knowledge and expertise on us as we diagnose and manage our many patients with headache disorders.
The issue begins with a practical and state-of-the-art review of acute migraine treatment by Dr Werner J. Becker, followed by an equally practical and state-of-the-art review of preventive migraine treatment by Dr Stephen D. Silberstein. In addition to providing their thoughtful approaches, each of these authors also provides clear and well-organized tables that will be helpful at the point of care as we manage our patients with acute and chronic headaches. Next, Dr E. Anne MacGregor gives us the great benefit of her expertise and experience to assist us in our management of women with migraine during menstruation and menopause. Dr Todd D. Rozen then provides a thorough and practical review of the emergency department and inpatient management of patients with status migrainosus and intractable headache, an article (and tables) that I suspect many of us will be pulling up often as we manage our patients in these settings.
Dr Stewart J. Tepper provides us with a thorough and up-to-date discussion of the current evidence base for the role (including potential benefits and risks) of nutraceutical treatment and behavioral approaches for headache. Dr Peter J. Goadsby then reviews the current diagnostic criteria and management of several unique migraine subtypes, such as migraine with brainstem aura and hemiplegic migraine, and also discusses uncommon and intriguing conditions that we will all encounter (and diagnose if we are aware of them), specifically hypnic headache and the exploding head syndrome. Dr Lawrence C. Newman next informs us about current diagnostic criteria and specific management strategies for each of the trigeminal autonomic cephalalgias, providing clarity with regard to recognizing and distinguishing these uncommon but severe and treatable entities.
Dr Todd J. Schwedt reviews the diagnosis and management of the various etiologies of thunderclap headache, a critically important clinical presentation to recognize given the potential life-threatening causes that must be diagnosed or excluded via an emergent, comprehensive, and thoughtful evaluation. Next, Dr William P. Cheshire Jr. discusses the current approach to diagnosis and management of severe facial and head pain that occurs due to the various cranial neuralgias, including trigeminal neuralgia, glossopharyngeal neuralgia, occipital neuralgia, postherpetic neuralgia, and others. Dr Bahram Mokri then imparts his current analysis of the evolving concept of spontaneous intracranial hypotension and provides his expert recommendations to inform us on how to approach the diagnosis and management of our patients with this important and complex syndrome. Dr Deborah I. Friedman then clearly and concisely reviews the diagnostic and management approach to disorders that can present with eye pain and headache, such as ocular and periorbital processes, giant cell arteritis, and primary neurologic disorders such as cervical artery dissections.
Dr Richard B. Lipton next reviews the risk factors and management of medication-overuse headache and chronic migraine, complicated problems requiring the kind of comprehensive and well-informed approach to management that he so clearly provides. In the final review article of the issue, Dr Andrew D. Hershey reviews the current state of the art in management of pediatric headache, carefully outlining the distinctions in clinical presentation, diagnosis, and therapy in children as compared to adults.
In this issue’s Ethical Perspectives article, Drs Michael A. Rubin and Deborah I. Friedman present the case of a patient presenting to an emergency department with headache due to a likely misdiagnosed subarachnoid hemorrhage, providing a springboard to their discussion of the ethics and nuances of disclosing another physician’s medical error. In this issue’s Practice Issues article, Drs Elliott A. Schulman and Kathleen Franchek-Roa discuss the importance of screening patients with headaches for abuse and review the evidence supporting this important recommendation. Next, Drs M. Cristina Victorio and Bruce H. Cohen review the many considerations involved in coding for the various encounters and procedures that can arise in the context of caring for patients with headache.
As with every issue of CONTINUUM, a number of opportunities exist for CME. By taking the Postreading Self-Assessment and CME Test, carefully crafted by Drs James Owens and Joseph E. Safdieh, after reading the issue, you may earn up to 12 AMA PRA Category 1 Credits™ toward self-assessment and CME. The Patient Management Problem, skillfully written by Dr Stephanie J. Nahas, follows the case of a 38-year-old woman who initially presents to the office in consultation for daily headaches. By following her case and answering multiple-choice questions corresponding to diagnostic and management decision points along the course of her evolving disorder, you will have the opportunity to earn up to 2 AMA PRA Category 1 CME Credits.
I am indebted to Dr Dodick for his tireless work in creating this wonderful volume and for bringing together such expert faculty, who have provided these stimulating discussions to inform our management of the many patients with headache syndromes we encounter daily as neurologists, whether in the office, emergency department, or hospital.
—Steven L. Lewis, MD, FAAN