This issue of Continuum is devoted to the diagnosis and management of our patients with headache. We are truly privileged to have Dr Peter J. Goadsby as the guest editor of this issue, and I am so appreciative that he has brought together such a remarkable group of experts to share their headache expertise with us.
The issue begins with the article by Drs Nazia Karsan, Pyari Bose, and Peter J. Goadsby on the growing topic of the premonitory (prodromal) phase of migraine, the characteristic features of which may be clues to the pathogenesis, and ultimately new treatment strategies, of the disorder. The next phase of migraine is discussed in the article by Dr Andrew Charles, who reviews the unique pathophysiologic, diagnostic, and management issues relevant to the migraine aura. Next, Drs Bose, Karsan, and Goadsby discuss the migraine postdrome, the least recognized and understood component of the migraine attack, which can so affect the quality of life and productivity of our patients.
The following two articles tackle the very practical topic of treatment of our patients with migraine. Drs Bert B. Vargas and Todd J. Schwedt provide their vast clinical experience and knowledge of the evidence-based headache literature (including relevant society guidelines) to review, respectively, the acute and preventive therapy of migraine.
The issue then turns from migraine as a specific cause of headache and disability to other important causes of headache and to specific populations (ie, children or pregnant women) with their own diagnostic and management issues. Dr Deborah I. Friedman discusses the diagnosis and management of headache syndromes that occur due to either low or high intracranial pressure, an article that will be of great benefit to the care of these patients who present with headaches (and other symptoms and signs) due to either of these extremes of intracranial pressure.
Turning to specific populations, Dr Matthew S. Robbins reviews the diagnosis and management of the primary and secondary headache syndromes that can occur in pregnancy and the postpartum state, including discussion of the issues that arise regarding medications and breast-feeding. Dr Amy A. Gelfand then discusses the many diagnostic and management issues related to primary and secondary headache syndromes in pediatric and adolescent patients with headache.
Dr Mark Burish next focuses on the diagnostic criteria and management options for cluster headache and the other trigeminal autonomic cephalalgias to help us provide the most up-to-date and effective management options for these severe headache syndromes. Dr Stewart J. Tepper then discusses the diagnosis and current treatment options for the cranial neuralgias, including a very clear explanation of the current nomenclature that surrounds these syndromes.
Dr Denise E. Chou next focuses on the many causes of secondary headache syndromes that we may encounter in our practices, the diagnosis and management of which may help prevent devastating outcomes. In the final review article of the issue, Dr Amaal Jilani Starling discusses several unusual headache disorders (and even nonheadache disorders such as exploding head syndrome) that need to be on our diagnostic radar.
In the Ethical and Medicolegal Issues article, Dr Joseph S. Kass, associate editor of this section of Continuum, and Ms Rachel V. Rose provide a practical review of the common legal considerations readers should keep in mind when moving to a new neurologic practice, a topic of great interest to many, if not all, of our readers in the United States at some point(s) in their careers.
After reading the issue and taking the Postreading Self-Assessment and CME Test written by Drs D. Joanne Lynn and Allison L. Weathers, you may earn up to 20 AMA PRA Category 1 CreditsTM toward self-assessment and CME or, for Canadian participants, a maximum of 20 hours toward the Self-Assessment Program (Section 3) of the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada. Additional credit can be obtained by listening to Continuum Audio interviews associated with this and other Continuum issues, available to all subscribers, and completing tests on the new Continuum Audio web platform or app. Continuum Audio is also accredited by the Royal College of Physicians and Surgeons of Canada.
Finally, if you have not already done so, please check out our recently launched dynamic and more user-friendly website at ContinuumJournal.com. We hope you will find it easier to search for and locate content (and download, as needed) wherever you are, including at the point of care. We also hope you enjoy the even easier access to the Continuum Audio interviews that accompany each article. We look forward to your comments on the website, which can be sent to [email protected].
I would like to extend my deepest gratitude to Dr Goadsby for his stewardship of this issue from its conceptual, or “prodromal,” stage to its current stage, where the fruits of his and his expert colleagues’ work will be of great benefit in our practices as we diagnose and manage our many patients with primary and secondary headache syndromes.
STEVEN L. LEWIS, MD, FAAN