Headache

August 2018, Volume 24, Issue 4
BROWSE ISSUES

Headache

August 2018, Vol.24, No.4

Guest Editor:

Peter J. Goadsby, MD, PhD

Editor-in-Chief:

STEVEN L. LEWIS, MD, FAAN

ISSN: 1080-2371

Online ISSN: 1538-6899

REVIEW ARTICLES
The Migraine Premonitory Phase
Karsan, Nazia; Bose, Pyari; Goadsby, Peter J.
CONTINUUM: Lifelong Learning in Neurology
August 2018 - Volume 24 - Issue 4, Headache - p 996-1008
doi: 10.1212/CON.0000000000000624
The Migraine Aura
Charles, Andrew
CONTINUUM: Lifelong Learning in Neurology
August 2018 - Volume 24 - Issue 4, Headache - p 1009-1022
doi: 10.1212/CON.0000000000000627
The Migraine Postdrome
Bose, Pyari; Karsan, Nazia; Goadsby, Peter J.
CONTINUUM: Lifelong Learning in Neurology
August 2018 - Volume 24 - Issue 4, Headache - p 1023-1031
doi: 10.1212/CON.0000000000000626
Acute Treatment of Migraine
Vargas, Bert B.
CONTINUUM: Lifelong Learning in Neurology
August 2018 - Volume 24 - Issue 4, Headache - p 1032-1051
doi: 10.1212/CON.0000000000000639
Preventive Therapy of Migraine
Schwedt, Todd J.
CONTINUUM: Lifelong Learning in Neurology
August 2018 - Volume 24 - Issue 4, Headache - p 1052-1065
doi: 10.1212/CON.0000000000000635
Headaches Due to Low and High Intracranial Pressure
Friedman, Deborah I.
CONTINUUM: Lifelong Learning in Neurology
August 2018 - Volume 24 - Issue 4, Headache - p 1066-1091
doi: 10.1212/CON.0000000000000623
Headache in Pregnancy
Robbins, Matthew S.
CONTINUUM: Lifelong Learning in Neurology
August 2018 - Volume 24 - Issue 4, Headache - p 1092-1107
doi: 10.1212/CON.0000000000000642
Pediatric and Adolescent Headache
Gelfand, Amy A.
CONTINUUM: Lifelong Learning in Neurology
August 2018 - Volume 24 - Issue 4, Headache - p 1108-1136
doi: 10.1212/CON.0000000000000638
Cluster Headache and Other Trigeminal Autonomic Cephalalgias
Burish, Mark
CONTINUUM: Lifelong Learning in Neurology
August 2018 - Volume 24 - Issue 4, Headache - p 1137-1156
doi: 10.1212/CON.0000000000000625
Cranial Neuralgias
Tepper, Stewart J.
CONTINUUM: Lifelong Learning in Neurology
August 2018 - Volume 24 - Issue 4, Headache - p 1157-1178
doi: 10.1212/CON.0000000000000637
Secondary Headache Syndromes
Chou, Denise E.
CONTINUUM: Lifelong Learning in Neurology
August 2018 - Volume 24 - Issue 4, Headache - p 1179-1191
doi: 10.1212/CON.0000000000000640
Unusual Headache Disorders
Starling, Amaal Jilani
CONTINUUM: Lifelong Learning in Neurology
August 2018 - Volume 24 - Issue 4, Headache - p 1192-1208
doi: 10.1212/CON.0000000000000636
Editor's Preface
Articles
Key Points
Abbreviations
Appendix
Issue Overview

Issue Overview

CONTINUUM: Lifelong Learning in Neurology August 2018 - Volume 24 - Issue 4, Headache -10.1212/01.CON.0000544427.02522.56 doi: 10.1212/01.CON.0000544427.02522.56

Issue Overview

Headache, Volume 24, Issue 4, August 2018

Continuum: Lifelong Learning in Neurology® is designed to help practicing neurologists stay abreast of advances in the field while simultaneously developing lifelong self-directed learning skills.

Learning Objectives

Upon completion of this Continuum: Lifelong Learning in Neurology Headache issue, participants will be able to:

  • Review the phenotype and possible neurobiological basis for premonitory symptoms of migraine, and recognize the importance of asking patients about these symptoms
  • Apply current knowledge regarding migraine aura to clinical practice
  • Recognize the key symptoms and salient features of the migraine postdrome
  • Formulate an evidence-based, individualized, acute treatment plan for patients with migraine
  • Discuss the indications and options for preventive therapy of migraine
  • Recognize typical and atypical clinical features of spontaneous intracranial hypotension and the pseudotumor cerebri syndrome
  • Discuss the symptoms, signs, risks, and management of headache disorders that present in pregnant and postpartum women
  • Differentiate secondary from primary headache disorders in children and adolescents, diagnose the common primary headache disorders that present clinically in this age group, and apply evidence-based treatment strategies for headache in children and adolescents
  • Diagnose and treat the trigeminal autonomic cephalalgias
  • Discuss the clinical features, diagnostic criteria, pathophysiology, and treatment strategies of cranial neuralgias
  • Recognize the clinical features of secondary headache syndromes and evaluate their underlying causes
  • Discuss the epidemiology, clinical features, differential diagnosis, recommended workup, and treatment for less commonly discussed unusual headache disorders
  • Review the legal issues a physician must consider when moving to a new medical practice

Core Competencies

This Continuum: Lifelong Learning in Neurology Headache issue covers the following core competencies:

  • Patient Care
  • Medical Knowledge
  • Practice-Based Learning and Improvement
  • Interpersonal and Communication Skills
  • Professionalism
  • Systems-Based Practice

Contributors

Peter J. Goadsby, MD, PhD, Guest Editor

Director, National Institute for Health Research and Wellcome Trust King’s Clinical Research

Facility; Professor of Neurology, King’s College London, London, United Kingdom

Relationship Disclosure: Dr Goadsby has received personal compensation for consulting, speaking engagements, and serving on the scientific advisory boards of Alder BioPharmaceuticals, Inc; Allergan; Amgen Inc; Autonomic Technologies, Inc; Dr. Reddy’s Laboratories Ltd; ElectroCore, LLC; Eli Lilly and Company; eNeura Inc; Novartis AG; Scion Pharmaceuticals, Inc; Teva Pharmaceutical Industries Ltd; and Trigemina, Inc. Dr Goadsby has received personal compensation as an editor for MedicoLegal Investigations Ltd; NEJM Journal Watch; UpToDate, Inc; and Wolters Kluwer and receives royalties from Oxford University Press. Dr Goadsby has received grants from Amgen Inc and Eli Lilly and Company. Dr Goadsby holds a patent on magnetic stimulation for headache with eNeura Inc without fee.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Goadsby reports no disclosure.

Pyari Bose, MD, MRCP

Neurologist, Headache Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology, and Neuroscience; National Institute for Health Research and Wellcome Trust King’s Clinical Research Facility, King’s College London, London, United Kingdom

Relationship Disclosure: Dr Bose has received personal compensation as a speaker for Teva Pharmaceutical Industries Ltd and has received research/grant funding from The Migraine Trust Clinical Training Fellowship.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Bose reports no disclosure.

Mark Burish, MD, PhD

Assistant Professor, Department of Neurosurgery; Director, Will Erwin Headache Research Center, University of Texas Health Science Center at Houston, Houston, Texas

Relationship Disclosure: Dr Burish has received personal compensation for serving as a lecturer for the Midwest Pain Society and the North American Neuromodulation Society and has received research/grant support from the American Headache Society, the National Headache Foundation, and the Will Erwin Headache Research Foundation.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Burish discusses the unlabeled/investigational use of baclofen, corticosteroids, deep brain stimulation, lithium, occipital nerve stimulation, oxygen, sphenopalatine ganglion stimulation, sumatriptan, topiramate, valproate, verapamil, and zolmitriptan for the treatment of cluster headache; indomethacin, topiramate, and verapamil for the treatment of paroxysmal hemicrania; carbamazepine, duloxetine, gabapentin, lamotrigine, lidocaine, oxcarbazepine, and topiramate for the treatment of short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing; and celecoxib, gabapentin, ibuprofen, indomethacin, melatonin, occipital nerve stimulation, onabotulinum toxin injections, topiramate, and verapamil for the treatment of hemicrania continua.

Andrew Charles, MD

Professor of Neurology, Meyer and Renee Luskin Chair in Migraine and Headache Studies; Director, University of California Los Angeles Goldberg Migraine Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California

Relationship Disclosure: Dr Charles receives personal compensation for serving on the advisory boards of Alder BioPharmaceuticals, Inc; Biohaven Pharmaceutical; Eli Lilly and Company; and eNeura Inc. Dr Charles receives personal compensation for serving as associate editor of Cephalalgia; as CME program speaker of Medicom and Medlearning Group; and as a consultant for Amgen Inc. Dr Charles has served as an expert witness in legal proceedings for Milano & Wanat LLC.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Charles discusses the unlabeled/investigational use of ketamine for the treatment for migraine aura.

Denise E. Chou, MD

Global Medical Director, Neuroscience, Amgen Inc, Thousand Oaks, California

Relationship Disclosure: Dr Chou has received personal compensation for serving on the advisory boards of Allergan, Amgen Inc, Eli Lilly and Company, Pernix Therapeutics, and Teva Pharmaceutical Industries Ltd; as a speaker for the American Academy of Neurology, Medscape Inc, and the PeerView Institute; and has received research/grant support as a principal investigator for Alder BioPharmaceuticals, Inc; Capnia, Inc; CEFALY Technology; and Teva Pharmaceutical Industries Ltd. Dr Chou is an employee of Amgen Inc.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Chou discusses the unlabeled/investigational use of glucocorticoids for the treatment of giant cell arteritis and Tolosa-Hunt syndrome, indomethacin for the treatment of hemicrania continua, and nonsteroidal anti-inflammatory drugs and oral or locally injected steroids for the treatment of primary trochlear headache (trochleitis).

Deborah I. Friedman, MD, MPH, FAAN

Professor, Department of Neurology and Neurotherapeutics, Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas

Relationship Disclosure: Dr Friedman has received personal compensation for serving on the advisory boards of Alder BioPharmaceuticals, Inc; Amgen Inc; Avanir Pharmaceuticals, Inc; Biohaven Pharmaceutical; ElectroCore, LLC; Supernus Pharmaceuticals, Inc; Teva Pharmaceutical Industries Ltd; and Zosano Pharma Corporation. Dr Friedman has received personal compensation for serving on the board of directors of the American Headache

Society, as a contributing author for MedLink Neurology, and on the editorial board of Neurology Reviews. Dr Friedman has received personal compensation as a consultant for Avanir Pharmaceuticals, Inc; Biohaven Pharmaceutical; ElectroCore, LLC; Eli Lilly and Company; Promius Pharma, LLC; and Teva Pharmaceutical Industries Ltd and as a speaker for Allergan; Amgen Inc; Avanir Pharmaceuticals, Inc; ElectroCore, LLC; Supernus Pharmaceuticals, Inc; and Teva Pharmaceutical Industries Ltd. Dr Friedman has received research/grant support from Autonomic Technologies, Inc; Axon Optics; Eli Lilly and Company; Merck & Co, Inc; and Zosano Pharma Corporation. Dr Friedman has served as an expert witness in legal cases involving idiopathic intracranial hypertension.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Friedman discusses the unlabeled/investigational use of acetazolamide for the treatment of pseudotumor cerebri syndrome, the use of gadolinium for MRI myelography for the diagnosis of spontaneous intracranial hypotension, and the use of zonisamide for the treatment of associated headache.

Amy A. Gelfand, MD

Director of Pediatric Headache, Assistant Professor of Neurology and Pediatrics, University of California San Francisco, San Francisco, California

Relationship Disclosure: Dr Gelfand has received personal compensation for serving on the medical advisory board of eNeura Inc; as associate editor for JAMA Neurology; and as a consultant for Biohaven Pharmaceutical, Eli Lilly and Company, and Zosano Pharma Corporation. Dr Gelfand has received research/grant support from eNeura Inc, the Migraine Research Foundation, the National Institutes of Health/National Center for Advancing Translational Sciences, and the University of California San Francisco Weill Institute for the Neurosciences. Dr Gelfand has received publishing royalties from UpToDate, Inc and has received compensation as a legal consultant.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Gelfand discusses the unlabeled/investigational use of all listed medications for the treatment of headache in children and adolescents, with the exceptions of almotriptan oral tablets, sumatriptan/naproxen combination tablets, and zolmitriptan nasal spray for adolescents 12 to 17 years of age for the treatment of acute migraine as well as topiramate in adolescents 12 to 17 years of age for migraine prevention. Rizatriptan is labeled for acute migraine treatment in children age 6 and older.

Nazia Karsan, MBBS, MRCP

Neurology Fellow, Headache Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology, and Neuroscience; National Institute for Health Research and Wellcome Trust King’s Clinical Research Facility, King’s College London, London, United Kingdom

Relationship Disclosure: Dr Karsan has received personal compensation for serving as a speaker for Teva Pharmaceutical Industries Ltd and has received research/grant funding from the Association of British Neurologists/Guarantors of Brain Clinical Research Training Fellowship.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Karsan reports no disclosure.

Joseph S. Kass, MD, JD, FAAN

Associate Dean, Office of Student Affairs; Professor of Neurology, Psychiatry, and Medical Ethics; Director, Alzheimer’s Disease and Memory Disorders Center, Baylor College of Medicine; Chief of Neurology, Ben Taub General Hospital, Houston, Texas

Relationship Disclosure: Dr Kass serves as associate editor of ethical and medicolegal issues for Continuum, as an associate editor for Continuum Audio, as a neurology section editor of Ferri’s Clinical Advisor for Elsevier, and as co-editor of Neurology Secrets, Sixth Edition. Dr Kass has received personal compensation for CME lectures from Pri-Med Medical Group and has received personal compensation as a medicolegal consultant in legal cases involving criminal cases, malpractice, and personal injury.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Kass reports no disclosure.

Matthew S. Robbins, MD, FAAN, FAHS

Associate Professor of Neurology, Albert Einstein College of Medicine; Chief of Neurology, Jack D. Weiler Hospital; Director of Inpatient Services, Montefiore Headache Center; Associate Program Director, Neurology Residency, Montefiore Medical Center, Bronx, New York

Relationship Disclosure: Dr Robbins has received personal compensation for serving as a section editor for Current Pain and Headache Reports and serves (without compensation) on the board of directors and as a member-at-large of the American Headache Society and as associate editor of Headache: The Journal of Head and Face Pain. Dr Robbins has received book royalties from John Wiley & Sons.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Robbins discusses the unlabeled/investigational use of medications and devices for the treatment of headache disorders in pregnant and breast-feeding women, including all analgesics, neuromodulation devices, preventive therapies, and triptans.

Rachel V. Rose, JD, MBA

Attorney, Rachel V. Rose Attorney at Law PLLC; Affiliated Faculty, Baylor College of Medicine, Houston, Texas

Relationship Disclosure: Ms Rose serves on the editorial board of BC Advantage.

Unlabeled Use of Products/Investigational Use Disclosure: Ms Rose reports no disclosure.

Todd J. Schwedt, MD, FAAN

Professor of Neurology, Mayo Clinic, Phoenix, Arizona

Relationship Disclosure: Dr Schwedt serves on the board of directors for the American Headache Society and the International Headache Society; receives personal compensation as associate editor for Cephalalgia, Headache, and Pain Medicine; and receives personal compensation as a consultant for Alder BioPharmaceuticals, Inc; Allergan; Amgen Inc; Autonomic Technologies, Inc; Avanir Pharmaceuticals, Inc; Dr. Reddy’s Laboratories Ltd; Eli Lilly and Company; Ipsen Bioscience, Inc; Nocira, LLC; Novartis AG; and Teva Pharmaceutical Industries Ltd. He has stock options in Aural Analytics; Nocira, LLC; and Second Opinion. Dr Schwedt has received research/grant support from the American Migraine Foundation, the National Institutes of Health, Patient-Centered Outcomes Research Institute, and the United States Department of Defense. Dr Schwedt has received publishing royalties from UpToDate, Inc.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Schwedt discusses the unlabeled/investigational use of numerous medications for the treatment of migraine; none of the therapies discussed are approved by the US Food and Drug Administration except for caloric vestibular stimulation, divalproex sodium, erenumab, propranolol, timolol, topiramate, transcranial magnetic stimulation, and transcutaneous supraorbital nerve stimulation for the treatment of migraine and the use of onabotulinumtoxinA for the treatment of chronic migraine.

Amaal Jilani Starling, MD, FAHS

Assistant Professor of Neurology, Mayo Clinic, Scottsdale, Arizona

Relationship Disclosure: Dr Starling has received personal compensation for serving on the medical advisory boards of Alder BioPharmaceuticals, Inc; Amgen Inc; Eli Lilly and Company; and eNeura Inc and as a consultant for Amgen Inc and Eli Lilly and Company. Dr Starling receives research/grant support from Mayo Clinic and the Migraine Research Foundation.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Starling discusses the unlabeled/investigational use of acetazolamide, beta-blockers including nadolol and propranolol, caffeine, celecoxib, clomipramine, clonazepam, cyclobenzaprine, ergotamine, flunarizine, gabapentin, indomethacin, lithium, melatonin, nifedipine, nonsteroidal anti-inflammatory drugs, onabotulinumtoxinA, topiramate, and tricyclic antidepressants including amitriptyline for the treatment of unusual headache disorders.

Stewart J. Tepper, MD, FAHS

Professor of Neurology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire

Relationship Disclosure: Dr Tepper has received personal compensation as editor-in-chief of the American Headache Society journal Headache Currents and has received personal compensation as a lecturer for CME. Dr Tepper has received personal compensation as a consultant for Acorda Therapeutics; Alder BioPharmaceuticals, Inc; Allergan; Amgen Inc; Autonomic Technologies, Inc; CEFALY Technology; Charleston Laboratories, Inc; DeepBench; Dr. Reddy’s Laboratories Ltd; ElectroCore, LLC; Eli Lilly and Company; eNeura Inc; Gerson Lehrman Group, Inc; Guidepoint Global, LLC; Impax; Neurolief Ltd; Novartis AG; Pfizer Inc; Scion NeuroStim LLC; Slingshot Insights; Supernus Pharmaceuticals, Inc; Teva Pharmaceutical Industries Ltd; and Zosano Pharma Corporation. Dr Tepper receives research/grant support paid to his employer (no personal compensation) from Alder BioPharmaceuticals, Inc; Allergan; Amgen Inc; Autonomic Technologies, Inc; Avanir Pharmaceuticals, Inc; Dr. Reddy’s Laboratories Ltd; ElectroCore, LLC; eNeura Inc; Scion NeuroStim LLC; Teva Pharmaceutical Industries Ltd; and Zosano Pharma Corporation. Dr Tepper has stock options from Autonomic Technologies, Inc and receives royalties from Springer.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Tepper discusses the unlabeled/investigational use of all listed medications for the treatment of neuralgias.

Bert B. Vargas, MD, FAAN, FAHS

Associate Professor, University of Texas Southwestern Medical Center, Dallas, Texas

Relationship Disclosure: Dr Vargas has received personal compensation for serving on the advisory boards of Alder BioPharmaceuticals, Inc; Allergan; Amgen Inc; Avanir Pharmaceuticals, Inc; Eli Lilly and Company; Pernix Therapeutics; Teva Pharmaceutical Industries Ltd; and Upsher-Smith Laboratories, LLC; for serving on the speaker’s bureau of Amgen Inc and Avanir Pharmaceuticals, Inc; and has received travel compensation as an editor for Neurology Today.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Vargas discusses the unlabeled/investigational use acetaminophen, acetylsalicylic acid, dexketoprofen, diclofenac, dipyrone, droperidol, haloperidol, ibuprofen, ketorolac, lasmiditan, metoclopramide, naproxen, peripheral nerve block, prochlorperazine, and valproate for the acute treatment of migraine.

Self-Assessment and CME Test Writers

D. Joanne Lynn, MD, FAAN

Associate Dean for Student Life, Clinical Professor of Neurology, The Ohio State University College of Medicine, Columbus, Ohio

Relationship Disclosure: Dr Lynn receives book royalties from Lippincott Williams & Wilkins and holds stock in Abbott Laboratories; AbbVie Inc; Amgen Inc; Bristol-Myers Squibb Company; CVS Health Corporation; Express Scripts Holding Company; General Electric; Merck & Co, Inc; and Zimmer Biomet.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Lynn reports no disclosure.

Allison L. Weathers, MD, FAAN

Associate Chief Medical Information Officer, Cleveland Clinic; Assistant Professor, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio

Relationship Disclosure: Dr Weathers serves on the editorial board of Continuum and as chair of the adult neurosciences specialty steering board for Epic.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Weathers reports no disclosure.

Methods of Participation and Instructions for Use

Continuum: Lifelong Learning in Neurology® is designed to help practicing neurologists stay abreast of advances in the field while simultaneously developing lifelong self-directed learning skills. In Continuum, the process of absorbing, integrating, and applying the material presented is as important as, if not more important than, the material itself.

The goals of Continuum include disseminating up-to-date information to the practicing neurologist in a lively, interactive format; fostering self-assessment and lifelong study skills; encouraging critical thinking; and, in the final analysis, strengthening and improving patient care.

Each Continuum issue is prepared by distinguished authors who are acknowledged leaders in their respective fields. Six issues are published annually and are composed of review articles, case-based discussions on ethical and practice issues related to the issue topic, coding information, and comprehensive continuing medical education (CME) and self-assessment offerings. For detailed instructions regarding Continuum CME and self-assessment activities, visit continpub.com/CME.

The review articles emphasize clinical issues emerging in the field in recent years. Case reports and vignettes are used liberally, as are tables and illustrations. Audio interviews with the authors of Continuum articles are published alongside each article, and video material relating to the issue topic accompanies issues when applicable.

The text can be reviewed and digested most effectively by establishing a regular schedule of study in the office or at home, either alone or in an interactive group. If subscribers use such regular and perhaps new study habits, Continuum’s goal of establishing lifelong learning patterns can be met.

© 2018 American Academy of Neurology.