Migraine and Other Headache Disorders PDF

Preface

With this first edition of Migraine and Other Headache Disorders, we celebrate the remarkable progress in the art and science of headache during the last decade. With 32 chapters by 54 leaders in the field, the book provides health care professionals with practical approaches to patient care and reviews the scientific foundations of headache. We emphasize migraine because of its high prevalence, enormous burden, and the increasing availability of effective management strategies. At the same time, we provide broad coverage of all the primary headache disorders. Finally, although not focusing on specific subtypes of secondary headaches, we discuss strategies for diagnosing and excluding the ominous causes of headache, based both on clinical evaluation and, when appropriate, the use of diagnostic testing.

Our understanding of headache and the approach to treatment have been transformed by insights from many places. Based on the Second Edition of the International Classification of Headache Disorders, the book provides a series of diagnostic algorithms intended to simplify clinical practice. We also present up-to-date epidemiologic information on the primary headache disorders. Epidemiologic studies show that the overwhelming majority of headache sufferers who seek treatment in primary care settings have migraine. Diagnosis becomes more efficient when that fact is taken into account. Doctors should avoid oversimplifying the differential diagnosis of the primary headaches, however.

Our understanding of migraine as a disorder has significantly evolved over the past decade, based on genetic, epidemiologic, and translational studies. Once considered an episodic pain problem, treating the pain seemed like a sensible strategy. In the past few years, many lines of evidence have suggested that migraine and other headache disorders are best understood as chronic disorders with episodic manifestations. Painful episodes are the most prominent manifestation of migraine. Nonetheless, between attacks, there is an enduring predisposition to headache that characterizes the migraine brain. Furthermore, migraine is not only a chronic disorder with episodic manifestations, it is sometimes a disorder that progresses in several ways. Progression may be clinical, as attacks increase in frequency until chronic or transformed migraine develops. This clinical progression is sometimes accompanied by the development of allodynia with sensitization as its presumed substrate. In addition, in some individuals, morphological progression takes the form of deep white matter lesion or posterior circulation strokes that increase with migraine attack frequency, probably reflecting neuroplastic changes in the brain. Herein we highlight the emerging data on progression and on the modifiable risk factors for migraine progression.

Progress in treatment has also taken several forms. Since 1990, ten new acute treatments with a multiplicity of formulations and two preventive drugs have been approved. Many studies show that acute treatments work best if given early in the attack. Combining acute treatments may improve treatment response in some individuals. In addition, recent epidemiologic data shows that, based on frequency and disability criteria, preventive treatment should be offered or considered in about 40% of migraine sufferers. The same studies show that only 12% currently receive preventive therapy. Preventive treatment decreases attack frequency and severity and possibly prevents migraine progression. The use of specific acute agents that act on the neural pathways of migraine pain, such as the triptans, dramatically improve patient outcomes.

Migraine and Other Headache Disorders highlights the treatment approaches developed at some of the best headache clinics in the world. It also reflects many of the strategies adopted at The Montefiore Headache Center. The Montefiore Headache Center was the first headache specialty care center in the world, founded in 1945 by Dr. Arnold Friedman, and it is where we are both proud to be.

We are extremely grateful to our mentors. Among them, Dr. Lipton wants to thank Dr. Seymour Solomon, who directed The Montefiore Headache Center for a quarter of a century, for being a wonderful mentor and teacher. He'd also like to thank his mentors and collaborators in research, particularly Drs. Philip Holzman, W. Allen Hauser, and Walter F. Stewart. Dr. Bigal wants to acknowledge Drs. Speciali and Bordini, from Brazil, and the teams at The New England Center for Headache (Rapoport, Sheftell, and Tepper) and at Montefiore (Lipton and Solomon) for their help and direction. We also want to thank the authors of the chapters in this book for their excellent work.

Finally, we owe special thanks to our families, particularly our wives (Amy Natkins Lipton and Janaı´na Maciel Bigal) and children (Lianna Lipton, Justin Lipton, Luı´sa Bigal, and Hanna Bigal) for supporting us through evenings and weekends spent writing and editing as we prepared this book.

Finally, to our readers, we hope this book furthers your efforts to improve the lives of headache sufferers. These common and disabling disorders are tremendously gratifying to treat. In a field where cures are rare, we can nonetheless help patients by empowering them with tools that relieve pain, restore their ability to function, and, perhaps, prevent disease progression.