© Thieme Medical Publishers
29 March 2010 (online)
It is an honor to introduce this issue of Seminars in Neurology that is dedicated to the topic of headache disorders. Headache remains one of the commonest symptoms to afflict humanity. This high frequency is reflected in primary care where headache is one of the top 10 symptoms for which patients are seen in the ambulatory care setting. Headache is also the commonest symptom that leads to neurologic consultation. Despite the high prevalence in practice, headache disorders have historically received little attention in medical school and in graduate medicine programs—including neurology residencies. Fortunately, headache medicine is being recognized more and more by academic centers where headache medicine specialists are increasingly found in departments of neurology. In addition, the United Council of Medical Specialties now accredits headache medicine fellowship programs and offers a headache medicine specialty certification exam. Over 200 physicians have now been certified in headache medicine. A greater understanding of the pathophysiology of headache disorders has paralleled the emergence of headache medicine as a specialty. In addition, there are increasing options that can lead to the effective management of headache disorders.
The topics and contributors to this issue of Seminars in Neurology have been selected with care to provide a contemporary view of selected, important topics in the field of headache medicine. I want to express my gratitude to the clinicians and scientists who have unselfishly shared their expertise in the papers that comprise the contents of this issue of the journal.
The lead off paper by Robbins and Lipton carefully summarizes the epidemiologic landscape of primary headache disorders. This paper outlines the impact of primary headache disorders and their comorbidities. The second article by Cutrer summarizes the current understanding of the pathophysiology of migraine—the most studied and best understood of the primary headache disorders. The third paper by De Luca and Bartleson delineates a logical and evidence-based approach to the diagnosis of headaches, basing this approach on features of the neurologic history and examination. The fourth paper by Taylor provides an important update on the options available for the acute treatment of migraine headaches. In the fifth paper, Garza and Schwedt review the classification of chronic daily headache and outline a variety of management options for this group of challenging disorders. In the sixth article, Cha reviews the relationship of vertigo and migraine. She discusses the features that suggest a relationship between these disorders and proposes approaches for management of vestibular migraine. In the seventh contribution, Halker, Vargas, and Dodick provide a comprehensive overview of diagnosis and treatment of cluster headaches, the most common of the trigeminal autonomic cephalgias and one of the most severe of headache disorders. Next, Goadsby, Cittadini, and Cohen review the rare, but often effectively treated, trigeminal autonomic cephalgias. The ninth paper reviews thunderclap headache, an acute dramatic headache presentation that must be treated as a neurologic emergency. This headache presentation is carefully reviewed by Ju and Schwedt who summarize the differential diagnosis and an approach for evaluation. Finally, Robertson, Black, and Swanson focus on patients with migraine attacks who present for care in the emergency department. Several options for management of migraine headaches are outlined.
The papers in this issue of Seminars in Neurology have been written with the goal of providing useful information for clinicians who care for patients with headache, and with the ultimate goal that these will aid patients. Indeed, headache disorders epitomize the statement by my friend and colleague, Dr. Ralph Józefowicz at the University of Rochester. He sagely observed that “Neurology is no longer diagnose and adios.” Indeed, our patients with headache disorders expect and deserve our best efforts to help them manage these often disabling disorders. It is the hope of all of the contributing authors that this issue will support the goal of better care for patients with headache disorders.
Finally, I want to thank the Editor-in-Chief of Seminars in Neurology, Dr. Karen Roos, for allowing my colleagues to contribute to this issue. She is a tireless worker who is the creative force behind this journal that is dedicated to the education of neurologists. All readers of Seminars are indebted to her for the impact this journal has on its readers and, ultimately, those they serve—their patients.
Jerry W Swanson, M.D. , F.A.C.P.
Professor of Neurology, Department of Neurology, Mayo Clinic
200 First Street SW, Rochester, MN 55905