Headache and Pain

Shuhan Zhu, MD

James Otis, MD, FAAN

This issue of Seminars in Neurology covers the topic of “Headache and Pain.” According to neurologists, pain complaints, such as headache, back pain, neck pain, and various neuropathic pains, account for up to 40% of referrals.

Despite being one of the most common reasons for referral, most neurologists are not trained to care for patients with difficult pain syndromes. This discrepancy between clinical need and training makes the care of pain and headache patients challenging. It is likely a contributor to one of the most difficult problems that our world faces, the opioid epidemic.

We wrote this issue with the goal of providing an overview of common pain syndromes and their treatments to the neurologists.

We review the assessment and management of various forms of headaches (arguably the most common pain-related referral to neurology), including migraine syndromes, tension type headaches, and postconcussion headaches. The Special Headaches in Women article highlights some of the intricacies of hormones, pregnancy, and lactation, and their effects on management. Overviews of radicular pain, myofascial pain, and neuropathic pain assessment and treatment are also provided.

The opioid epidemic has shown us the risks of this class of medications. For patients with difficult to treat pain syndromes, opioids at times may be required, and methods for risk reduction in pharmacotherapy are reviewed.

We hope, this issue provides you a systematic and succinct overview on the assessment and treatment of common pain conditions in neurology.