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Headache medicine for the pain practitioner
Techniques in Regional Anesthesia and Pain Management (2009) 13, 1
Headache medicine for the pain practitioner Pain medicine is alive and thriving in the body of work done by many specialties, including anesthesia, rehabilitation medicine, and neurology, among others. Different pain syndromes often have different levels of ownership among the medical specialties, and the complaint of headache tends to reside in the neurology court— or headache medicine to be precise; but all practitioners in the art of pain medicine need to understand this common complaint. Headache often accompanies another pain complaint. With the sensitivity of the trigeminal system, one can easily develop headache spontaneously, or with minimal provocation, in a way that does not exist much in other parts of the body. Pain clinicians need to understand the approach to the common primary headache syndromes—tension-type headache, migraine, and cluster headache—in addition to a thorough familiarity with common secondary headaches, such as those caused by altered intracranial pressure, vascular catastrophes, and so on. Head imaging is performed not to confirm a diagnosis of primary headache, but to rule out secondary causes. Headache medicine relies almost entirely on a history to direct a diagnosis and treatment plan. It is hoped that the not-toodistant future will bring more therapeutic options for headache. There is a particular need for more daily medications to treat the chronic daily headache syndromes and more
1084-208X/$ -see front matter © 2009 Elsevier Inc. All rights reserved. doi:10.1053/j.trap.2009.04.003
investment in the science of headache, particularly from the National Institutes of Health. The articles in this issue cover what I feel are the most important aspects of headache medicine for the pain practitioner. They include an introduction to the classification of headache; acute and prophylactic treatment of migraine and tension-type headache; the diagnosis of cluster headache and treatment options; nonmedication management of migraine; an introduction to the pathophysiology of migraine; interventions in headache management; and, last but not least, behavioral management, which is desperately needed. Headache medicine has fought for recognition; and, since 2006, the United Council for Neurologic Subspecialties has an examination in headache medicine, supported by the major neurological organizations. A special thank you to Oscar De Leon-Casasola, MD, and our contributors: Dyveke Pratt, MD, Cynthia Bamford, MD, Stewart Tepper, MD, Fred Taylor, MD, Randall Weeks, MD, Morris Levin, MD, Alan Rapoport, MD, Marissa Chang, MD, and all those who made this edition possible. Brian E. McGeeney, MD, MPH Guest Editor
Headache medicine for the pain practitioner Pain medicine is alive and thriving in the body of work done by many specialties, including anesthesia, rehabilitation medicine, and neurology, among others. Different pain syndromes often have different levels of ownership among the medical specialties, and the complaint of headache tends to reside in the neurology court— or headache medicine to be precise; but all practitioners in the art of pain medicine need to understand this common complaint. Headache often accompanies another pain complaint. With the sensitivity of the trigeminal system, one can easily develop headache spontaneously, or with minimal provocation, in a way that does not exist much in other parts of the body. Pain clinicians need to understand the approach to the common primary headache syndromes—tension-type headache, migraine, and cluster headache—in addition to a thorough familiarity with common secondary headaches, such as those caused by altered intracranial pressure, vascular catastrophes, and so on. Head imaging is performed not to confirm a diagnosis of primary headache, but to rule out secondary causes. Headache medicine relies almost entirely on a history to direct a diagnosis and treatment plan. It is hoped that the not-toodistant future will bring more therapeutic options for headache. There is a particular need for more daily medications to treat the chronic daily headache syndromes and more
1084-208X/$ -see front matter © 2009 Elsevier Inc. All rights reserved. doi:10.1053/j.trap.2009.04.003
investment in the science of headache, particularly from the National Institutes of Health. The articles in this issue cover what I feel are the most important aspects of headache medicine for the pain practitioner. They include an introduction to the classification of headache; acute and prophylactic treatment of migraine and tension-type headache; the diagnosis of cluster headache and treatment options; nonmedication management of migraine; an introduction to the pathophysiology of migraine; interventions in headache management; and, last but not least, behavioral management, which is desperately needed. Headache medicine has fought for recognition; and, since 2006, the United Council for Neurologic Subspecialties has an examination in headache medicine, supported by the major neurological organizations. A special thank you to Oscar De Leon-Casasola, MD, and our contributors: Dyveke Pratt, MD, Cynthia Bamford, MD, Stewart Tepper, MD, Fred Taylor, MD, Randall Weeks, MD, Morris Levin, MD, Alan Rapoport, MD, Marissa Chang, MD, and all those who made this edition possible. Brian E. McGeeney, MD, MPH Guest Editor