Management Of Acute And Chronic Headache Pain An Issue Of Medical Clinics

This issue of Medical Clinics covers the current best practices surrounding the management of patients with acute and chronic headache pain. Guest edited by Steven Waldman, MD, JD, the topics covered will include concerning factors in the diagnosis of headache pain, imaging techniques, tension headaches, migraine headaches, cluster headaches, postdural puncture headaches and more.

This issue of Medical Clinics of North America, Guest Edited by Charles Argoff, MD is devoted to Chronic Pain Management. Dr. Argoff has assembled a group of expert authors to review the following topics: Chronic Pain Management: An Overview of Taxonomy, Conditions Commonly Encountered, and Assessment; The Acute to Chronic Pain Transition: Can Chronic Pain Be Prevented?; What Do We Know About the Pathophysiology of Chronic Pain? Implications for Treatment Considerations; An Overview of Pharmacologic Management of Chronic Pain; An Overview of Nonmedical Treatment of Chronic Pain; Managing Chronic Headache Disorders; Managing Osteoarthritis and Other Chronic Musculoskeletal Pain Disorders; Managing Neuropathic Pain; Managing Low Back and Other Spinal Pain Disorders; Exploring the Use of Chronic Opioid Therapy for Chronic Pain: When, How and for Whom?; The Role of Invasive Pain Management Modalities in the Treatment of Chronic Pain; Multimodal Management of Chronic Pain: What is the Evidence?; Managing Chronic Pain in Special Populations; and The Future of Pain Management as a Subspecialty: Meeting the Needs of the Patients We Care For.

This book provides a detailed overview of the current state of knowledge regarding the pathophysiology of both primary headaches – migraine, tension-type headache (TTH), and cluster headache – and the very important and frequent type of secondary headache, medication overuse headache (MOH). After an introductory chapter describing relevant neuroanatomy and vascular anatomy, the evidence gained from animal models regarding the pathophysiology of migraine and the other primary headaches is reviewed. Knowledge of the genetic component in the different types of headache is then examined with reference to recent evidence, for example regarding the implication of the trigeminovascular system and cortical spreading depression in migraine. Detailed information is provided on insights into primary headaches from imaging studies, including functional magnetic resonance imaging and positron emission tomography and on their neurophysiology and biochemistry. A further series of important chapters describe present knowledge of the pathophysiology of each specific type of headache and consider future directions. Written by acknowledged experts in their fields from Europe and the United States, clinicians and students will find Pathophysiology of Headaches to be an excellent source of up-to-date information on why patients experience headaches. In addition, it will be of value for pain researchers investigating the underlying mechanisms of headache.

Migraine is an extremely common condition affecting 28 million Americans. Fully 1 in every 6 adult women suffers from this malady. Patients with migraine are frequently seen in the Emergency Room and Urgent Care Clinic for acute treatment of their headaches. Headache generally accounts for nearly 3 % of all ER visits, resulting in almost 3.5 million visits annually. There currently are no widely used guidelines for the treatment of patients with headache in the ER or UCC, and reducing the number of CT scans remains a key goal for administrators in many ER or urgent care settings. In one study, 35 drugs, alone or in combination, were used to treat migraine. The most common medication class used was narcotics, which were used in 25% of the visits. The next two most commonly used classes were antiemetics and NSAIDs. Only 5% of patients seen for headache received headache-specific medications during their visit. ER and Urgent Care physicians generally have little or no formal training in treating these patients. Consequently, they often feel less comfortable ruling out secondary causes of headaches and using appropriate headache treatment medications and procedures. Since many patients have received narcotics in previous visits, providers may view them as drug seekers. Patients seen in ERs and UCCs for acute treatment of their headaches often report high levels of dissatisfaction. They often end up in the ER or UCC because they don’t have a formal treatment strategy for their severe headaches. Health plans and insurance agencies are often frustrated by the high cost of fragmented care for patients with headaches. Because of the environment that most ER and UCC providers operate in, many unnecessary scans and tests are done because of uncertainty of the diagnosis and unfamiliarity of the patient. Primary care physicians are also frustrated by patients with headaches presenting to them after being seen in the ER or UCC, wanting a refill of their narcotics that they were given. Many patients don’t follow up with their PCPs and simply keep returning to the ER/UCC for their treatment. In short, all involved in the care for patients with headache are frustrated by the current system. The care for these patients is clearly not optimal. It doesn’t have to be that way. There are a wide variety of effective treatment options available, but are underutilized in the acute setting. With these treatment options, patients no longer have to be treated only with parenteral narcotics, only to perpetuate the cycle of suboptimal care described above. This concise handbook covers all aspects of acute headache care, including care of the child and adolescent with acute headaches, treatment of pregnant and breastfeeding women with acute headaches and appropriate evaluation of secondary headaches. In addition, two other novel chapters are included: one on caring for older patients with acute headaches as well as a chapter describing how to ensure a seamless transition of the patient back to a headache interested provider. Representing an important milestone in the care of patients with headache, this is the first concise handbook available to exclusively address the issue of headache treatment in the acute care setting. Including protocols and strategies that can be used right away, Management of Headaches in Emergency Room and Urgent Care Settings: Diagnosis and Management provides information about lesser known, but effective strategies such as greater occipital nerve blocks that can be easily learned and incorporated in the acute care setting. It emphasizes the continuity of care that is so vital to keep headache patients from returning to the ER and UCC for acute treatment.

M. WILKINSON Patients with frequent or daily headaches pose a very difficult problem for the physician who has to treat them, particularly as many patients think that there should be a medicine or medicines which give them instant relief. In the search for the compound which would meet this very natural desire, many drugs have been manufactured and the temptation for the physician is either to increase the dose of a drug which seems to be, at any rate, partially effective, or to add one or more drugs to those which the patient is already taking. Although there have been some references to the dangers of overdosage of drugs for migraine in the past, it was not until relatively recently that it was recognized that drugs given for the relief of headache, if taken injudiciously, may themselves cause headache. The first drugs to be implicated in this way were ergotamine and phenazone. In the case of ergotamine tartrate, the dangers of ergotism were well known as this was a disorder which had been known and written about for many years. In the treatment of headache, fully blown ergotism is rare and in recent years has usually been due to self-medication in doses much greater than those prescribed although there are a few recorded cases where toxic amounts have been given.

The Cleveland Clinic Manual of Headache Therapy is a hands-on, practical guide to diagnosis, work-up, and treatment of common headache disorders. Each chapter is written by a Cleveland Clinic Headache Center care provider. The book uses an evidence-based approach to sift through the wealth of available data and identify the most appropriate treatments. This manual is aimed at practicing neurologists and pain specialists, fellows and residents, and also primary care physicians. The Cleveland Clinic Manual is the most trusted source on this ever expanding and developing topic.

Discussing real-world cases, this practical guide highlights areas of diagnostic uncertainty and shows common pitfalls in headache diagnosis and treatment.

This comprehensive, practical title invites all clinicians to take a fresh look at the evaluation and management of chronic daily headache (CDH). Developed by a distinguished international panel of experts, the book examines key social and economic issues around CDH and clarifies the diagnosis of CDH disorders, providing an understanding of the underlying biological substrates, offering guidance on the use of diagnostic testing and additional consultations, and outlining treatment strategies with the greatest potential to alleviate the burden of these patients and to provide the highest quality of care. The book fully examines the constellation of symptoms that constitute chronic daily headache, while also discussing the role of behavioral medicine and the important elements involved in taking a good history. The major forms and biology of chronic daily headache are covered, as is the role of diagnostic testing and treatment. The risk factors that lead patients to transform episodic primary headache disorders into the chronic form are examined. Invasive and neuromodulatory techniques are also discussed. A section on the classification of these disorders rounds out this important contribution to the literature. Chronic Headache – A Comprehensive Guide to Evaluation and Management will be of great interest to neurologists, primary care physicians, nurse practitioners, physician assistants, medical students, and other clinicians with an interest in chronic daily headache.