Headache

It is a pleasure to introduce this issue of Seminars in Neurology, which is devoted to the topic of headache. Headache is one of the commonest symptoms of humankind. Further, it is the most frequent reason that individuals are seen by neurologists. In addition, migraine is the most common diagnosis made by neurologists. Despite the epidemiologic landscape of headache, headache disorders have traditionally been afforded very little attention in medical schools and even neurology residencies. It might be reasonable as some have said, to consider headache as the Rodney Dangerfield of neurologic complaints, “It don't get no respect.” This is despite the fact that many individuals regularly suffer pain and disability secondary to headaches and effective treatment is usually available. Fortunately for headache sufferers, this viewpoint is slowly but steadily changing. In the last decade there has finally been research that is unlocking the heretofore secrets of headache pathophysiology, and rational treatment modalities are now available. What's more, it is no longer uncommon to see headache specialists represented among academic departments of neurology. The place of headache as a specialty is likewise being affirmed as the United Council for Neurologic Specialties intends to begin to offer certification examinations in Headache Medicine and to accredit headache fellowship programs. These efforts will further assure that headache sufferers will no longer be neglected by their physicians.

Both the topics and the authors have been selected with care to cover a broad contemporary view of headache. I am indebted to my colleagues who are dedicated headache clinicians and have given of their time and expertise. The lead off paper by Ramadan and Olesen provides an overview of the 2nd Edition of the International Classification of Headache Disorders that was recently published by the International Headache Society. These criteria for headache diagnosis are widely accepted by investigators in the field, and a working knowledge of them is important for clinicians because these criteria are utilized in the vast majority of studies that are published in the field of headache. The second article by Bartleson carefully considers the initial approach to headache diagnosis. It emphasizes the historical and examination features that point to the possibility of a secondary headache and require the physician to further investigate the patient with headache. In the third paper, Cutrer succinctly reviews the advances in migraine pathophysiology that have led to a much better basic understanding of this disorder and have informed physicians and scientists who aim to develop new effective tools for the management of migraine. The fourth article by Rozen outlines a rational and practical approach to acute migraine headache therapy. The fifth paper by Buchanan and Ramadan nicely discusses the agents that are currently available for migraine headache prophylaxis and further delineates potential future agents. In the sixth of the series of papers, Holroyd and Drew rigorously review the literature that supports behavioral methods in migraine management. The seventh contribution by Black succinctly outlines the diagnosis and treatment of both sporadic and familial hemiplegic migraine and reviews the genetics of the heterogeneous genetics of the latter. Migraine, which is approximately three times more common in women than men, presents some management issues that are unique to this gender. Lay and Broner masterfully outline these issues and propose practical approaches in the eighth paper. Migraine in children presents some distinct problems that are delineated by Mack in the ninth contribution to this issue. In the tenth piece in the issue Boes, Black, and Dodick tackle one of the most common difficult scenarios seen in the headache population, that of chronic daily headache along with the often confounding problem of medication overuse headache. In the eleventh paper, the unique disorder of cluster headache is thoroughly discussed by Capobianco and Dodick. In the final article, Boes and Swanson undertake to review some uncommon, but distinct headache disorders, which require accurate diagnosis such that appropriate and effective therapy can be selected.

The last 20 years has seen the field of headache come of age and take its place among other medical specialties. It is past the time when patients with “only a headache” are given anything but their physicians' thoughtful and empathetic care. I want to thank Dr. Karen Roos, Editor in Chief of Seminars in Neurology, for asking me to organize this issue and my colleagues who have unselfishly answered the call to share their expertise. It is my hope that this installment will be a useful tool for neurologic clinicians to provide effective care to their patients with headache.