Diagnosis and classification of headache
Headache is the most common neurologic complaint. Migraine is by far the most frequent headache type seen by office-based physicians.Migraine remains under-recognized, under-diagnosed, and therefore under-treated in everyday medical practice. With time severely restricted in primary care day-to-day practice, a user friendly approach to assessment of headaches and differentiation into the broad types of "worrisome headache," migraine, tension-type, and others is necessary. A consensus-based, practical, rapid, six essential-question screening technique is outlined.
Headache in women.
Women have more migraine than men. Some secondary headaches are more common in women. Menses, pregnancy, and menopause have an impact on the frequency and treatment of headache. Oral contraceptives can be used in women with migraine with some precautions.
[Headache disorders]
Primary headache disorders such as migraine, tension-type headache, and cluster headache are prevalent and disabling neurological disorders. Although most headache disorders are largely treatable, they are under-recognized, under-diagnosed, and under-treated. Many headache sufferers in Japan do not receive appropriate and effective health care; hence, the illness, which should be relieved, persists and acts as an individual and societal burden. One of the barriers most responsible for this is poor awareness of the disorders. For lifting the burden, health care must be improved. Education is an essential way to resolve these issues at multiple levels. We have a Japanese version of the international headache classification and diagnostic criteria II (ICHD-II) and guidelines for the management of chronic headaches. Utilization of these resources is key for the improvement of headache management in our country. Not only neurologists, but also neurosurgeons and other medical specialists are participating in headache care in Japan. The Japanese Headache Society and the Japanese Society for Neurology should play major roles in health care service, education programs, as well as clinical and basic research for headache disorders. The road map for realizing our aim on headache treatment is as follows: (1) increase the number of units concerning headache in lectures for medical students, implement training programs for residents and neurologists, and offer continuous medical educations for physicians and neurologists; (2) secure more funding for headache research; (3) propagate medical care for headache in primary care settings and regional fundamental hospitals; (4) reform the health care system for headache and incentivize appropriate compensation for headache care in public health insurance; and (5) spread appropriate information on medical and socio-ethical issues related to headache for the sufferers and citizens. The authors expect that many neurologists have an interest in headache and understanding headaches, and better health care for headache disorders will bring great benefits for the sufferers.
Chronic daily headache
Chronic daily headache (CDH) represents one of the most challenging medical conditions that a health care provider is called on to treat. This article outlines the scope of this misunderstood condition,updates the reader on the revised diagnostic criteria for chronic daily headache, and gives practical insight into diagnosis and treatment. Four specific subtypes of CDH are covered: chronic tension-type headache, chronic migraine, new daily persistent headache, and hemicrania continua. Through better recognition and treatment of this all too common condition, this segment of our population can be better helped to lead quality lives.
Guideline for primary care management of headache in adults
Objective: To increase the use of evidence-informed approaches to diagnosis, investigation, and treatment of headache for patients in primary care.
Quality of evidence: A comprehensive search was conducted for relevant guidelines and systematic reviews published between January 2000 and May 2011. The guidelines were critically appraised using the AGREE (Appraisal of Guidelines for Research and Evaluation) tool, and the 6 highest-quality guidelines were used as seed guidelines for the guideline adaptation process.
Main message: A multidisciplinary guideline development group of primary care providers and other specialists crafted 91 specific recommendations using a consensus process. The recommendations cover diagnosis, investigation, and management of migraine, tension-type, medication-overuse, and cluster headache.
Conclusion: A clinical practice guideline for the Canadian health care context was created using a guideline adaptation process to assist multidisciplinary primary care practitioners in providing evidence-informed care for patients with headache.
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