Abstract
Headache is considered the most common pain condition, yet the varieties of headache have only recently been organized into a diagnostic system with operational rules. This review outlines the classification system established in 1988 by the International Headache Society as it relates to diagnosis and treatment of the three main types of primary headache: migraine, tension-type, and cluster headaches. New directions in drug and nondrug treatments, both symptom-directed and prophylactic, are highlighted.
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References and Recommended Reading
Headache Classification Committee of the International Headache Society: Classification and diagnostic criteria for headache disorders, cranial neuralgias, and facial pain. Cephalalgia 1988, 8 (suppl 7):1–96.
World Health Organization: ICD-10 Guide for headaches: guide to the classification, diagnosis and assessment of headaches in accordance with the tenth revision of the International Classification of Diseases and Related Health Problems and its application to neurology. Cephalalgia 1997, 17 (suppl 19).
Rasmussen BK, Jensen R, Schroll M, Olesen J: Epidemiology of headache in a general population: a prevalence study. J Clin Epidemiol 1991, 44:1147–57.
Gobels H, Petersen-Braun M, Soyka D: The epidemiology of headache in Germany: a nationwide survey of a representative sample on the basis of the headache classification of the International Headache Society. Cephalalgia 1994, 14:97–106.
Pryse-Phillips W, Findlay H, Tugwell P et al.: A Canadian population survey on the clinical epidemiologic and societal impact of migraine and tension-type headache. Can J Neurol Sci 1992, 19:333–339.
Silberstein SD, Lipton RB, Goadsby PJ: Headache in Clinical Practice. Oxford: Isis Medical Media; 1998. An excellent book for clinical use.
Stewart WF, Simon D, Schechter A, Lipton RB: Population variation in migraine prevalence: a meta-analysis. J Clin Epidemiol 1995, 48:269–280.
Kudrow L: Cluster headache. In Headache: Clinical, Therapeutic, Conceptual and Research Aspects. Edited by Blau JN. London: Chapman and Hall; 1987.
Ekbom KA: Clinical comparison of cluster headache and migraine. Acta Neurol Scand 1970, 46 (suppl 41):1.
Merikangas KR: Genetics of migraine and other headaches. Curr Opinion Neurol 1996, 9:202–205.
Merikangas KR: Genetic epidemiology of migraine. In Migraine: A Spectrum of Ideas. Edited by Sandler M, Collins GM. Oxford: Oxford University Press; 1990:40–47.
Russell MB, Andersson PG, Thomsen LL, Iselius L: Cluster headache is an autosomal dominantly inherited disorder in some families: a complex segregation analysis. J Med Genet 1995, 32:954–956.
Iversen HK, Langemark M, Andersson PG, et al.: Clinical characteristic of migraine and episodic tension-type headache in relation to old and new diagnostic criteria. Headache 1990, 30:514–519.
Silberstein SD. Migraine symptoms: results of a survey of selfreported migraineurs. Headache 1995, 35:387–396.
Manzoni GC, Granella F, Sandrini G, et al.: Classification of chronic daily headache by International Headache Society criteria: limits and new proposals. Cephalalgia 1995, 15:37- 43.
Nappi G, Granella F, Sandrini G, Manzoni GC: Chronic daily headache: how should it be included in the IHS classification? Headache, in press. A state of the art article on the problem of the so-called chronic daily headache.
Rasmussen BK: Migraine and tension-type headache in a general population: psychosocial factors. Int J Epidemiol 1992, 21:1138–1143.
Jensen R, Sandrini G: Chronic tension-type headache. In The Headaches, edn 2. Edited by Olesen J, Welch MW, Tfelt-Hansen P. New York: Lippincott-Raven, in press. The book The Headaches represents the most comprehensive review of all the aspects concerning primary and secondary headache.
Rasmussen BK: Migraine and tension-type headache in a general population: precipitating factors, female hormones, sleep patterns and relation to lifestyle. Pain 1993, 53:65–72.
Sandrini G, Antonaci F, Pucci E, et al.: Comparative study with EMG, pressure algometry and manual palpation in tensiontype headache and migraine. Cephalalgia 1994, 14:451–457.
Schoenen J, Maertens de Noordhout A: Headache. In Textbook of Headache. Edited by Wall PD, Melzack R. New York: Churchill Livingstone: 1994.
Schoenen J, Gérard P, De Pasqua V, Sianard-Gainko J: Multiple clinical and paraclinical analyses of chronic tension-type headache associated or unassociated with disorder of pericranial muscles. Cephalalgia 1991, 11:135–139.
Sjaastad O: Cluster Headache Syndrome. London: Saunders; 1992. Excellent, detailed review on tension-type headache.
Goadsby PJ, Lipton RB: A review of paroxysmal hemicranias, SUNCT syndrome and other short-lasting headaches with autonomic features, including new cases. Brain 1997, 120:193–209.
Olesen J: Clinical and pathophysiological observations in migraine and tension-type headache explained by integration of vascular, subraspinal and myofascial inputs. Pain 46, 125–132.
Wolff HG: Headache and Other Head Pain. New York: Oxford University Press; 1963.
Sicuteri F: Migraine, a central biochemical dysnociception. Headache 1986, 16:145–149.
Moskowitz MA: Neurogenic versus vascular mechanism of sumatriptan and ergot alkaloids in migraine. Trends Pharmacol Sci 1992, 13:307–312.
Ferrari MD, Saxena PF: On serotonin and migraine: a clinical and pharmacological review. Cephalalgia 1993, 13:151–156.
Strassman AM, Raymond SA, Burstein R: Sensitization of meningeal sensory neurons and the origin of headaches. Nature 1996, 384:560–563.
Goadsby PJ, Edvinsson L, Ekman R: Release of vasoactive peptides in the extracerebral circulation of man and the cat during the activation of the trigeminovascular system. Ann Neurol 1988, 23:193–196.
Goadsby PJ, Edvinsson L, Ekman R: Vasoactive peptide release in the extracerebral circulation of humans during migraine headache. Ann Neurol 1990, 28:183–187.
Goadsby PJ, Edvinsson L: Human in vivo evidence for trigeminovascular activation in cluster headache. Brain 1994, 117:427–34.
Fanciullacci M, Alessandri M, Figini M, et al.: Increases in plasma calcitonin gene-related peptide from extracerebral circulation during nitroglycerin-induced cluster headache attack. Pain 1995, 60:119–23.
Goadsby PJ, Edvinsson L: Neuropeptide changes in a case of chronic paroxysmal hemicrania-evidence for trigemino-parasympathetic activation. Cephalalgia 1996, 16:448–450.
Olesen J, Saxena PR: 5-hydroxytryptamine Mechanisms in Primary Headaches. In Frontiers in Headache Research, vol 2. New York: Raven Press; 1992.
Lauritzen M: Pathophysiology of the migraine aura: the spreading depression theory. Brain 1994, 117:199–210.
Moskowitz MA, Nozaki K, Kraig RP: Neocortical spreading depression provokes the expression of C-fos protein-like immunoreactivity within trigeminal nucleus caudalis via trigeminovascular mechanisms. J Neurosci 1993, 13:1167–1177.
Gerber WD, Schoenen J: Biobehavioral correlates in migraine: the role of hypersensitivity and information-processing dysfunction. Cephalalgia 1998, 18 (suppl 21):5–11.
Áfra J, Proietti Cecchini A, De Pasqua V, Albert A, et al.: Visual evoked potentials during long periods of pattern-reversal stimulation in migraine. Brain 1998, 121:233–241.
Schoenen J, Wang W, Albert A, Delwaide PJ: Potentiation instead of habituation characterizes visual evoked potentials in migraine patients between attacks. Eur J Neurol 1995, 2:115–122.
Olesen J, Schoenen J: Tension-type headache: classification, mechanisms and treatment. In Frontiers in Headache Research, vol 3. New York: Raven Press; 1993. ood review on tension-type headache
Schoenen J: Exteroceptive suppression of temporalis muscle activity: methodological and physiological aspects. Cephalalgia 1993, 13:3–10.
Schoenen J: Exteroceptive suppression of temporalis muscle activity inpatients with chronic headache and in normal volunteers: methodology, clinical and pathophysiological relevance. Headache 1993, 33:3–17.
Sjastaad O: Cluster headache syndrome. In Major Problems in Neurology, vol 23. London: Saunders; 1992.
Sandrini G, Alfonsi E, Ruiz et al.: Impairment of corneal pain perception in cluster headache. Pain 1991, 47:299–304.
May A, Bahra A, Büchel C, et al.: Hypothalamic activation in cluster headache attacks. Lancet 1998, 352:275–278.
Silberstein SD, Young WB (for the king Panel of the Headache and Facial Pain Section of the American Academy of Neurology: Safety and efficacy of ergotamine tartrate and dihydroergotamine in the treatment of migraine and status migrainous. Neurology 1995, 45:577–584.
Ferrari MD: Migraine. Lancet 1998, 351:1043–1051. A good synthesis on recent progess in this field.
Schoenen J: Acute migraine therapy: the new drugs. Curr Opinion Neurol 1997, 10:237–243.
Goadsky,P: A triptan too far [editorial]? J Neurol Neurosurg Psychiatry 1998, 64:143–147. An excellent up-to-date editorial on the criteria to compare triptan efficacy.
Nappi G, Facchinetti F, Rossi F, eds: Headache and menstrually relate disorders:in search of a consensus. Cephalalgia 1997, 17 (Suppl. 20). New proposal for the classification of menstrual migraine.
Mathew NT: Drug-induced headache. Neurol Clin 1990, 8:903- 912.
Silberstein SD: Treatment of headache in primary care practice. Am J Med 1984, 77 (3A):65–72.
Kudrow L: Response of cluster headache attack to oxygen inhalation. Headache 1981, 21:1–4.
Ekbom K. Treatment of acute cluster headache with sumatriptan. N Engl J Med 1991, 325:322–326.
Blanchard EB, Appelbaum KA, Guarnieri P, et al.: Five-year follow- up on the treatment of chronic headache with biofeedback and/or relaxation. Headache 1987, 27:580–583.
Solomon SD, Lipton RB, Newman LC: Prophylactic therapy of cluster headaches. Clin Neuropharmacology 1991, 14:116–130.
Silberstein SD, Lipton RB: Overview of diagnosis and treatment of migraine. Neurology 1994, 44:6–16.
NappiG,Mantoni GC: Primary Headaches: Clinical Approach and Management.London:Smith-Gordon and Co. Limited;1996. An interesting personal view on the headache.
Lawrence ER, Hossain M, Littlestone W: Sandomigran for migraine prophylaxis: controlled multicenter trial in general practice. Headache 1977, 17:109–112.
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Sandrini, G., Nappi, G. Primary headaches: Diagnosis and treatment. Current Review of Pain 3, 100–108 (1999). https://doi.org/10.1007/s11916-999-0033-x
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DOI: https://doi.org/10.1007/s11916-999-0033-x