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Purpose Migraine can negatively impact patient functioning and quality of life. Here, we report the effects of galcanezumab (GMB), a humanized monoclonal antibody that binds to calcitonin gene-related peptide, on patient-reported outcome (PRO) measures in migraine. Methods CGAJ was a Phase III, randomized, open-label study (12-month open-label and 4-month post-treatment follow-up) in patients with episodic or chronic migraine. Patients aged 18–65 years with diagnosis of migraine (≥ 4 migraine headache days per month) as defined by International Classification of Headache Disorders (ICHD)-3 beta guidelines were included in the study. Patients were randomized 1:1 with subcutaneous GMB 120 mg (with a loading dose of 240 mg) or GMB 240 mg given once monthly for 12 months. Changes from baseline in PRO measures such as Migraine-Specific Quality of Life Questionnaire v2.1 (MSQ) and Migraine Disability Assessment (MIDAS) were assessed. Results A total of 135 patients were randomized to each galcanezumab dose group. Mean (SD) baseline MSQ total scores were 53.85 (20.34) [GMB 120 mg] and 53.69 (18.79) [GMB 240 mg]. For MIDAS, mean (SD) total scores were 45.77 (42.06) [GMB 120 mg] and 53.96 (61.24) [GMB 240 mg]. Within-group mean improvement from baseline on MSQ and MIDAS total scores and all individual item/domain scores were statistically significant for both GMB dose groups, at all-time points during the treatment phase (p Conclusion Galcanezumab was associated with statistically significant changes from baseline in the PRO measures across the entire 12-month treatment period. These results indicate improved health-related quality of life and decreased disability among patients treated with galcanezumab.

Migraine remains a prevalent disease that can be hard to differentiate from other disorders with headache symptoms. It is an episodic disorder with possible characteristic symptoms prior to the headache, a headache phase, and the postdromal phase. The International Headache Society, an international professional headache association, has developed a tool to diagnose and classify migraines, which is routinely updated based on clinical evidence. The current version of this resource, the third edition of the International Classification of Headache Disorders (ICHD-3), subdivides migraine into the following six categories based on symptoms: migraine without aura, migraine with aura, chronic migraine, complications of migraine, probable migraine, and episodic syndromes that may be associated with migraine. Because this diagnostic classification relies on the quantity, quality, and duration of symptoms, finding ways to promote accurate reporting and minimize recall bias becomes important. For a small percentage of migraine sufferers, the disease can progress to a chronic condition with headaches >50% of days in the month resulting in significant disability and decreased quality of life. Understanding both the common and uncommon symptoms associated with migraine can help medical practitioners correctly diagnose the disease to more quickly initiate treatment.

It is uncommon for a headache that is due to rhinosinusitis (aka “sinus headache”) to occur. In such a situation, an initial sinus infection by a viral or bacterial pathogen leads to formation of a viscous, discoloured discharge from the nose, hyposmia or anosmia, pain or a sense of pressure in the facial region and usually pyrexia. Pain in the face and headache normally abate within a week of the infection resolving. Ongoing pain should prompt a review of the diagnosis. The International Classification of Headache Disorders has published useful criteria which may be used to distinguish different kinds of headache. In sinus headache, pain over the face, facial pressure, blockage of the nose and sinuses are present. Additionally, the following symptoms, which are also present in migraine disorders, may occur: nausea, photosensitivity or noise intolerance, moderate to severe headache, a pulsatile or throbbing sensation and exacerbation due to activity. Despite the popularity of the term “sinus headache” among patients themselves and general practitioners, in the media and in advertising copy, its use is deprecated by ENT specialists, allergists and neurologists, who feel that the term lacks precision and may lead to inappropriate interventions. The term sinus headache is generally applied when a headache is accompanied by pain in the face or facial pressure. It is the facial pain and pressure that brings the association with sinus disease. In this chapter, nasal diseases and headache are reviewed.

Childhood headache is not an uncommon problem in clinical practice. From an aetiological perspective, headache is divided into primary and secondary. The distinction between the two should be the first step in the evaluation process, which in turn dictates the subsequent investigations, when needed, and management. A headache that has a progressive course or unusual features in association with additional symptoms suggestive of an intracranial pathology or abnormal neurological signs should always prompt consideration for neuroimaging. However, this has to be balanced with the need for not to over-investigate. Recognition of the different subtypes of primary and secondary headaches is facilitated by the use of the latest editions of the International Classification of Headache Disorders (ICHD). This system, however, is primarily based on data extrapolated from adult studies making it applicable for childhood somewhat less sensitive and specific. Acute management of headache in a previously well child should include an initial clinical assessment to exclude potential secondary causes. Early use of simple analgesics, a triptan and an antiemetic either solely or in combination is needed in the management of migraine exacerbations. Frequent migraine attacks that negatively impact the child’s quality of life warrant treatment with a suitable prophylactic drug for a period of few months whilst triggering and maintaining factors are eliminated as much as possible. Drug treatment of tension-type headache is usually unsatisfactory and thus coping strategies may be more appropriate. The possibility of medication-overuse headache should be considered and reviewed regularly during initial and follow-up visits.

Trigeminal neuralgia (TN), also known as tic douloureux, is a rare and distinct facial pain syndrome often characterized by brief and recurrent episodes of unilateral electric-like pain accompanied by facial spasm or tic that may become recurrent and chronic. The occurrence of this condition increases with age and is more common in females. This peculiar syndrome can be triggered by mild cutaneous stimulation of “trigger zones” and typically follows the distribution of the trigeminal nerve, often the maxillary (V2) and mandibular (V3) distribution. Most cases of trigeminal neuralgia are caused by vascular compression of the trigeminal nerve, also known as classic trigeminal neuralgia. The other classification is known as painful trigeminal neuropathy and is caused by lesions other than vascular compression, such as post-herpetic neuralgia, post-traumatic trigeminal neuropathy, multiple sclerosis, and other space-occupying lesions. The clinical features of the syndrome help diagnose trigeminal neuralgia. The diagnostic criteria, as described by the International Classification of Headache Disorders, 3rd edition, include factors such as frequency, timing, distribution, and characteristics of the pain. Patients who meet the diagnostic criteria are recommended to have magnetic resonance imaging (MRI) to rule out secondary causes. Differential diagnosis includes any of the causes of secondary or painful trigeminal neuropathy, dental issues, and other uncommon causes of headache (such as cluster-tic syndrome and primary stabbing headache). Management entails pharmacologic therapy, percutaneous interventional procedures, surgery, and radiation therapy. The prognosis is variable and recurrence is common, described as waxing and waning in nature. We present a case report of TN of the maxillary and mandibular division, including background history, pathophysiology, clinical findings, diagnosis, treatment approach recommendations, and future therapies.

Physicians, researchers and clinical trial developers from around the world, working in the headache field, speak a common language based on the International Classification of Headache Disorders (ICHD). The current ICHD-3 does not include a definition of refractoriness for primary headaches. To fill the gap, the European Headache Federation (EHF) developed new consensus criteria for refractory chronic migraine (rCM) and refractory chronic cluster headache (rCCH) particularly for the purposes of randomized-controlled trials (RCTs) involving experimental medications and neuromodulation, but they may also help for referral from a primary care provider to a headache specialist and for medical cost reimbursement. EHF definitions of rCM and rCCH have to be considered as a useful and mandatory tool in any multidisciplinary or innovative therapeutic approach.

Chronic daily headache (CDH) is a category of headaches that affects 4% of the general population. While it does not have recognition in the current version of the International Classification of Headache Disorders (ICHD 3), it is a well-recognized clinical entity among headache specialists, and has been defined by Silberstein and Lipton as a headache lasting 15 or more days per month for at least three consecutive months. The majority of CDH is represented by transformed or chronic migraine (CM) and chronic tension-type headaches (CTTH). However, Hemicrania Continua (HC), Chronic Cluster (CC), and New Daily Persistent Headache (NDPH) are also included in this headache category (Headache Classification Committee of the International Headache Society (IHS), Cephalalgia. 33(9):629–808, 2013). Common comorbidities that are associated with CDH include medication overuse headaches, and psychiatric disorders such as depression, anxiety, and post-traumatic stress disorder (PTSD), as well as the myriad of comorbidities associated specifically with CM (Tzu-Hsien, Update of inpatient treatment for refractory chronic daily headache. Berlin: Springer Science; 2015). The best approach to treatment of CDH is a multidisciplinary one that includes medications, as well as non-pharmacologic therapies. Chronic daily headache remains a challenge for headache specialists and other clinicians, and accounts for more than 85% of the economic burden of headache on society (Soo-Jin, Outcome of chronic daily headache or chronic migraine. Berlin: Springer Science; 2015). Since there is no cure at this time, the goal of treatment remains reduction in the frequency, severity, and duration of headaches, with improvement in quality and function of life and reduced disability. This would create a positive economic impact on society through decreased costs and burden of disease.

The frequent or regular intake of medication to treat acute headache episodes can lead to an increase in headache frequency and finally to a transition from episodic to chronic headache. Many patients with chronic headache take abortive medication on a daily basis. Medication overuse headache (MOH) is defined by the International Classification of Headache Disorders as a headache in patients with a pre-existing primary headache disorder (e.g., migraine or tension-type headache) occurring on ≥15 days per month for >3 months. Also, these primary headache disorders occur in association with overuse of medication for acute or symptomatic headache treatment. The prevalence of MOH in the general population is around 1%. MOH is more common in people with chronic migraine and chronic daily headache than in patients with episodic migraine. The phenotype of the headache in MOH depends on the initial primary headache and the type of overused acute medication. Treatment of MOH occurs in three stages. First, we educate patients about the relationship between frequent intake of acute headache medication and MOH to reduce intake of acute medication. In a second step migraine prevention should be initiated in chronic migraine (topiramate or onabotulinumtoxinA in migraine) or amitriptyline in chronic tension-type headache. In patients who fail to cease overuse of overused medication with preventive therapy, then detoxification occurs on an outpatient basis or in a day hospital or inpatient setting, depending on severity and comorbidities. The success rate of treatment is around 50–70%, with higher relapse rates in patients with opioid overuse. Patient education and continuity of care in the follow-up period reduce relapse rates.

Background Individually both migraine and post-traumatic stress disorder (PTSD) prevalence estimates are higher among women. However, there is limited data on the association of migraine and PTSD in women during pregnancy. Methods We examined the association between migraine and PTSD among women attending prenatal clinics in Peru. Migraine was characterized using the International Classification of Headache Disorders (ICHD)-III beta criteria. PTSD was assessed using the PTSD Checklist-Civilian Version (PCL-C). Multivariable logistic regression analyses were performed to estimate odds ratios (OR) and 95% confidence intervals (CI) after adjusting for confounders. Results Of the 2922 pregnant women included, 33.5% fulfilled criteria for any migraine (migraine 12.5%; probable migraine 21.0%) and 37.4% fulfilled PTSD criteria. Even when controlling for depression, women with any migraine had almost a 2-fold increased odds of PTSD (OR: 1.97; 95% CI: 1.64–2.37) as compared to women without migraine. Specifically, women with migraine alone (i.e. excluding probable migraine) had a 2.85-fold increased odds of PTSD (95% CI: 2.18–3.74), and women with probable migraine alone had a 1.61-fold increased odds of PTSD (95% CI: 1.30–1.99) as compared to those without migraine, even after controlling for depression. In those women with both migraine and comorbid depression, the odds of PTSD in all migraine categories were even further increased as compared to those women without migraine. Conclusion In a cohort of pregnant women, irrespective of the presence or absence of depression, the odds of PTSD is increased in those with migraine. Our findings suggest the importance of screening for PTSD, specifically in pregnant women with migraine. This research was supported by awards from the National Institutes of Health (NIH), National Institute of Minority Health and Health Disparities (T37-MD- 001449), and the Eunice Kenney Shriver National Institute of Child Health and Human Development (R01-HD-059835). The NIH had no further role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication. Revisión por pares

This case illustration aims to introduce the clinical features of headache attributed to intracranial neoplasm in a young child and to introduce the International Classification of Headache Disorders (Cephalalgia ;33(9):720, 2013). The analysis of symptoms aims to help the clinicians to understand the clinical characteristics of tumour-related headache and differential diagnosis between primary headaches and tumour-related headaches during childhood and point out red flags for early diagnosis.

This case illustrates the typical clinical features of migraine without aura in a young child and introduces the International Classification of Headache Disorders (Cephalalgia 33(9):629–808, 2013). The analysis of symptoms will help the clinicians in excluding more complex and sinister causes of headache and in making a positive diagnosis of the type of primary headache disorder. The management plan meets the specific needs of this child with discussion on most effective treatment of acute attacks as the main objective. Advice on healthy lifestyle and prognosis forms part of the patient education on the disorder.

All headache disorders, including migraine, are diagnosed according to the criteria specified in the International Classification of Headache Disorders, which is currently in its third edition (ICHD-3), and the tenth edition of the World Health Organization’s International Classification of Diseases (ICD-10) [1, 2]. ICHD-3 diagnostic criteria for episodic migraine with and without aura are shown in Table 2.1.

Post-traumatic headache (PTH) attributed to head trauma is now well defined in The International Classification of Headache Disorders (ICHD-3 beta), but the treatment still remains a significant enigma for headache experts. Despite a high prevalence and significant disease burden the underlying mechanisms are widely unknown and management is not evidence-based and complicated. This chapter aims to cover the diagnostic challenges and the existing treatment strategies for both the acute and persistent PTH.

Chapter 4 in the current International Classification of Headache Disorders (ICHD-IIIβ) includes a number of primary headache disorders that are clinically heterogeneous [1]. In general, their pathogenesis is still poorly understood and their treatments are suggested on the basis of anecdotal reports or uncontrolled trials. The chapter includes some clinical entities, such as primary stabbing headache or hypnic headache, that are primary in most cases, together with, for instance, primary thunderclap headache or primary cough headache, entities where our efforts must be directed to rule out a secondary origin. Two headache disorders which appeared in Chap. 13 in the previous Classification have now been moved to this chapter: cold stimulus headache and external-pressure headache, while hemicrania continua has been now moved to Chap. 3 as evidence indicates that it rightly belongs to trigeminal autonomic cephalalgias [1].

This chapter reviews the evaluation and diagnosis of children and adolescents who present with episodic migraine and its subtypes. The International Classification of Headache Disorders, third is used to describe the pediatric and migraine equivalents.