Headache & Migraine: Tailored Treatments to Maximize Outcomes

It has been an honor to work with the wonderful team at Practical Neurology to develop this exciting issue focusing on practical ways to improve your headache medicine practice. This issue explores opportunities for augmenting clinical practice to incorporate acute and prevention procedures, standardized protocols, and new treatments. A special thank you goes out to the innovative leaders in headache medicine who combined their expertise to provide insight into the nuances of a modern, evidence-based headache practice. We review the most current literature to guide providers in any care setting, from private practice to the hospital, with recommendations for improving care in the ever-evolving field of headache.

Dr. McPherson, Dr. Rademacker, and Dr. Bajwa provide a review of important considerations for headache associated with the cervical spine. This article offers valuable insight through the eyes of an innovative physical therapist and chiropractor, Dr. McPherson and Dr. Rademacker, respectively, who are leaders in their respective fields. In addition, Dr. Bajwa brings together his expertise in pain management relating to the cervical spine. These combined perspectives offer a holistic approach to examining and treating cervicogenic headache.

There is an established link between headache and obesity, with evidence showing that weight loss can improve headache. Dr. McVige, Dr. Bowe, Lanie Masset, and Abby Graff explore the evidence for weight management and headache relief by reviewing current research evaluating diet, exercise, pharmaceutical treatments, as well as surgical interventions. Within my own practice, I have noted a desperate need for clinical guidance on how to approach weight management in patients with headache. The goal of this article is to highlight available evidence and point out the many gaps in knowledge, with the intent to guide future research. The hope is that this article may allow clinicians to initiate the difficult conversations about weight loss as it relates to headache.

Dr. Khoury, Dr. Saikali, Harshini Sirvisetty, Dr. Hauser Chatterjee, Dr. Dominguez Moreno, and Dr. Conger-Love are an astute group of headache procedural experts. They present a review of the most current evidence for non-botulinum toxin injection therapies (pericranial nerve blocks and trigger points) and their efficacy in treating adult and pediatric headache. Although these therapies are currently considered standard practice, there is a paucity of large scale, randomized trials assessing efficacy in headache. This article eloquently summarizes the literature, while offering beautiful visual aids to allow the reader to both better understand and incorporate these procedures into their own practice. The hope is that this article may provide incentive for further large-scale studies, as standard practice suggests these procedures can provide benefit to headache patients.

GUEST MEDICAL EDITOR’S FEATURED ARTIST:
CARLY GLASHAUSNER

For this issue of Practical Neurology, Dr. McVige would like to showcase the art of one of her patients: Carly Glashausner, a Junior at the Massachusetts College of Art and Design. Originally from Buffalo, NY, Carly has used painting as a source of joy for as long as she can remember, and she is particularly drawn to portraits because they are a powerful way to express identity. “I found out later in life that I am autistic, which helped me understand myself better.” According to Carly, the featured self-portrait “depicts the chaos that my mind went through while learning to cope with my difficulties.”

Outpatient infusion centers can provide essential acute and preventive care for headache. Dr. Mechtler, Joseph Hirtreiter, Chris Raylea, Dr. Denes, Lanie Masset, and Christine Mann comprehensively present the vast amount of literature supporting intravenous (IV) infusion therapies as an alternative headache treatment when conventional pharmaceuticals prove ineffective. Dr. Metchler is the highly esteemed Medical Director of DENT Neurologic Insitute (DNI) and Christine Mann is the Executive Director of DNI Infusion Centers. Together with their team, they share valuable insight into developing and managing a successful outpatient infusion center.

The transition from childhood to adulthood is often tumultuous as a person learns to mature and leave the protective oversight of their family and pediatrician. The final article by an impressive group—Dr. Bazarsky, Dr. Zayne Washington III, Dr. Scott, Dr. Strauss, and Dr. O’Brien—explores ways to optimize and improve the transition of pediatric patients into adult headache practice. This transition can be daunting for patients, parents, and clinicians. Smooth passage requires communication, coordination, and support from all parties. This esteemed group of pediatric and neurologic professionals does an amazing job of highlighting the challenges young people face while offering solutions and thorough yet compassionate protocols.

I would like to express my extreme gratitude to these brilliant authors who made this isssue possible. The landscape of headache medicine is continuously advancing, and knowing how to propel your practice forward will be the key to success for you and your patients.