Headache: Disorders and Treatment in Distinct and Diverse Patient Populations

I am honored to serve as the guest medical editor of this issue of Practical Neurology. Readers are likely aware that headaches are not a unique phenomenon, and that with a global prevalence of 96%, we all will likely at some point suffer from a headache. Tension-type headaches are the most common primary headache disorder seen (40% active prevalence) with migraine as the second (10% active prevalence) most common. Owing to associated disability seen with this condition, migraine is the most frequent headache disorder treated by neurologists. Headaches do not discriminate against age –even colic has been suggested as one early expression of migraine–nor race, gender, sexual orientation, or socioeconomic status, but they can have different presentations, impacts, and outcomes in each of these populations. Therefore, the treatment and management plan should be individualized to factor in determinants of health unique to your patient. This month’s issue is organized to take you through the lifespan, focusing on the prevalent headaches in each age group and in unique populations.

Dr. Jennifer Robblee begins with Management of Headache in Pregnant Women. Although the first steps in migraine and headache treatment during pregnancy are appropriately conservative, this approach often may be insufficient. Dr. Robblee provides a fantastic review of the safety and efficacy of both guideline-based treatments along with off-label treatment options. Transitioning nicely into the next stage of life is the article by Drs. Laura Brickman and Lileth Mondok which covers Migraine in Children and Adolescents. Here the authors discuss the nuances and differences between migraine presentation in children and adolescents versus adults. Additionally, they address the disability, safety of treatments and other periodic syndromes related to migraine which are unique to this patient population.

In Headache in Men, Dr. James Murtha dives into the distinctive features of migraine in men and the possible disparities seen in migraine care. Cluster headache, which is often viewed as a male headache disorder in contrast to migraine which affects more females than males, is reviewed as well. This transitions into the next article, Cluster Headache and Other Trigeminal Autonomic Cephalalgias (TAC) by Drs. Brian Johnson and Juliette Preston. This article focuses on headache disorders often confused with cluster headaches, such as migraine and trigeminal neuralgia (TN), which often can present with subtle autonomic symptoms. As treatment differs for TACs, migraine, TN, and other headache disorders, it’s imperative to distinguish subtleties between clinical features and diagnostic criteria to initiate appropriate management and to help patients achieve rapid pain relief.

Next, Drs. Cynthia Armand, Clarimar Borrero-Mejias, Anna Pace, and Juliana VanderPluym navigate through an important topic in their article, Update on Underrepresented Populations in Headache Medicine: What Is Known and Care Considerations. Social determinants of health to consider in headache practice include ethnicity, orientation, geography, and socioeconomic and insurance status, all of which are reviewed in this article along with caring for these underserved and vulnerable communities. Another population that warrants special consideration is older adults. Drs. Stern, Anderson, Roberton, and Halker Singh address this unique group in their article on Headache in Older Adults.

And last, but certainly not least, Drs. Carrie Dougherty and Minal Patel take us through a wonderful case-based review of Headaches Not to Miss Regardless of Patient Population: Thunderclap Headache in the Emergency Department. This article addresses secondary headaches which if diagnosed early can help patients avert significant disability and even mortality.

I want to sincerely thank the authors for sharing their passion and expertise in headache medicine with us in this issue of Practical Neurology. Now sit back, grab a cup a coffee or other beverage of your choice (unless it’s a migraine trigger, of course), as there’s a lot to enjoy in this issue.