Department of Neurology

Milestone 10: Headache Syndromes — Patient Care

Specifics about each Level and each Item:  What you do you need to know:

Level 2

• Diagnoses and manages common headache syndromes

Migraine without aura
Migraine with “classic” auras
Tension-type headaches
Status migrainosus

• Identifies headache emergencies

CNS infection (meningitis and encephalitis)
SAH
Cerebral Venous Thrombosis
Giant Cell Arteritis
Hydrocephalus
Pituitary Apoplexy 

Level 3

• Recognizes uncommon headache syndromes

Cluster and other TACs
Trigeminal neuralgia/atypical facial pain
Occipital neuralgia/Cervicogenic/TMJ
Secondary headaches (due to OSA, medication adverse effects, anemia)
Low pressure headache (post spinal HA and spontaneous)
High pressure headache (Idiopathic Increased Intracranial Pressure; Pseudotumor Cerebri)

• Diagnoses and manages headache emergencies

CNS infection (meningitis and encephalitis)
SAH
Cerebral Venous Thrombosis
Giant Cell Arteritis
Hydrocephalus
Pituitary Apoplexy

Level 4 

• Diagnoses and manages uncommon headache syndromes

Cluster and other TACs
Trigeminal neuralgia/atypical facial pain
Occipital neuralgia/Cervicogenic/TMJ
Secondary headaches (due to OSA, medication adverse effects, anemia)
Low pressure headache (post spinal HA and spontaneous)
High pressure headache (Idiopathic Increased Intracranial Pressure; Pseudotumor Cerebri)

Resources for each Level:

Level 2 Resources:

 The International Headache Classification (ICHD-2): http://www.ihs-classification.org/en/

 American Headache Society: Resident and Fellow Section: http://www.americanheadachesociety.org/residents_fellows_students/medical_student_headache_cases/

 Holland S., Silberstein S.D., Frietag F., et al.  Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society.  Neurology 2012;78;1337.

 Holland S., Silberstein S.D., Frietag F., et al.  Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society.  Neurology 2012;78;1346.

Migraine Diagnosis and Pathophysiology.  Ward, Thomas N.  CONTINUUM: Lifelong Learning in Neurology. 18(4, Headache):753-763, August 2012.

Acute and Preventative Treatment of Migraine.  Rizzoli, Paul B.   CONTINUUM: Lifelong Learning in Neurology. 18(4, Headache):764-782, August 2012.

Tension-Type Headache.  Kaniecki, Robert G.  CONTINUUM: Lifelong Learning in Neurology. 18(4, Headache):823-834, August 2012.

Silberstein S.D., Lipton R.B, and Dodick D.W. (editors), Wolff’s Headache, eighth edition (2008).  Giant Cell Arteritis and Polymyalgia Rheumatica, Chapter 26, pages 651-662.

Silberstein S.D., Lipton R.B, and Dodick D.W. (editors), Wolff’s Headache, eighth edition (2008).  Emergency Headache, Including Thunderclap Headache, Chapter 31, pages 747-765.

Silberstein S.D., Lipton R.B, and Dodick D.W. (editors), Wolff’s Headache, eighth edition (2008). Table 5-1:Reasons to Consider Neuroimaging for Headaches, and Table 5-2: Causes of headache that can be missed on Routine CT Scan of the Head.  Chapter 5, page 64.

Raskin NH.  Repetitive intravenous dihydroergotamine as therapy for intractable migraine.  Neurology 1986;36 (7): 995-997.

Level 3 Resources:

Schedule one half-day clinic with Dr. Steven Gunzler in Botox clinic

The International Headache Classification (ICHD-2): http://www.ihs-classification.org/en/

American Headache Society: Resident and Fellow Section: http://www.americanheadachesociety.org/residents_fellows_students/medical_student_headache_cases/

Trigeminal Autonomic Cephalalgias.  Goadsby, Peter J.   CONTINUUM: Lifelong Learning in Neurology. 18(4, Headache):883-895, August 2012.

Facial Pain, Cervical Pain, and Headache.  Graff-Radford, Steven B.   CONTINUUM: Lifelong Learning in Neurology. 18(4, Headache):869-882, August 2012.

Francis, G.J, Becker W.J., and Pringsheim, T.M.  Acute and preventative pharmacologic treatment of cluster headache.  Neurology 2010;75: 463-473.

Up-to-Date 2013: Paroxysmal hemicrania: Clinical features and diagnosis.

Up-to-Date 2013: Paroxysmal hemicrania: Treatment and prognosis.

Level 4 Resources

Schedule one half-day clinic with Dr. Steven Gunzler in Botox clinic

Migraine in Women.  Brandes, Jan L.   CONTINUUM: Lifelong Learning in Neurology. 18(4, Headache):835-852, August 2012.

Migraine and Motion Sensitivity.  Furman, Joseph M.   CONTINUUM: Lifelong Learning in Neurology. 18(4, Headache):1102-1117, August 2012.

Medication-Overuse Headache.  Tepper, Stewart J.   CONTINUUM: Lifelong Learning in Neurology. 18(4, Headache):807-822, August 2012.

Silberstein S.D., Lipton R.B, and Dodick D.W. (editors), Wolff’s Headache, eighth edition (2008).  Headaches in women, Chapter 28, pages 691-710.