Revisiting the ICHD-3 criteria for headache attributed to mild traumatic injury to the head: Insights from the Toronto Concussion Study Analysis of Acute Headaches Following Concussion.

Background: There is limited prospective data on the prevalence, timing of onset, and characteristics of acute headache following concussion/mild traumatic brain injury.

Methods: Adults diagnosed with concussion (arising from injuries not related to work or motor vehicle accidents) were recruited from emergency departments and seen within one week post injury wherein they completed questionnaires assessing demographic variables, pre-injury headache history, post-injury headache history, and the Sport Concussion Assessment Tool (SCAT-3) symptom checklist, the Sleep and Concussion Questionnaire (SCQ) and mood/anxiety on the Brief Symptom Inventory (BSI).

Results: A total of 302 participants (59% female) were enrolled (mean age 33.

A real-world, observational study of erenumab for migraine prevention in Canadian patients.

Objectives: To assess real-world effectiveness, safety, and usage of erenumab in Canadian patients with episodic and chronic migraine with prior ineffective prophylactic treatments.

Background: In randomized controlled trials, erenumab demonstrated efficacy for migraine prevention in patients with ≤4 prior ineffective prophylactic migraine therapies. The "Migraine prevention with AimoviG: Informative Canadian real-world study" (MAGIC) assessed real-world effectiveness of erenumab in Canadian patients with migraine.

Real-world persistence of erenumab for preventive treatment of chronic and episodic migraine: Retrospective real-world study.

Objective: To describe the real-world treatment persistence (defined as the continuation of medication for the prescribed treatment duration), demographics and clinical characteristics, and treatment patterns for patients prescribed erenumab for migraine prevention in Canada.

Background: The effectiveness of prophylactic migraine treatments is often undermined by poor treatment persistence. In clinical trials, erenumab has demonstrated efficacy and tolerability as a preventive treatment, but less is known about the longer term treatment persistence with erenumab.

Headache Hygiene in Pediatrics: Brushing Up on the Basics.

Headache hygiene refers to self-management behaviors and practices aimed at reducing headache-related disability and improving self-efficacy. Although self-management interventions have an established place in the management of a wide range of chronic conditions, there is still not a standardized approach to this in pediatric headache. In this article, we focus on headache hygiene approaches including education, lifestyle interventions, and psychologic interventions.

The Non-Inferiority Margins in Migraine Research (NIMM) Survey.

Objectives: To survey experts in Headache Medicine on their opinions regarding appropriate non-inferiority margins for outcomes commonly used in migraine research.

Methods: Members of the American Headache Society and the Canadian Headache Society were invited to participate in the Non-Inferiority Margins in Migraine Research (NIMM) survey. Adult and child neurologists with expertise in Headache Medicine were eligible to participate.

Canadian Headache Society systematic review and recommendations on the treatment of migraine pain in emergency settings.

Background: There is a considerable amount of practice variation in managing migraines in emergency settings, and evidence-based therapies are often not used first line.

Methods: A peer-reviewed search of databases (MEDLINE, Embase, CENTRAL) was carried out to identify randomized and quasi-randomized controlled trials of interventions for acute pain relief in adults presenting with migraine to emergency settings. Where possible, data were pooled into meta-analyses.

Metabolic headaches.

This article discusses headaches secondary to disorders of homeostasis, which include headaches attributed to (1) hypoxia and/or hypercapnia (high-altitude, diving, or sleep apnea), (2) dialysis, (3) arterial hypertension (pheochromocytoma, hypertensive crisis without hypertensive encephalopathy, hypertensive encephalopathy, preeclampsia or eclampsia, or autonomic dysreflexia), (4) hypothyroidism, (5) fasting, (6) cardiac cephalalgia, and (7) other disorder of homeostasis. Clinical features and diagnosis as well as therapeutic strategies are discussed for each headache type.

Canadian Headache Society Guideline: acute drug therapy for migraine headache.

Objectives: The primary objective of this guideline is to assist the practitioner in choosing an appropriate acute medication for an individual with migraine, based on current evidence in the medical literature and expert consensus. It is focused on patients with episodic migraine ( headache on ≤ 14 days a month).

Methods: A detailed search strategy was used to find a relevant meta-analyses, systematic reviews and randomized double-blind controlled trials.

Canadian Headache Society guideline for migraine prophylaxis.

Objectives: The primary objective of this guideline is to assist the practitioner in choosing an appropriate prophylactic medication for an individual with migraine, based on current evidence in the medical literature and expert consensus. This guideline is focused on patients with episodic migraine (headache on ≤ 14 days a month).

Methods: Through a comprehensive search strategy, randomized, double blind, controlled trials of drug treatments for migraine prophylaxis and relevant Cochrane reviews were identified.

Cost of health care among patients with chronic and episodic migraine in Canada and the USA: results from the International Burden of Migraine Study (IBMS).

Objective: To evaluate and compare healthcare resource use and related costs in chronic migraine and episodic migraine in the USA and Canada.

Background: Migraine is a common neurological disorder that produces substantial disability for sufferers around the world. Several studies have quantified overall costs associated with migraine in general, with recent estimates ranging from $581 to $7089 per year.

Botulinum toxin type A and acute drug costs in migraine with triptan overuse.

Background: Patients with chronic migraine and medication overuse are significant consumers of health care resources.

Objective: To determine whether botulinum toxin type A prophylaxis reduces the cost of acute migraine medications in patients with chronic migraine and triptan overuse.

Methods: In this multicenter, open-label study, patients with chronic migraine (≥ 15 headache days/month) who were triptan overusers (triptan intake ≥ 10 days/month for ≥ 3 months) received botulinum toxin type A (95-130 U) at baseline and month three.

Patterns of care and outcomes after computed tomography scans for headache.

Background: concerns exist about potential overuse of computed tomography (CT) scans for headache in ambulatory care.

Methods: we sought to examine health services use, brain tumor diagnosis, and death during the year after CT scanning for headache by linking records of an audit of 3930 outpatient CT brain scans performed in 2005 in Ontario, Canada, to administrative databases.

Results: of 623 patients receiving CT scans for a sole indication of headache, few (2.

Headaches attributable to infectious diseases.

Headache is the most common symptom that humans experience. While the vast majority of headaches are due to benign primary headache disorders, a small but important minority of headaches are due to secondary causes. Whereas significant emphasis is placed on educating physicians regarding prompt recognition of subarachnoid hemorrhage and headaches secondary to brain tumors, attention toward headaches secondary to infectious causes is often neglected.

From psychoneurosis to ICHD-2: an overview of the state of the art in post-traumatic headache.

Post-traumatic headache (PTH) is an important public health issue - head injuries are common, headache is the most common sequelae of head injuries, and PTH can be particularly disabling. Fortunately, for most individuals with PTH, the headache gradually dissipates over a period of several days, weeks, or months either spontaneously or aided by non-pharmacologic and/or pharmacologic management. Regrettably, for a minority of head-injured individuals, the PTH is intractable and disabling despite aggressive and comprehensive treatment.

The metabolic headaches.

This review discusses headaches secondary to disorders of homeostasis, formerly known as "headaches associated with metabolic or systemic diseases." They include the headaches attributed to 1) hypoxia and/or hypercapnia (high altitude, diving, sleep apnea); 2) dialysis; 3) arterial hypertension; 4) hypothyroidism; 5) fasting; and 6) cardiac cephalalgia. For each headache type, we discuss the clinical features and diagnosis, as well as therapeutic strategies.

Migraine prevalence, diagnosis, and disability.

The goal of the Canadian Migraine Forum was to work towards improving the lives of Canadians with migraine by reducing their migraine-related disability. This paper reviews the epidemiology and diagnosis of migraine, and the effects of migraine on health related quality of life. Many patients with migraine do not consult a physician for their headaches, and when they do they often do not receive a correct diagnosis.

An approach to the patient with painful ophthalmoplegia, with a focus on Tolosa-Hunt syndrome.

The differential diagnosis of painful ophthalmoplegia is extensive and consists of numerous sinister etiologies, including neoplasms (ie, primary intracranial tumors, local or distant metastases), vascular (eg, aneurysm, carotid dissection, and carotid-cavernous fistula), inflammatory (ie, orbital pseudotumor, giant cell arteritis, sarcoidosis, and Tolosa-Hunt syndrome), and infectious etiologies (ie, fungal and mycobacterial), as well as other miscellaneous conditions (ie, ophthalmoplegic migraine and microvascular infarcts secondary to diabetes). A systematic approach to the evaluation of painful ophthalmoplegia can lead to prompt recognition of serious disorders that can be associated with significant morbidity or mortality if left untreated. Inflammatory conditions such as Tolosa-Hunt syndrome and orbital pseudotumor are highly responsive to corticosteroids but should be diagnoses of exclusion.

Migraine and white matter hyperintensities.

Patients with migraine are at increased risk for white matter hyperintensities detected on magnetic resonance imaging. The presence of nonspecific white matter hyperintensities may cause uncertainty for physicians and anxiety for patients. The pathophysiology and long-term consequences of these lesions are unknown.

Duration of migraine is a predictor for response to botulinum toxin type A.

Objective: To identify the clinical characteristics and/or injection parameters that predict a favorable response to botulinum toxin type A in patients with episodic and chronic migraine.

Background: There is emerging scientific and clinical evidence to support the utility of botulinum toxin type A (BoNT-A) in the prophylaxis of episodic and chronic migraine headache. However, the patient characteristics and injection strategies that predict a favorable treatment response are unknown.

Management of chronic daily headache: challenges in clinical practice.

Chronic daily headache (CHD) refers to a category of headache disorders that are characterized by headaches occurring on more than 15 days per month. This category is subdivided into long- and short-duration (>4 or <4 hours) CDH disorders based on the duration of individual headache attacks. Examples of long-duration CDH include transformed migraine (TM), chronic migraine (CM), new daily persistent headache (NDPH), acute medication overuse headache, and hemicrania continua (HC).