Editorial: Vertigo and migraine: A more than two-fold connection

Cephalalgia (Impact Factor: 4.89). 07/2010; 30(7):774-6. DOI: 10.1177/0333102409355603
Source: PubMed
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Available from: Steven D Rauch
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    ABSTRACT: Chronic headaches are defined as headaches occurring more than 15 days per month for several months. In clinical practice, chronic migraine, chronic tension-type headache, hemicrania continua and new daily persistent headache are the most important ones. The differential diagnosis is usually a challenge, as it can be difficult to distinguish symptomatic variants from primary headaches. Medication overuse headache is an important differential diagnosis. Epidemiological studies show that primary forms are predominantly rare with a prevalence of less than 1%. Regarding diagnostic investigations, cerebral MRI scans are the method of choice followed by lumbar puncture. The therapeutic management has to be tailor made. Hemicrania continua is exceptional with its obligatory response to indomethacin, a fact that is crucial for the diagnosis and simultaneously represents the treatment of choice. The group of symptomatic headaches is heterogeneous. Red flags help to judge the necessity of further diagnostic tests.
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    ABSTRACT: Kopfschmerzen werden als chronisch definiert, wenn sie an mehr als 15 Tagen pro Monat über mehrere Monate auftreten. Sie stellen eine differenzialdiagnostische Herausforderung dar, da symptomatische Formen klinisch nur schwer von den primären Syndromen abzugrenzen sind. In der täglichen Praxis müssen die chronische Migräne, der chronische Kopfschmerz vom Spannungstyp, die Hemicrania continua sowie der neu aufgetretene tägliche Kopfschmerz bedacht werden. Epidemiologische Studien zeigen, dass primäre Formen mit einer Prävalenz von weniger als 1% meist selten sind. Eine wichtige Differenzialdiagnose stellt der medikamenteninduzierte Kopfschmerz dar. An apparativer Diagnostik nimmt die kranielle Magnetresonanztomographie neben der Liquorpunktion die wichtigste Rolle ein. Die Therapie der Dauerkopfschmerzen erfolgt differenziert, wobei die streng einseitige Hemicrania continua eine Sonderrolle einnimmt, da hier das obligate Ansprechen auf Indometacin diagnostisch wegweisend ist und zugleich auch die Therapie der Wahl darstellt. Die Gruppe der symptomatischen Kopfschmerzen ist heterogen, „red flags“ helfen die Notwendigkeit einer apparativen Diagnostik einzuschätzen.
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    ABSTRACT: Chronic migraine is a common and disabling complication of migraine with a population prevalence of about 2%. Emerging evidence suggests that episodic migraine and chronic migraine differ not only in degree, but also in kind. Compared with patients with episodic migraine, those with chronic migraine have worse socioeconomic status, reduced health-related quality of life, increased headache-related burden (including impairment in occupational, social, and family functioning), and greater psychiatric and medical comorbidities. Each year, approximately 2.5% of patients with episodic migraine develop new-onset chronic migraine (ie, chronification). Understanding the natural disease course, improving treatment and management, and preventing the onset could reduce the enormous individual and societal burden of chronic migraine, and thus, have become important goals of headache research. This review provides a summary of the history of nomenclature and diagnostic criteria, as well as recent studies focusing on the epidemiology, natural history, and burden of chronic migraine.
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