Preface

This issue of Neurologic Clinics reviews migraine and other primary headaches, one of the most common disorders seen by neurologists (accounting for about 20% of the general neurologist's practice), which affects 90% of the population and is the cause of 90% of all headaches. Secondary headache disorders were reviewed in Neurologic Clinics in 2004. Primary headache manifestations vary from the most mundane to among the most interesting in all of neurology. Migraine and tension-type headaches affect huge portions of the population, at times with significant impairment, with about 35 million persons yearly having attacks in the United States. Tension-type headaches have a lifetime prevalence of up to 78%. Neurologists may be particularly interested in migraine as over 50% of neurologists themselves are migraineurs.

Many of the neurologist's patients (and often the bane of their practice) are the 4-5% of the population with chronic daily headache and 0.5% with severe daily headaches who may be unresponsive to treatment in perhaps 30% of cases. Among the trigeminal autonomic cephalagias, headaches can range from the uncommon, such as cluster headache with a prevalence only as high as 2 out of 1000 people, to the extremely rare short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing. Other uncommon primary headaches are equally fascinating such as stabbing, cough, exertional, sexual, thunderclap, hypnic, and new daily persistent headaches.

This issue reviews the following topics: the epidemiology, burden and comorbidities of migraine; pathophysiology of migraine; transient neurologic dysfunction in migraine; vestibular migraine; diagnostic testing for migraine and other primary headaches; acute treatment of migraine; preventive migraine treatment; behavioral medicine for migraine; chronic migraine; pediatric migraine; women and migraine; the migraine association with cardiac anomalies, cardiovascular disease and stroke; tension-type headache; trigeminal autonomic cephalalgias; and other primary headaches. I hope this issue will update your knowledge of this exciting and rapidly expanding field and further your interest in headaches (and the subspecialty of headache medicine for which you can now gain subspecialty certification through the United Council for Neurologic Subspecialties).

Although the pathophysiology of primary headaches is poorly understood, effective treatments may often be available, but better treatments are clearly needed. Neurologists, people with headaches, and their families should lobby for more government funding for headache research as annual funding for migraine research is only about $13 million in the United States and €6 million in Europe.

I thank our distinguished contributors for their outstanding articles. I also thank Don Mumford, senior developmental editor, and the Elsevier production team for an excellent job. Finally, I am grateful for the support of my wife, Marilyn, and our children, Elliott, Rochelle, and Jonathan.

Competing interests: my wife, my three children, and I are all migraineurs (but that's not why I became a neurologist).