Solid resources for migraine

[hrandani]

Can anybody provide some pointers on where to look, what to read as far as headaches and migraines go? I've always been fascinated by migraines, and while I've tried to read a lot on the subject, the material I've found is generally very old or contradictory. I've read every thread here that came up in the search function here, but did not find any pointers on books or literature. I've found a lot of little things in various papers such as the association with foramen ovale, even one case where a stray hair in the ear caused migraines, lists of various treatments (but not why some work and others don't) but no top to bottom, in depth corpus of knowledge.

I was considering specializing in neurology, and if that happened I would definitely do headache medicine. The problem is that a lot of resources I find seem to be heavy into alternative medicine or bunk, and it's hard to separate the wheat from the chaff. I get the feeling there are a lot of very desperate people with migraines and headaches.

I'm a medical student in Mexico, and while there are still the same amount of patients with migraines as there are in the US, the attending at my school throws some calcium channel blockers and ibuprofen at most patients and call it a day. It rarely works. While the standard of care is quite different here, I feel like most doctors here hate patients with headaches because they have absolutely no clue what is going on with the patient or how to fix it. Any help would be deeply appreciated.

I'm generally looking for anything that you felt was a good resource, whether it was explaining the pathophys, the treatment, etc. Anything at all on the topic.

Thank you very much.

---

Members don't see this ad.

 

[typhoonegator]

Books tend to be necessarily a bit behind the curve of migraine science, research, abortion, and prophylaxis. Primary research is where it is at. There are several good reviews of current theories of migraine etiology out there. Here are a few citations for migraine pathogenesis and therapeutics.

I'm an intensivist now, so migraine is pretty far off my radar, but in residency I used to enjoy most of my migraineurs. There are the chronic malcontents and malingerers out there who you will never help, but you can make a big difference for some people by getting them on a good prophylactic regimen (as long as they have sufficient number of headache days per month). I used to start with propranolol, CCB or a TCA, and work from those to more exotic agents like topiramate, carbamazepine, or duloxetine. You also get to play sleuth with people about their sleep habits, caffeine intake, exercise, EtOH, etc. looking for other potential triggers/sensitizers.

I'm sure there are office practice neurologists on this forum that can offer a lot more anectodal and evidence-based information than I can.


Fenstermacher N, Levin M, Ward T. Pharmacological prevention of migraine. BMJ. 2011 Feb 18;342583.

Shevel E. The extracranial vascular theory of migraine-a great story confirmed by the facts. Headache. 2011 Mar;51(3):409-17.

Pringsheim T, Davenport WJ, Becker WJ. Prophylaxis of migraine headache. CMAJ. 2010 Apr 20;182(7):E269-76.

Lauritzen M, Dreier JP, Fabricius M, Hartings JA, Graf R, Strong AJ. Clinical relevance of cortical spreading depression in neurological disorders: migraine, malignant stroke, subarachnoid and intracranial hemorrhage, and traumatic brain injury. J Cereb Blood Flow Metab. 2011 Jan;31(1):17-35.

Liem MK, Oberstein SA, van der Grond J, Ferrari MD, Haan J. CADASIL and migraine: A narrative review. Cephalalgia. 2010 Nov;30(11):1284-9.

Freilinger T, Ackl N, Ebert A, Schmidt C, Rautenstrauss B, Dichgans M, Danek A. A novel mutation in CACNA1A associated with hemiplegic migraine, cerebellar dysfunction and late-onset cognitive decline. J Neurol Sci. 2011 Jan 15;300(1-2):160-3.

Jackson JL, Shimeall W, Sessums L, Dezee KJ, Becher D, Diemer M, Berbano E, O'Malley PG. Tricyclic antidepressants and headaches: systematic review and meta-analysis. BMJ. 2010 Oct 20;341:c5222.

 

[typhoonegator]

Please ignore the

The emoticon filter interprets "colon d" as some sort of little green man.

 

[hrandani]

I really appreciate you taking the time to put that together, I'll see if I can get someone with journal access to forward me those articles.

Would getting a copy of Wolf's Headache (2007) be useful or, like you said, outdated?

 

[typhoonegator]

Definitely a decent book, and would get you acquainted with the diagnostic criteria for differing headache types and mainstays of treatment (which sadly haven't changed a ton over the years). I don't recall how much that book goes into pathophysiology of migraine, but it probably isn't as up to date on that particular facet as periodicals will be, particularly if you are interested in genetics or overlap with SAH or PFO/stroke physiologies.

 

[Hog Daddy]

Wolff's is a great book. You will stand head and shoulders above other neurologists, who tend to skim the surface of headache diagnosis and treatment.

 

[danielmd06]

Wolff's is a great book. You will stand head and shoulders above other neurologists, who tend to skim the surface of headache diagnosis and treatment.

I love this book as well.

 

[Lesassier]

I know its 2 years earlier and a lot of cross-over in terms of contributing authors but how does The Headaches Oleson, etal compare to Wolff?

 

[95439]

Books tend to be necessarily a bit behind the curve of migraine science, research, abortion, and prophylaxis. Primary research is where it is at. There are several good reviews of current theories of migraine etiology out there. Here are a few citations for migraine pathogenesis and therapeutics.

I'm an intensivist now, so migraine is pretty far off my radar, but in residency I used to enjoy most of my migraineurs. There are the chronic malcontents and malingerers out there who you will never help, but you can make a big difference for some people by getting them on a good prophylactic regimen (as long as they have sufficient number of headache days per month). I used to start with propranolol, CCB or a TCA, and work from those to more exotic agents like topiramate, carbamazepine, or duloxetine. You also get to play sleuth with people about their sleep habits, caffeine intake, exercise, EtOH, etc. looking for other potential triggers/sensitizers.

I'm sure there are office practice neurologists on this forum that can offer a lot more anectodal and evidence-based information than I can.


Fenstermacher N, Levin M, Ward T. Pharmacological prevention of migraine. BMJ. 2011 Feb 18;342583.

Shevel E. The extracranial vascular theory of migraine-a great story confirmed by the facts. Headache. 2011 Mar;51(3):409-17.

Pringsheim T, Davenport WJ, Becker WJ. Prophylaxis of migraine headache. CMAJ. 2010 Apr 20;182(7):E269-76.

Lauritzen M, Dreier JP, Fabricius M, Hartings JA, Graf R, Strong AJ. Clinical relevance of cortical spreading depression in neurological disorders: migraine, malignant stroke, subarachnoid and intracranial hemorrhage, and traumatic brain injury. J Cereb Blood Flow Metab. 2011 Jan;31(1):17-35.

Liem MK, Oberstein SA, van der Grond J, Ferrari MD, Haan J. CADASIL and migraine: A narrative review. Cephalalgia. 2010 Nov;30(11):1284-9.

Freilinger T, Ackl N, Ebert A, Schmidt C, Rautenstrauss B, Dichgans M, Danek A. A novel mutation in CACNA1A associated with hemiplegic migraine, cerebellar dysfunction and late-onset cognitive decline. J Neurol Sci. 2011 Jan 15;300(1-2):160-3.

Jackson JL, Shimeall W, Sessums L, Dezee KJ, Becher D, Diemer M, Berbano E, O'Malley PG. Tricyclic antidepressants and headaches: systematic review and meta-analysis. BMJ. 2010 Oct 20;341:c5222.

I'm not as uptodate as I was a year ago, but the CNS Hypovolemic Syndrome theory seemed to be gaining some ground then. Is that still valid in your estimation? I ask migraineurs all the time what works for them and I've heard good things about the suboccipital nerve block, when meds fail.