Joshua M. Cohen

Migraine and vestibular symptoms--identifying clinical features that predict "vestibular migraine".

Background.— Migraine and symptoms that may suggest a vestibular disorder (referred to herein broadly as vestibular symptoms—VS) often co‐exist. In part due to a lack of standardized diagnostic criteria, this relationship remains unknown to many physicians.

Fremanezumab as Add-On Treatment for Patients Treated With Other Migraine Preventive Medicines

Fremanezumab (formerly TEV‐48125) is a monoclonal antibody directed against calcitonin‐gene‐related peptide (CGRP), a validated target for migraine preventive therapy. In two previous phase 2 studies, fremanezumab administered once every 28 days for 12 weeks was found to be effective and safe as a preventive treatment for patients suffering from episodic migraine (EM) and chronic migraine (CM).

The ABMS MOC Part III Examination: Value, Concerns, and Alternative Formats.

This article describes the presentations and discussions at a conference co-convened by the Council on Medical Education of the American Medical Association (AMA) and by the American Board of Medical Specialties (ABMS). The conference focused on the ABMS Maintenance of Certification (MOC) Part III Examination. This article, reflecting the conference agenda, covers the value of and evidence supporting the examination, as well as concerns about the cost of the examination, and—given the current format—its relevance. In addition, the article outlines alternative formats for the examination that four ABMS member boards are currently developing or implementing. Lastly, the article presents contrasting views on the approach to professional self-regulation. One view operationalizes MOC as a high-stakes, pass–fail process while the other perspective holds MOC as an organized approach to support continuing professional development and improvement. The authors hope to begin a conversation among the AMA, the ABMS, and other professional stakeholders about how knowledge assessment in MOC might align with the MOC program’s educational and quality improvement elements and best meet the future needs of both the public and the physician community.

Young Adults With Headaches: The Transition From Adolescents to Adults.

Migraine is a common condition that for many begins in childhood and may progress over the course of ones life. The transition from adolescence to adulthood is a critical time for those who suffer from migraine and can be marked by a variety of important considerations for the patient and practitioner. Medication choices may be a challenge during adolescent years as Food and Drug Administration (FDA) approved options are few and many more studies are needed to understand the benefits and risks of use of these agents in adolescents. However, as patients transition to adulthood, FDA approved options and the level of evidence improve significantly. Late adolescents may also struggle with a variety of psychiatric comorbidities that may simultaneously create challenges in determining treatment but also open opportunities to manage multiple comorbidities and address underlying depression, anxiety, and behavioral issues. For late adolescent girls, the beginning of sexual activity, onset of gynecologic conditions, or presence of irregular or painful menses may raise questions regarding the use of oral contraceptives (OCs). Given data on the risks of these medications in women with migraine, especially those with aura or those who smoke, important conversations between physicians and their migraine patients can help risk stratify and determine the risk/benefit profile for the potential use of these agents. Much more data are needed to fully understand the transition from adolescence to adulthood for those suffering with migraine and this article seeks to shed light on the limited understanding currently available in established literature.

Headache and Dizziness: How to Differentiate Vestibular Migraine from Other Conditions.

Headache and dizziness are two of the most common symptoms prompting medical evaluation and may be seen in many primary and secondary headache and dizziness syndromes. Many of these disease processes share common characteristics making determination of the diagnosis extremely challenging. As more is understood about the concurrence of these symptoms, new diagnostic considerations have emerged, and the beta version of the latest edition of the International Classification of Headache Disorders describes a new entity termed vestibular migraine that may affect many patients presenting with headache and dizziness. This article examines the epidemiology of headache and dizziness, describes the presenting features of patients with conditions which often express these two symptoms, discusses recommendations for evaluation and testing for these patients, and serves to aid in the differentiation between vestibular migraine and other potential diagnoses.

A Case of Barotrauma‐Induced Post‐Traumatic Headache With a Cluster Headache Phenotype

INTRODUCTION We present a case of a 49-year-old man who presents with post-traumatic headache with a cluster phenotype following barotrauma. Informed consent for publication has been obtained from the patients reported in this manuscript. According to the International Headache Society Classification ICHDIII, cluster headaches can be defined as part of the trigeminal autonomic cephalagias. Cluster headaches are severe attacks of strictly unilateral pain with a duration of 15-180 minutes and a frequency that ranges from once every other day to eight times per day. Attacks are associated with conjunctival injection, lacrimation, rhinorrhea, sweating, miosis, ptosis, nasal congestion, and eyelid edema. Specifically, episodic cluster headaches are attacks occurring in bouts lasting up to 1 year, broken up by pain-free remission periods lasting 1 month or longer. Barotrauma refers to injury sustained from failure to equalize the pressure of an air-containing space with that of the surrounding environment. It can be defined as rapid or dangerous changes in air pressure, affecting enclosed cavities within the body such as the sinuses, known as sinus barotrauma. The most common examples of barotrauma occur in air travel and scuba diving, but the degree of pressure changes are much more dramatic during scuba diving. Barotrauma can affect several different areas of the body, including the ear, face, and lungs. Our patient suffered from serious sinus barotrauma as a result of a deep diving accident and experienced gushing blood out of the left nostril at the time of the incident. Post-traumatic headache is defined by the International Headache Society Classification ICHDIII beta as a headache attributed to trauma or injury to the head and/or neck. The traumatic injury is described as a structural or functional injury resulting from the action of external forces on the head. These can include, but are not limited to, the head striking or being struck by an object, penetration of the head by a foreign body, and forces generated from blasts or explosions. The headache must also be experienced within 7 days after the injury to the head, the regaining of consciousness following the Address all correspondence to J.M. Cohen, The Headache Institute and Adolescent Headache Center, Mount Sinai Roosevelt, 425 W. 59th Street, Suite 4A, NY 10019, USA.