Kathleen Farmer

Primary Headaches: A Convergence Hypothesis

After reviewing the historic differentiation between migraine and tension‐type headache, the authors note that the similarities between these two types of primary headaches outweigh the differences, and so hypothesize that these headaches share a common pathophysiology. The convergence hypothesis for primary headaches links the clinical features of an evolving headache to current pathophysiological models. The authors suggest that successive symptoms experienced clinically reflect an escalating pathophysiological process, beginning with the premonitory period and progressing into tension‐type headache and, if uninterrupted, finally into migraine. The clinical manifestations of other headache types, such as so‐called sinus headache or temporomandibular headache, may also be explained by this model. A convergence hypothesis for primary headaches has important implications for earlier recognition, diagnosis, and treatment.

A Multi-Center Double-Blind Pilot Comparison of OnabotulinumtoxinA and Topiramate for the Prophylactic Treatment of Chronic Migraine

(Headache 2011;51:21‐32)

Understanding the patient with migraine: the evolution from episodic headache to chronic neurologic disease. A proposed classification of patients with headache.

Traditionally, episodic primary headache disorders are characterized by a return of preheadache (normal) neurologic function between episodes of headache. In contrast, patients with chronic headache often do not return to normal neurologic function between headache attacks. This article proposes that the evolution from episodic migraine to chronic headache may parallel the neurologic disruption observed during the progression of an acute migraine attack and that changes in baseline neurologic function between episodes of headache may be a more sensitive indicator of headache transformation than headache frequency alone. Early recognition of nonheadache changes in nervous system function may offer a more sensitive and specific approach to migraine prevention.

Sumatriptan Nasal Spray and Cognitive Function During Migraine: Results of an Open‐Label Study

Objective.—To examine measures of cognitive function during acute migraine, before and after treatment with sumatriptan nasal spray, 20 mg.

A Pilot Study to Measure Cognitive Efficiency During Migraine

Background and Objectives.—The measurement of cognitive efficiency during migraine has produced conflicting results primarily due to the types of tests used. The objectives of this pilot study were two‐fold: to measure cognitive efficiency during migraine, compared to a migraine‐free period, and to evaluate the effects of therapy with a 5‐HT1 agonist (sumatriptan injection, 6 mg) on the cognitive efficiency of migraineurs during a migraine.

Nurse-Based Education: An Office-Based Comparative Model for Education of Migraine Patients

Background.— A person with migraine needs to be prepared to make therapeutic decisions on her own. For this reason, patients often need education to understand the nuisances of managing theirmigraines. In this study an educationalCD‐ROM/DVD that described the pathophysiology was utilized by nurses in an office‐based primary care setting for patient education. Outcomes from this encounter were measured.

The Bowel and Migraine: Update on Celiac Disease and Irritable Bowel Syndrome

This article explores possible relationships between migraine, irritable bowel syndrome (IBS), celiac disease (CD), and gluten sensitivity. These seemingly distinct medical entities curiously share many common epidemiological, psychosocial, and pathophysiological similarities. Considerable evidence is emerging to support a concept that experiencing significant threatening adverse events creates a state of hypervigilance in the nervous system, which associates with exaggerated response to future threats and episodic attacks of migraine and IBS. While this sensitizing response is generally considered to reside in the central nervous system, it may be possible that the initiation resides in the enteric nervous system as well. What appears to link migraine, IBS, and CD is a disease model of a genetically sensitive nervous system transformed into one that is hypervigilant, and that over time can often develop disabling and pervasive disease.

Evaluation of Sumatriptan‐Naproxen in the Treatment of Acute Migraine: A Placebo‐Controlled, Double‐Blind, Cross‐Over Study Assessing Cognitive Function

To assess the cognitive effects of acute migraine and the subsequent impact of acute treatment in a controlled setting.

Two Center, Randomized Pilot Study of Migraine Prophylaxis Comparing Paradigms Using Pre‐Emptive Frovatriptan or Daily Topiramate: Research and Clinical Implications

(Headache 2012;52:749‐764)

Acupuncture in the treatment of headache: a traditional explanation of an ancient art.

Over the past 4000 years, acupuncture has survived the test of time. Recent scientific studies posit acupuncture is an effective intervention for back and joint pain and headache, including migraine.