Larry Charleston

Expert consensus recommendations for the performance of peripheral nerve blocks for headaches - A narrative review

To describe a standardized methodology for the performance of peripheral nerve blocks (PNBs) in the treatment of headache disorders.

Trigger point injections for headache disorders: expert consensus methodology and narrative review.

To review the existing literature and describe a standardized methodology by expert consensus for the performance of trigger point injections (TPIs) in the treatment of headache disorders. Despite their widespread use, the efficacy, safety, and methodology of TPIs have not been reviewed specifically for headache disorders by expert consensus.

The Sphenopalatine Ganglion: Anatomy, Pathophysiology, and Therapeutic Targeting in Headache

The sphenopalatine ganglion (SPG) has attracted the interest of practitioners treating head and face pain for over a century because of its anatomical connections and role in the trigemino‐autonomic reflex. In this review, we discuss the anatomy of the SPG, as well as what is known about its role in the pathophysiology of headache disorders, including cluster headache and migraine. We then address various therapies that target the SPG, including intranasal medication delivery, new SPG blocking catheter devices, neurostimulation, chemical neurolysis, and ablation procedures.

Burning Mouth Syndrome: A Review of Recent Literature

Burning mouth syndrome (BMS) is a complex chronic disorder of orofacial sensation that is challenging in both diagnosis and treatment. The diagnosis of BMS is primarily one of exclusion, and recently classification of the disorder has been challenged. Although the exact pathophysiology of primary BMS is unknown, there has been a growing body of work to provide insight into the pathogenesis of the disorder over the past few years. Pharmacological treatments recently reported to have some success in BMS include anxiolytics, anticonvulsants, antidepressants, atypical antipsychotics, histamine receptor antagonist, and dopamine agonists. In addition, other therapies and treatments are being considered. This paper reports many of the most recent data related to BMS and its classification, diagnosis, impact on quality of life, pathophysiology, co-morbidities, and pharmacological and non-pharmacological treatments.

Do Trigeminal Autonomic Cephalalgias Represent Primary Diagnoses or Points on a Continuum

The question of whether the trigeminal autonomic cephalalgias (TACs) represent primary diagnoses or points on a continuum has been debatable for a number of years. Patients with TACs may present with similar clinical characteristics, and occasionally, TACS respond to similar treatments. Prima facie, these disorders may seem to be intimately related. However, due to the current evidence, it would be challenging to accurately conclude whether they represent different primary headache diagnoses or the same primary headache disorder represented by different points on the same continuum. Ultimately, the TACs may utilize similar pathways and activate nociceptive responses that result in similar clinical phenotypes but “original and initiating” etiology may differ, and these disorders may not be points on the same continuum. This paper seeks to provide a brief comparison of TACs via diagnostic criteria, secondary causes, brief overview of pathophysiology, and the use of some key treatments and their mechanism of actions to illustrate the TAC similarities and differences.

Is sinus disease the cause of my headaches? An update on sinus disease and headache.

The interplay between head pain caused by sinus disease and primary headaches is complex. Classification of secondary headaches, attributed to disorders of the nose or paranasal sinuses has been recently updated. New treatments including office- based procedures are emerging for patients with chronic sinusitis. This paper briefly reviews sinus disease and headache.

Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache SocietyAuthor Response

EVIDENCE-BASED GUIDELINE UPDATE: NSAIDs AND OTHER COMPLEMENTARY TREATMENTS FOR EPISODIC MIGRAINE PREVENTION IN ADULTS: REPORT OF THE QUALITY STANDARDS SUBCOMMITTEE OF THE AMERICAN ACADEMY OF NEUROLOGY AND THE AMERICAN HEADACHE SOCIETY Larry Charleston IV, Grand Rapids, MI: Holland et al.1 highlighted the evidence of complementary treatments for the prevention of episodic migraine. There are a few natural supplements used in the prevention of migraine or its associated symptoms that were not classified in these guidelines. A review of additional natural supplements may be worthy of examination and classification based on their respective evidence. One underpowered, randomized, controlled trial of 600 mg/day of -lipoic acid (thioctic acid) showed a strong trend for decreased monthly attack frequency (p 0.06). Within-group analysis showed significant reduction in attack frequency, headache days, and headache severity in the treatment group.2 Vitamin E effectively reduced the severity of headache pain, abortive headache medication usage, functional disability, and associated migraine symptoms (phonophobia, photophobia, and nausea) in pure menstrual migraine in a randomized, controlled trial.3 The authors recommended a dosage of 400 IU for 5 days starting 2 days prior to menses. In an open, preliminary trial, a combination of 60 mg Ginkgo Biloba Terpenes Phytosome, 11 mg coenzyme Q10, and 8.7 mg vitamin B2 (Migrasoll) was effective in reducing both aura frequency and duration in the study population.4

Migraine Care Challenges and Strategies in US Uninsured and Underinsured Adults: A Narrative Review, Part 1

To review the scope of the problem facing individuals with migraine who are under‐ or uninsured. In this first of a 2‐part narrative review, we will explore migraine epidemiology and the challenges that face this vulnerable population.

Do racial/ethnic disparities exist in recommended migraine treatments in US ambulatory care?:

Background Racial disparities in migraine have been reported in the US. Migraine in African Americans (AA) is more frequent, more severe, more likely to become chronic and associated with more depression and lower quality of life compared to non-Hispanic Whites (NHW). It is possible that racial differences in prescribing practices contribute to these differences, but little is known about the quality of migraine prescribing patterns in the US or whether racial differences exist. Objective To determine if racial differences in quality of migraine medical prescription care exist. Methods We used data from the National Ambulatory Medical Care Survey to estimate differences in the use of migraine prophylactic and abortive medications by race. Quality of migraine care was defined using the American Academy of Neurology Headache Quality Measure Set (AAN-HQMS). Patients were assigned to one of four categories representing the overall quality of evidence for their abortive and prophylactic medications using the AAN-HQMS. We hypothesized that there would be suboptimal migraine treatment in minority populations. Racial comparisons were made using descriptive statistics after applying NAMCS survey weights. Results Two thousand, eight hundred and sixty visits were included in the study, representing approximately 50 million migraine visits in the US from 2006–2013. In all, 41.3% of AA, 40.8% of NHW, and 41.2% of Hispanic (HI) patients received no prophylactic treatments (p = 0.99). A total of 18.8% of AA patients, 11.9% of NHW patients, and 6.9% of HI patients received exclusively Level A prophylaxis (p = 0.30). A total of 47.1% of AA patients, 38.2% of NHW patients, and 36.3% of HI patients received no abortive treatments (p = 0.23). In total, 15.3% of AA patients, 19.4% of NHW patients, and 17.7% of HI patients received any Level A abortives (i.e. triptans or Dihydroergotamine; DHE, p = 0.64). A total of 15.2% of all patients had a prescription for opiates, but there were no racial differences. Conclusions Migraine may be undertreated with prophylactic medications. Level A acute analgesics may be underused and opiates overused. No major racial/ethnic differences in abortive or prophylactic treatment were identified.

Headache Literacy-A Definition and Theory to Help Improve Patient Outcomes of Diverse Populations and Ameliorate Headache and Headache Care Disparities.

In this work, we will define headache literacy (HL), provide a rationale for the need for increased HL, discuss what we know and the potential shortcomings of current headache education interventions, and briefly propose how domains of HL can be leveraged to develop interventions to improve headache outcomes and improve disparities in these outcomes. In spite of growing public and professional awareness, disparities in pain care still persist. The AHRQ reported in 2012 that “disparities in quality and outcomes by income, race, and ethnicity are large and persistent, and were not. . .improving substantially.” At about this same time, an Institute of Medicine report on chronic pain identified the development of interventions targeting health disparities in pain as a major research priority and guided the development of the National Pain Strategy (NPS). The NPS suggests disparities in pain care including headaches may be due to conscious and unconscious biases and negative attitudes, beliefs, perceptions, misconceptions about higherrisk populations groups (eg, race and gender biases), lack of sufficient knowledge of behavioral and biological issues that affect pain, management and data to understand pain and its treatment in higher risk and vulnerable populations, and pain itself. There is a paucity of research regarding racial/ ethnic disparities and in methods of ameliorating racial/ethnic disparities in headache medicine. A summary of the literature by Shavers et al suggests racial/ethnic disparities in pain may be due to the From the Department of Neurology, University Of Michigan, Ann Arbor, MI, USA (L. Charleston); Department of Internal Medicine and Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA (M. Heisler); Center for Clinical Management Research, Ann Arbor Veterans Affairs Health System, Ann Arbor, MI, USA (M. Heisler).