Pathophysiology of Migraine
Migraine is the most common disabling primary headache globally. Attacks typically present with unilateral throbbing headache and associated symptoms including, nausea, multisensory hypersensitivity, and marked fatigue. In this article, the authors address the underlying neuroanatomical basis for migraine-related headache, associated symptomatology, and discuss key clinical and preclinical findings that indicate that migraine likely results from dysfunctional homeostatic mechanisms. Whereby, abnormal central nervous system responses to extrinsic and intrinsic cues may lead to increased attack susceptibility. (Source: Neurologic Clinics)
Source: Neurologic Clinics - October 1, 2019 Category: Neurology Authors: Peter J. Goadsby, Philip R. Holland Source Type: research

Acute Treatment of Migraine
All patients with migraine merit acute treatment, which should optimally achieve a sustained pain-free response. Maximum acute treatment is associated with reduced risk of transformation of episodic to chronic migraine. The American Headache Society published the most recent complete evidence assessment of acute migraine treatments in 2015. Noninvasive neuromodulation represents a new, Food and Drug Administration –approved nonsignificant risk alternative for acute migraine therapy. The future of acute migraine treatment includes new devices and formulations of existing medications, new classes of acute medications, ...
Source: Neurologic Clinics - September 26, 2019 Category: Neurology Authors: Stewart J. Tepper Source Type: research

Inpatient Management of Migraine
Migraine is a frequently disabling neurologic condition which can be complicated by medication overuse headache and comorbid medical disorders, including obesity, anxiety and depression. Although most migraine management takes place in outpatient clinics, inpatient treatment is indicated for migraine refractory to multiple outpatient treatments, with intractable nausea or vomiting, need for detoxification from medication overuse (such as opioids and barbiturates), and significant medical and psychiatric disease. The goals of inpatient treatment include breaking the current cycle of headache pain, reducing the frequency and...
Source: Neurologic Clinics - September 26, 2019 Category: Neurology Authors: Michael J. Marmura, Angela Hou Source Type: research

An Update
Migraine is the most common disabling primary headache globally. Attacks typically present with unilateral throbbing headache and associated symptoms including, nausea, multisensory hypersensitivity, and marked fatigue. In this article, the authors address the underlying neuroanatomical basis for migraine-related headache, associated symptomatology, and discuss key clinical and preclinical findings that indicate that migraine likely results from dysfunctional homeostatic mechanisms. Whereby, abnormal central nervous system responses to extrinsic and intrinsic cues may lead to increased attack susceptibility. (Source: Neurologic Clinics)
Source: Neurologic Clinics - September 26, 2019 Category: Neurology Authors: Peter J. Goadsby, Philip R. Holland Source Type: research

Migraine and other Primary Headaches
NEUROLOGIC CLINICS (Source: Neurologic Clinics)
Source: Neurologic Clinics - September 26, 2019 Category: Neurology Authors: Randolph W. Evans Source Type: research

Copyright
ELSEVIER (Source: Neurologic Clinics)
Source: Neurologic Clinics - September 26, 2019 Category: Neurology Source Type: research

Contributors
RANDOLPH W. EVANS, MD (Source: Neurologic Clinics)
Source: Neurologic Clinics - September 26, 2019 Category: Neurology Source Type: research

Contents
Randolph W. Evans (Source: Neurologic Clinics)
Source: Neurologic Clinics - September 26, 2019 Category: Neurology Source Type: research

Forthcoming Issues
Neuroimaging (Source: Neurologic Clinics)
Source: Neurologic Clinics - September 26, 2019 Category: Neurology Source Type: research

Pediatric Migraine
This article outlines key features of diagnosis and treatment of migraine in children and adolescents. It emphasizes techniques that can be used by clinicians to optimize history taking in this population, as well as recognition of episodic conditions that may be associated with migraine and present in childhood. Acute treatment strategies include use of over-the-counter analgesics and triptan medications that have been approved by the US Food and Drug Administration for use in children and adolescents. Preventive treatment approach includes lifestyle modifications, behavioral strategies, and consideration of preventive me...
Source: Neurologic Clinics - August 31, 2019 Category: Neurology Authors: Kaitlin Greene, Samantha L. Irwin, Amy A. Gelfand Source Type: research

Other Primary Headaches
This article reviews the clinical diagnosis and management of these heterogeneous headaches. (Source: Neurologic Clinics)
Source: Neurologic Clinics - August 31, 2019 Category: Neurology Authors: Vicente Gonz ález-Quintanilla, Julio Pascual Source Type: research

Diagnostic Testing for Migraine and Other Primary Headaches
This article evaluates the reasons for diagnostic testing and the use of neuroimaging, electroencephalography, lumbar puncture, and blood testing. The use of diagnostic testing in adults and children who have headaches and a normal neurologic examination, migraine, trigeminal autonomic cephalalgias, hemicrania continua, and new daily persistent headache are reviewed. (Source: Neurologic Clinics)
Source: Neurologic Clinics - August 31, 2019 Category: Neurology Authors: Randolph W. Evans Source Type: research

Transient Neurologic Dysfunction in Migraine
Transient disturbances in neurologic function are disturbing features of migraine attacks. Aura types include binocular visual, hemi-sensory, language and unilateral motor symptoms. Because of the gradual spreading quality of visual and sensory symptoms, they were thought to arise from the cerebral cortex. Motor symptoms previously included as a type of migraine aura were reclassified as a component of hemiplegic migraine. ICHD-3 criteria of the International Headache Society, added brainstem aura and retinal aura as separate subtypes. The susceptibility to all types of aura is likely to be included by complex and perhaps ...
Source: Neurologic Clinics - August 28, 2019 Category: Neurology Authors: Rod Foroozan, F. Michael Cutrer Source Type: research

Migraine
affects an estimated 12% of the population. Global estimates are higher. Chronic migraine (CM) affects 1% to 2% of the global population. Approximately 2.5% of persons with episodic migraine progress to CM. Several risk factors are associated with the progression to CM. There is significant short-term variability in migraine frequency independent of treatment. Migraine is associated with cardiovascular disease, psychiatric disease, and sleep disorders. It is the second most disabling condition worldwide. CM is associated with higher headache-related disability/impact, medical and psychiatric comorbidities, health care res...
Source: Neurologic Clinics - August 27, 2019 Category: Neurology Authors: Rebecca C. Burch, Dawn C. Buse, Richard B. Lipton Source Type: research

Trigeminal Autonomic Cephalalgias
The trigeminal autonomic cephalalgias (TACs) are a group of primary headache syndromes all marked by unilateral headache and ipsilateral cranial autonomic features. The TACs include cluster headache, paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing, and hemicrania continua. Pathophysiology includes the trigeminal pain system, autonomic system, hypothalamus, and more recently an identified role for the vagus nerve. Diagnosis is made after looking at headache frequency, duration, and accompanying symptoms. Each TAC has its own unique treatment, which is dis...
Source: Neurologic Clinics - August 24, 2019 Category: Neurology Authors: Mark J. Burish, Todd D. Rozen Source Type: research

Migraine in Women
Migraine is a lifelong condition that disproportionately affects women and, if not effectively managed, can lead to significant disability. It is important for clinicians to have a good understanding of the impact of the hormonal fluctuations that occur throughout a female migraineur ’s life, so that appropriate, stratified therapies can be implemented. In doing so, whether it is migraine onset at menarche in an adolescent young woman, or migraine worsening in a perimenopausal female migraineur, quality of life can be ensured. (Source: Neurologic Clinics)
Source: Neurologic Clinics - August 22, 2019 Category: Neurology Authors: Ana Marissa Lagman-Bartolome, Christine Lay Source Type: research

Behavioral Interventions for Migraine
This article details treatments for migraine management and prevention, ranging from traditional to newly emerging interventions. Similarly, this article reviews key person-related factors that may affect migraine prevalence and management. Aspects related to patient-physician relationships and communication are also reviewed. Research involving childhood and adolescent migraine is reviewed, and special considerations regarding this population are summarized. Clinical trials and other studies have provided evidence that these behavioral interventions, when combined with pharmacotherapy, show a marked improvement in primary...
Source: Neurologic Clinics - August 22, 2019 Category: Neurology Authors: Andrea P érez-Muñoz, Dawn C. Buse, Frank Andrasik Source Type: research

Preventive Treatment for Episodic Migraine
Episodic migraine is a debilitating condition. Preventive therapy is used to reduce frequency, duration, or severity of attacks. This review discusses principles of preventive treatment with a focus on preventive treatment options for people with episodic migraine. Specifically discussed is evidence and use of new migraine-specific treatment options for episodic migraine, such as calcitonin gene-related peptide monoclonal antibodies, a noninvasive transcutaneous electrical nerve stimulation device, and a single-pulse transcranial magnetic stimulator device. Also discussed are evidence-based updates from the 2012 American A...
Source: Neurologic Clinics - August 22, 2019 Category: Neurology Authors: Simy K. Parikh, Stephen D. Silberstein Source Type: research

Migraine in the Emergency Department
Diagnostic testing is of limited value among patients with migraine who present to an emergency department. Various nonopioid, disease-specific treatments are available for patients who present to an emergency department with migraine headache and associated features. Emergency physicians should recognize that the acute migraine presentation is part of an underlying disorder; care should be geared to the underlying headache disorder in addition to the acute attack. (Source: Neurologic Clinics)
Source: Neurologic Clinics - August 22, 2019 Category: Neurology Authors: Benjamin W. Friedman Source Type: research

Migraine and Other Primary Headaches
This issue of Neurologic Clinics reviews migraine and other primary headaches. Secondary headaches were reviewed in Neurologic Clinics in 2014. Neurologic Clinics last covered primary headaches in 2009. Since then, there have been many advances, including most recently, monoclonal antibodies to CGRP, gepants, ditans, and neuromodulating devices. (Source: Neurologic Clinics)
Source: Neurologic Clinics - August 21, 2019 Category: Neurology Authors: Randolph W. Evans Tags: Preface Source Type: research

Vestibular Migraine
The term vestibular migraine designates recurrent vertigo that is caused by migraine. Vestibular migraine presents with episodes of spontaneous or positional vertigo lasting seconds to days that are accompanied by migraine symptoms. Because headache is often absent during acute attacks, other migraine features have to be identified by thorough history taking. In contrast, vestibular testing serves mainly for the exclusion of other diagnoses. Treatment still lacks solid evidence. It is targeted at the underlying migraine and comprises explanation and reassurance, lifestyle modifications, and drugs. (Source: Neurologic Clinics)
Source: Neurologic Clinics - August 20, 2019 Category: Neurology Authors: Thomas Lempert, Michael von Brevern Source Type: research

Circadian Rhythms
This article reviews the available data looking at the association between circadian dysregulation and cardiometabolic, neurologic, and neurodegenerative disease risk. In addition we discuss the limited but growing evidence supporting the use of circadian-based interventions to improve overall health. (Source: Neurologic Clinics)
Source: Neurologic Clinics - June 28, 2019 Category: Neurology Authors: Sabra M. Abbott, Phyllis C. Zee Source Type: research

Assessment of Circadian Rhythms
Circadian rhythms are observed in most physiologic functions across a variety of species and are controlled by a master pacemaker in the brain called the suprachiasmatic nucleus. The complex nature of the circadian system and the impact of circadian disruption on sleep, health, and well-being support the need to assess internal circadian timing in the clinical setting. The ability to assess circadian rhythms and the degree of circadian disruption can help in categorizing subtypes or even new circadian rhythm disorders and aid in the clinical management of the these disorders. (Source: Neurologic Clinics)
Source: Neurologic Clinics - June 28, 2019 Category: Neurology Authors: Kathryn J. Reid Source Type: research

Circadian Rhythm Disorders
NEUROLOGIC CLINICS (Source: Neurologic Clinics)
Source: Neurologic Clinics - June 28, 2019 Category: Neurology Authors: Phyllis C. Zee Source Type: research

Copyright
ELSEVIER (Source: Neurologic Clinics)
Source: Neurologic Clinics - June 28, 2019 Category: Neurology Source Type: research

Contributors
RANDOLPH W. EVANS, MD (Source: Neurologic Clinics)
Source: Neurologic Clinics - June 28, 2019 Category: Neurology Source Type: research

Contents
Phyllis C. Zee (Source: Neurologic Clinics)
Source: Neurologic Clinics - June 28, 2019 Category: Neurology Source Type: research

Forthcoming Issues
Migraine and other Primary Headaches (Source: Neurologic Clinics)
Source: Neurologic Clinics - June 28, 2019 Category: Neurology Source Type: research

A Perfect Time for Circadian Medicine
This issue of Neurologic Clinics is devoted to the important emerging field of circadian medicine and its implications to the practice of neurology, and medicine as a whole. This issue comes on the heels of the 2017 Nobel Prize in Physiology or Medicine, which recognized the seminal discovery of the genetic mechanisms that generate circadian rhythms and the overarching impact of biological timing to the practice of medicine. Since the mid 1990s, and in particular during the past decade, discoveries demonstrated the ubiquity of these molecular circadian clocks in nearly all tissues of the nervous system and throughout the b...
Source: Neurologic Clinics - June 28, 2019 Category: Neurology Authors: Phyllis C. Zee Tags: Preface Source Type: research

Irregular Sleep-Wake Rhythm Disorder
This article focuses on irregular sleep-wake rhythm disorder (ISWRD) and its associations with several other comorbidities. Irregular sleep-wake rhythm disorder is a circadian disorder characterized by a lack of a clear sleep-wake pattern. The disorder has yet to be fully understood from pathophysiologic perspective. Treatments are available, but there is a need for development of novel interventions. The goal of this article is to focus on multiple aspects of ISWRD. (Source: Neurologic Clinics)
Source: Neurologic Clinics - May 29, 2019 Category: Neurology Authors: Temitayo Oyegbile, Aleksandar Videnovic Source Type: research

Circadian Rhythm Sleep-Wake Phase Disorders
This article reviews delayed and advanced sleep-wake phase disorders. Diagnostic procedures include a clinical interview to verify the misalignment of the major nocturnal sleep episode relative to the desired and social-normed timing of sleep, a 3-month or greater duration of the sleep-wake disturbance, and at least a week of sleep diary data consistent with the sleep timing complaint. Treatment options include gradual, daily shifting of the sleep schedule (chronotherapy); shifting circadian phase with properly timed light exposure (phototherapy); or melatonin administration. Future directions are discussed to conclude the...
Source: Neurologic Clinics - May 29, 2019 Category: Neurology Authors: Elizabeth Culnan, Lindsay M. McCullough, James K. Wyatt Source Type: research

Genetics of Circadian Rhythms
In mammals, genetic influences of circadian rhythms occur at many levels. A set of core “clock genes” have been identified that form a feedback loop of gene transcription and translation. The core genetic clockwork generates circadian rhythms in cells throughout the body. Polymorphisms in both core clock genes and interacting genes contribute to individual differences in the expres sion and properties of circadian rhythms. The circadian clock profoundly influences the patterns of gene expression and cellular functions, providing a mechanistic basis for the impact of the genetic circadian system on normal physio...
Source: Neurologic Clinics - May 29, 2019 Category: Neurology Authors: Martha Hotz Vitaterna, Kazuhiro Shimomura, Peng Jiang Source Type: research

Challenging Circadian Rhythm Disorder Cases
The complex interplay of the sleep and circadian systems, which are substantially differentially regulated, provides for plasticity that is expressed in health and disease. The classic circadian rhythm disorders are readily recognizable, but atypical forms can be identified by actigraphy and melatonin profilometry. Although the dim-light melatonin onset test maps the start of the biological night, 24-hour mapping can define the limits of the biological night, whereas other forms of strategic testing can identify conditions such as iatrogenic hypermelatoninemia. Routine testing in clinical practice can expand the range of i...
Source: Neurologic Clinics - May 24, 2019 Category: Neurology Authors: Melanie Pogach, Robert Joseph Thomas Source Type: research

Sleep and Circadian Medicine
This article highlights how research and technologic advances in circadian biology might translate to improved patient care. (Source: Neurologic Clinics)
Source: Neurologic Clinics - May 11, 2019 Category: Neurology Authors: Marc D. Ruben, John B. Hogenesch, David F. Smith Source Type: research

Circadian Neurobiology and the Physiologic Regulation of Sleep and Wakefulness
Endogenous central and peripheral circadian oscillators are key to organizing multiple aspects of mammalian physiology; this clock tracks the day-night cycle and governs behavioral and physiologic rhythmicity. Flexibility in the timing and duration of sleep and wakefulness, critical to the survival of species, is the result of a complex, dynamic interaction between 2 regulatory processes: the clock and a homeostatic drive that increases with wake duration and decreases during sleep. When circadian rhythmicity and sleep homeostasis are misaligned —as in shifted schedules, time zone transitions, aging, or disease&mdash...
Source: Neurologic Clinics - May 7, 2019 Category: Neurology Authors: William J. Schwartz, Elizabeth B. Klerman Source Type: research

Shift Work Disorder
Shift work and its negative consequences are becoming more relevant as the economy becomes increasing globalized. For many individuals, shift work serves as a significant biological and psychosocial challenge leading to Shift Work Disorder (SWD). Beyond the symptoms of sleep and excessive sleepiness, the range of consequences for health and daily functioning in those with SWD are reviewed, along with evidence-based recommendations for clinical management, including comprehensive clinical assessments and intervention strategies that target multiple domains through pharmacologic and nonpharmacologic methods. A review of impo...
Source: Neurologic Clinics - May 7, 2019 Category: Neurology Authors: Philip Cheng, Christopher Drake Source Type: research

Non –24-hour Sleep-Wake Rhythm Disorder
Non –24-hour sleep-wake rhythm disorder is a circadian rhythm sleep-wake disorder characterized by an inability to entrain to the 24-hour environment. Patients present with complaints of insomnia or hypersomnia, with progressive daily shifts of sleep-wake activity on actigraphy or sleep logs. Although first recognized in blind individuals without light perception, it also can be seen in individuals with intact vision. Treatment focuses on timed melatonin in blind individuals, whereas it is more complex in sighted individuals, using multiple time cues, such as light, melatonin, social interaction s, feeding, and activ...
Source: Neurologic Clinics - April 30, 2019 Category: Neurology Authors: Sabra M. Abbott Source Type: research

Eleven Themes in the History of Systemic and Nervous System Vasculitides
Vasculitis is defined as inflammation of blood vessel walls for at least some time during the course of the disease, and affects arteries and veins of varying caliber. Two Chapel Hill Consensus Conferences, in 1994 and 2012, provide consensus on nosology and definitions for the commonest forms of vasculitis. The category of single-organ vasculitis, suggesting the limited expression of a systemic vasculitis, includes primary central nervous system vasculitis and nonsystemic peripheral nervous system vasculitis. The historical aspects of systemic and limited forms of vasculitis are reviewed in 11 relevant themes. (Source: Neurologic Clinics)
Source: Neurologic Clinics - April 3, 2019 Category: Neurology Authors: David S. Younger Source Type: research

Stroke due to Vasculitis in Children and Adults
The vasculitides are diseases characterized by inflammation of blood vessels and inflammatory leukocytes in vessel walls. There is an increased propensity for ischemic stroke, resulting from compromise of vessel lumina with distal tissue ischemia; and hemorrhagic or nonhemorrhagic stroke, and aneurysmal formation and bleeding, due to loss of vessel integrity. (Source: Neurologic Clinics)
Source: Neurologic Clinics - April 3, 2019 Category: Neurology Authors: David S. Younger Source Type: research

Overview of the Vasculitides
This article is an introduction and overview of the clinical presentation, differential diagnosis, laboratory evaluation, and treatment of systemic and nervous system vasculitides. (Source: Neurologic Clinics)
Source: Neurologic Clinics - April 3, 2019 Category: Neurology Authors: David S. Younger Source Type: research

Granulomatous Angiitis
Granulomatous inflammation, the prototypical histopathology of adult and childhood vasculitis, is characterized by inflammation of blood vessels accompanied by giant cells and epithelioid cells in the walls of cerebral vessels ranging from small leptomeningeal veins to large named cerebral arteries. Headache, hemiparesis, mental changes, abnormal cerebrospinal fluid protein content, and pleocytosis are suggestive features that warrant brain and leptomeningeal biopsy to make the diagnosis certain and begin cytotoxic therapy to improve outcome. (Source: Neurologic Clinics)
Source: Neurologic Clinics - April 3, 2019 Category: Neurology Authors: David S. Younger Source Type: research

Vasculitis of the Nervous System
Systemic and nervous system vasculitides are a heterogeneous group of related disorders, each characterized by vascular inflammation such that it has the potential to cause serious morbidity and mortality if unrecognized and therefore untreated. Systemic vasculitis affects all populations and every nationality and walk of life, from childhood to older age. The first issue of “Vasculitis of the Nervous System” published in the Neurologic Clinics 30 years ago met the urgent need for a clear, concise, and reliable source of epidemiology, pathogenesis, clinical presentation, laboratory evaluation, and management of...
Source: Neurologic Clinics - April 3, 2019 Category: Neurology Authors: David S. Younger Tags: Preface Source Type: research

Vasculitis and the Nervous System
NEUROLOGIC CLINICS (Source: Neurologic Clinics)
Source: Neurologic Clinics - April 3, 2019 Category: Neurology Authors: David S. Younger Source Type: research

Copyright
ELSEVIER (Source: Neurologic Clinics)
Source: Neurologic Clinics - April 3, 2019 Category: Neurology Source Type: research

Contributors
RANDOLPH W. EVANS, MD (Source: Neurologic Clinics)
Source: Neurologic Clinics - April 3, 2019 Category: Neurology Source Type: research

Contents
David S. Younger (Source: Neurologic Clinics)
Source: Neurologic Clinics - April 3, 2019 Category: Neurology Source Type: research

Forthcoming Issues
Circadian Rhythm Disorders (Source: Neurologic Clinics)
Source: Neurologic Clinics - April 3, 2019 Category: Neurology Source Type: research

Genetic Basis of Vasculitides with Neurologic Involvement
“Vasculitides are a heterogeneous group of inflammatory diseases of blood vessels in which genetic variation plays an important role in their susceptibility and clinical spectrum. Because of the use of novel technologies and the increase of the sample size of the study cohorts, the knowledge of th e genetic background of vasculitides has considerably expanded during the last years. However, few insights have been obtained regarding the genetics underlying severe clinical phenotypes, such as those related to the nervous system. In this review the authors provide an updated overview of the gene tic landscape behind vas...
Source: Neurologic Clinics - March 18, 2019 Category: Neurology Authors: Francisco David Carmona, Raquel L ópez-Mejías, Ana Márquez, Javier Martín, Miguel A. González-Gay Source Type: research

Imaging the Vasculitides
“Neuroimaging plays a vital role in the diagnosis of primary and secondary vasculitic disorders. There multiple neuroimaging options available to accurately describe the underlying clinical deficits of involved cases. Noninvasive neuroimaging modalities provide less risk and when interdigitated, f orm the basis for a more conclusive understanding of the disease process. There are instances in which invasive cerebral angiography may be needed to image the intricate and at times, small involved vessels. Neuroradiologists should be included in the multidisciplinary team of physicians caring for patients with vasculitide...
Source: Neurologic Clinics - March 18, 2019 Category: Neurology Authors: David S. Younger Source Type: research

Peripheral Nerve Vasculitis
“The vasculitic neuropathies encompass a wide range of disorders characterized by ischemic injury to the vasa nervorum. Patients with vasculitic neuropathies develop progressive, painful sensory or sensorimotor deficits that are typically multifocal or asymmetric. Depending on the underlying etiol ogy, the vasculitis may be confined to the peripheral nervous system; may be one manifestation of a primary systemic vasculitis; or one manifestation of a systemic vasculitis that is secondary to underlying connective tissue disease, drug exposure, viral infection, or paraneoplastic syndrome. This a rticle reviews the class...
Source: Neurologic Clinics - March 18, 2019 Category: Neurology Authors: Kelly G. Gwathmey, Jennifer A. Tracy, P. James B. Dyck Source Type: research