[caption id="attachment_5653" align="aligncenter" width="560"]The Michigan Headache Clinic was founded in 1981 as a private practice by Edmund Messina, M.D., and Jayne Bailey Messina, R.N. The following is based on an interview with Doctor Edmund Messina, the Director of the Clinic. The Michigan Headache Clinic was founded in 1981 as a private practice by Edmund Messina, M.D., and Jayne Bailey Messina, R.N. The following is based on an interview with Doctor Edmund Messina, the Director of the Clinic.[/caption] Doctor Edmund Messina attended medical school at the University of Illinois in Chicago. He remained in Chicago to complete an Internal Medicine internship at the former Michael Reese Hospital, and then traveled to Saint Louis, MO for a neurology residency at Washington University. Dr. Messina reflects on his years in medical school and internship in the book, The Spattered White Coat. He advised that his introduction to headache medicine occurred when he attended a lecture on headache in medical school which was presented by Seymour Diamond, MD, the Executive Chairman of the National Headache Foundation.

Migraine with aura is known to be a risk factor for ischemic stroke – a stroke that occurs when an artery to the brain is blocked. Now research suggests that older migraineurs are more likely to experience symptomless strokes as well. These strokes, sometimes called “silent strokes,” occur when a blood clot interrupts the flow of blood to the brain. While their symptoms are not apparent, they are a risk factor for future strokes.

To help improve patient care, The American Headache Society (AHS) recently released five practices that health care professionals and patients should avoid or question regarding headache treatment. The guidelines and considerable information about them appeared in the November-December issue of Headache. The list was created as part of the Choosing Wisely initiative of the American Board of Internal Medicine Foundation, which stresses the importance of physician and patient conversations in improving care and eliminating unnecessary tests and procedures. The Choosing Wiselyrecommendations should not be the final word in decisions about treating headache disorders or any other condition, experts say.  Instead, they are intended to foster conversation about what is — and is not — appropriate and necessary treatment.

A debate at the International Headache Congress during June in Boston, between a plastic surgeon and a neurologist, concluded with roughly 500 health professionals expressing skepticism about a surgical procedure for migraine. Bahman Guyuron, MD, of the University Hospitals and Case Medical Center in Cleveland, Ohio, and Hans-Christoph Diener, MD, PhD, a neurologist with the University of Essen in Germany, expressed far different views about the surgery, which Dr. Guyuron developed. It is performed by Dr. Guyuron and other physicians at several surgical centers throughout the U.S.

An incomplete network of arteries that supplies blood to the brain may be a cause of migraine, particularly migraine with aura, according to a new study from the Perelman School of Medicine at the University of Pennsylvania. Previously, experts believed that dilation of blood vessels in the head caused migraine, but more recently migraine experts have attributed the headache disorder to abnormal brain signals. Now, however, the researchers involved with this study say that blood vessels may well play an important role in migraine. Also, alterations of the blood supply to the brain because of structural variations may contribute to the abnormal neuronal activity that initiates migraine.

While most individuals who experience a mild traumatic brain injury recover fully, about 15% will suffer long-term neurological issues, including headache. Currently, computed tomography CT scans are used to assess such injuries, but a recent study reveals that magnetic resonance imaging (MRIs) may be the more effective tool for predicting long-term outcomes.

Migraine is thought to affect 11% of the world’s population, but a recent study of Norwegian neurologists suggests its prevalence may, in fact, be much higher. Earlier studies have found migraine to be more common among neurologists than in the general population; to better understand this association, Karl B. Alstadhaug, MD, PhD, of Nordland Hospital in Bodo, Norway, led this study of 245 neurologists: 35% reported that they had experienced migraine headache. Divided along gender and time lines, nearly 37% of the women reported migraine within the last year compared to roughly 16% of the men. Combined, that is twice the rate of migraine among the general Norwegian population.

THE CASE Lynda is a 44-year-old dental assistant who came to The New England Center for Headache in Stamford, Connecticut, with a one-week history of drooping of the right eyelid, a right-sided headache, and a diagnosis of cluster headache made by her family doctor. Her headache was intense and continuous, and her eyelid drooped more and more over the course of the week. During my examination, Lynda told me she'd had a right-sided headache six months previously that was so severe she went to an emergency room for the first time in her life. All tests, including a spinal tap, CT, MRI and MRA (magnetic resonance angiogram, used to visualize the heart, blood vessels or blood flow in the circulatory system) were normal and the headache disappeared in about a week. At that time, she did not have a drooping eyelid. The week before I saw her, however, she experienced the rapid onset of a right-sided, steady, intense pain which did not change. She gradually noticed that her eyelid was drooping. Everything was normal during my exam, except that her right eye was shut. When I lifted her eyelid and asked her to follow my light, the eye could only look to the right. This finding concerned me. I did not think she had cluster headache, though that condition can be associated with a drooping eyelid, red and tearing eye, or stuffed or running nostril all on the same side as the pain. While these “clusters” of attacks are also quite severe, they last for only a short time (about 45-60 minutes) and reoccur a number of times per day, often at the same time every day, sometimes wakening the patient in the night. Lynda's headache was constant.

Headache and Facial Pain - Department of Neurology - Stanford Hospital and Clinics 211 Quarry Rd., Suite 206 Palo Alto, CA 94043 Phone: 650-723-6469 Fax: 650-725-9526 Certified: Yes (CAQ - 2016) DISCLAIMER Links to information on healthcare providers who treat headaches are available as a service to headache suffers and their families. NHF does...