ARCH Is Bringing Asia Closer to the Rest of the World.

As the immediate Past President (KR) of Asian Regional Consortium For Headache (ARCH) and the newly appointed President (TW) of ARCH, we are pleased to share our thoughts with the readers of MDPI [...].

Uncommon (Group 4.0) Primary Headaches: Less Familiarity and More Missed Diagnosis.

BACKGROUND: Other primary headaches make up group 4.0 of the International Classification of Headache Disorders third edition (ICHD-3). This group includes a clinically varied group of headache entities whose pathophysiology is not well understood and whose treatments are based on open-label reports. OBJECTIVE: To review and update the uncommon primary headaches included under group 4.0 in ICHD-3. METHODS: We reviewed the headache disorders listed under group 4.0 of ICHD-3 for the clinical features, diagnostic criteria, and management, and described recent updates of these relatively rare disorders. RESULTS: The entities included in this group have a characteristic presentation in practice. Some of them are activity-related and can be provoked by Valsalva maneuver (primary cough headache), some by prolonged exercise (primary exercise headache), and some by sexual excitation (primary headache associated with sexual activity); primary thunderclap headache has also been included here because all the above-listed entities can sometimes present in thunderclap fashion too. Two of the entities in this group 4.0 are linked to direct physical stimuli viz. cold stimulus headache and external pressure headache. Also included in this group are primary stabbing headaches and nummular headaches that are presumed to be due to the involvement of the terminal branches of the sensory nerves supplying the scalp and are, therefore, termed "epicranial headaches." Hypnic headache syndrome and new daily persistent headache are included here as "miscellaneous headaches" because we still do not know enough about their causation. CONCLUSION: The headache disorders included under group 4.0 in ICHD-3 are uncommon, heterogeneous entities, which may pose diagnostic and management challenges to the physicians. The diagnosis may be missed owing to a lack of familiarity.

Migraine: epidemiology and systems of care.

Migraine is a neurovascular disorder that affects over 1 billion people worldwide. Its widespread prevalence, and associated disability, have a range of negative and substantial effects not only on those immediately affected but also on their families, colleagues, employers, and society. To reduce this global burden, concerted efforts are needed to implement and improve migraine care that is supported by informed health-care policies. In this Series paper, we summarise the data on migraine epidemiology, including estimates of its very considerable burden on the global economy. First, we present the challenges that continue to obstruct provision of adequate care worldwide. Second, we outline the advantages of integrated and coordinated systems of care, in which primary and specialist care complement and support each other; the use of comprehensive referral and linkage protocols should enable continuity of care between these systems levels. Finally, we describe challenges in low and middle-income countries, including countries with poor public health education, inadequate access to medication, and insufficient formal education and training of health-care professionals resulting in misdiagnosis, mismanagement, and wastage of resources.

Incidence and pattern of headache in cerebral venous thrombosis.

Cerebral venous thrombosis (CVT) is a challenging condition because of the variability of clinical presentations. CVT can present at all ages, but is seen more in young and middle-aged women. CVT does not necessarily occur only when there is an obvious underlying etiology. In almost 30% of cases, the etiology cannot be established. CVT can present with an acute thunderclap headache, fever, seizures, focal deficits, impaired sensorium, or papilloedema. Headache is known to be the most frequently associated initial complaint, and is present in more than 80% of patients, but it is not always remembered that headache can be the sole presenting complaint of CVT and even when early papilloedema is absent. Headache can occur in isolation in up to 5% of CVT cases. There is no identifiable, uniform, recognizable pattern of headache in CVT, but this article discusses the "Headache Profile" that is seen more commonly in this setting with an illustration of one such case where the innocuous headache turned sinister. Magnetic resonance imaging with venography is the investigation of choice to diagnose CVT; computed tomography alone will miss a significant number of cases. One must keep in mind the possibility of CVT in every patient who presents with new-onset headache of any type, any severity, and in any location, particularly when there is worsening in spite of analgesics. Earlier the diagnosis, earlier the treatment, better is the outcome.