[Drug-resistant headache: is it the end?]. / Céphalées pharmacorésistantes: nouvelles approches du casse-tête.

Chronic primary headache often cause significant interference with function and quality of life despite acute and preventive medicines. New treatments are emerging for pharmacologically intractable cluster headache and migraine. Occipital nerve stimulation in chronic cluster headache and botulinum toxin in chronic migraine represent the most promising therapies.

[Clinical management of primary headaches: interdisciplinary guidelines]. / Recommandations inter- disciplinaires du réseau douleur des HUG: approche clinique des céphalées primaires.

Primary headaches, whose aetiologies cannot be identified by current diagnostic methods, represent the most frequent headaches and must be distinguished from secondary or symptomatic headaches, e.g. related to traumatic, vascular, inflammatory or neoplastic processes. Only an appropriate treatment will meet the expectations of patients, for who even a mild headache may generate important fears and handicaps. Medical history and physical examination form the basis for targeting the right diagnosis before any biological or radiological testing. The article presents guidelines implemented at the Geneva University Hospitals by the Pain Network of the institution. Therapeutic modalities and recommendations concerning the need for specialized assessments are presented to provide a framework in both emergency situation and long-term care.

[Treatment of migraine: an update]. / Traitement de la migraine: une mise à jour.

Over 12% of the population suffer from migraine, and though it can be incapacitating, the condition is too often minimized. The hidden costs of the disability, measured in terms of lost of productivity, are considerable. However, when treated correctly, the patient's quality of live can improve immensely, thus avoiding the tendency of leading to chronic daily headache (CDH) often associated with analgesic overuse. The availability of new treatments means that attacks can be targeted more specifically: the triptans, the latest, in Switzerland, being rizatriptan and eletriptan, offer different advantages with different constraints. Of particular importance, the maximum dose and the interval between doses must be scrupulously followed. At the same time, new developments in the prophylactic treatment of migraine show encouraging results, in particular the anti-epilectic drugs such as gabapentin and topiramate.