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Biomedical subjects

Fabio Antonaci

Publications and source records attributed to Fabio Antonaci.

3 recordsLinked to original sources

Diagnosing cervicogenic headache.

The notion that disorders of the cervical spine can cause headache is more than a century old, yet there is still a great deal of debate about cervicogenic headache (CEH) in terms of its underlying mechanisms, its signs and symptoms, and the most appropriate treatments for it. CEH is typically a unilateral headache that can be provoked by neck movement, awkward head positions or pressure on tender points in the neck. The headaches can last hours or days, and the pain is usually described as either dull or piercing. Convergence of the upper cervical roots on the nucleus caudalis of the trigeminal tract is the most commonly accepted neurophysiological explanation for CEH. In most cases, CEH is caused by pathology in the upper aspect of the cervical spine, but the type and exact location of the pathology varies substantially among individual cases. Anaesthetic blocks may be necessary to confirm the diagnosis of CEH, showing that the source of pain is in the neck. Differential diagnosis is sometimes a challenge because CEH can be mistaken for other forms of unilateral headache, especially unilateral migraine without aura. Neuroimaging and kinematic analysis of neck motion may aid in diagnosing difficult CEH.

Humans↗

Concepts leading to the definition of the term cervicogenic headache: a historical overview.

The idea that headache may originate from a problem at the neck or cervical spine level has fascinated and stimulated researchers for centuries. Contributions and reports seeking to clarify this issue have multiplied in the past 80 or 90 years. Bärtschi-Rochaix reported what seems to have been the first clinical description of cervicogenic headache, but it was not until 1983 that Sjaastad and his school defined diagnostic criteria for this syndrome. The current, revised International Headache Society Classification (ICHD-II) includes the term cervicogenic headache, but the diagnostic criteria it gives differ from those of the International Association for the Study of Pain (IASP), and also from the most recent Cervicogenic Headache International Study Group (CHISG) definition (1998).

Cervical Vertebrae↗

Guidelines for the organization of headache education in Europe: the headache school.

According to its mission statement, one of the goals of the European Headache Federation (EHF) is to "educate Europe" about headache through the teaching of the key health personnel, such as young physicians and all those involved in headache management, about the seriousness of headache disorders. The countries of Europe share a close geographical proximity that facilitates international exchanges, particularly between university faculties. In recent years, this has, indeed, been the working basis of European educational endeavours in the field of headache. For a number of years, annual summer schools were organized in different European countries and a permanent Summer Headache School was set up in Cambridge (to be held every alternate year). The last summer headache school was held in Vilnius in 2002. In the past decade, a patronage scheme was also set up, which, combining two or more countries (one developed, one or more developing), allowed international exchanges of doctors and students for training purposes. In some centres, participants were also able to gain clinical practice and research experience by staying at the host institutions for extended periods of time. As a result of all this activity there have emerged, in Europe, "clusters" of people with a particular interest in headache. However, the rapid growth of insight into headache (new molecules, new headache categories, etc.) has contributed to a widening of the scientific gap between developing and developed countries. Moreover, in the past four years, due to the relative restriction of national/international drug company budgets, it has proved possible to organize only relatively inexpensive teaching courses. As a result, countries whose medical communities had been developing a "headache culture" now find themselves destined to be increasingly held back. Therefore, the EHF, in order to promote education on headache in Europe at national level, felt there was a need for guidelines for the organization of educational courses that meet uniform standards of excellence and in terms of code of conduct: guaranteed courses that will attract investors and those seeking to increase their knowledge, skills and understanding in the area of primary and secondary headache. The guidelines, presented here, specify the ideal length of a headache course, the number of lectures it should include, as well as the ideal number of participants and teachers. A sample course outline is provided, together with a checklist to help the organizers to meet the criteria for an EHF-approved headache school.

Curriculum↗