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Aim: To study the compliance of neurologists and headache specialists to chronic headache and chronic migraine (CM) diagnosis and treatment guidelines., Material and Methods: The survey included 634 neurologists from all regions of the Russian Federation. Mean age of respondents was 40.7±8.5 years, mean years of experience 14.2±7.8 years., Results: Most doctors work in outpatient or hospital settings (49% and 24%, respectively), 7% were headache specialists. Tension-type headache (TTH) was diagnosed in 30% and CM in 17% of patients while 44% of patients were presumed to have a mixed headache disorder (TTH+CM). Only 10% of physicians do not use instrumental diagnostic methods in chronic headache. This study has shown sufficient attention to comorbid conditions and frequent prescription of headache preventative treatment. Botox prescription data is equivocal: 35% of physicians recommend such treatment, 27% do not, while other doctors prescribe it for off-label indications., Conclusion: To overcome clinical inertia, further education in chronic headaches and their optimal treatment is warranted.

Aim: To evaluate the rationale for different approaches to preventive chronic migraine (CM) treatment by comparing clinical outcomes and financial burden of the disease in the real-world practice., Material and Methods: Sixty-six patients with CM were enrolled at the Alexander Vein Headache Clinic (60 women and 6 men, aged 28-51). All patients were divided into 3 groups: group 1 (n=22) received oral preventative treatment with topiramate, up to 100 mg daily, for three months; group 2 (n=20) received 12 acupuncture sessions (3 sessions a week); group 3 (n=24) received 155-195 units of botulinum toxin type A (botox, BTA). The follow-up period in all groups was 3 months. Efficacy was evaluated by clinical examination, the Headache Impact Test (HIT-6) and questionnaires to assess subjective patient satisfaction and treatment tolerability., Results: BTA demonstrated the highest efficacy in this study. Compared to the oral preventative treatment and acupuncture, BTA reduced the frequency of headache faster and more significantly facilitating CM transformation into episodic migraine (headache frequency was 16.1±0.1; 18.0±0.02; and 13.9±0.3 in groups 1, 2 and 3, respectively, after one month of treatment). BTA also improved the quality of life faster and more significantly and was better tolerated (good - 51%, 75% and 85% in groups 1, 2 and 3, respectively; satisfactory - 35%, 25% and 15% in groups 1, 2 and 3, respectively; bad 14% in the oral prevention group). In the BTA group, the majority of patients demonstrated earlier treatment satisfaction. Despite higher (compared to topiramate) direct costs in the BTA group (RUB 29 931.51 and RUB 32 085.87, respectively), the predicted cost of a headache-free day was the smallest and totaled RUB 652.15 (compared to RUB 692.86 and RUB 1017.60 in the topiramate and acupuncture groups, respectively)., Conclusion: The data on the efficacy and costs of different CM prevention strategies would facilitate optimal treatment choice for neurologists and patients.

Migraine is one of the most common neurological disorders, affecting women. Physiological changes in the hormonal status can modulate the functional status of pain and analgesic systems of the brain and, by involving different pathophysiological mechanisms, change the course of migraine. In addition to an analysis of epidemiological data, the review provides current views on the clinical features of the disease in women population at different periods of life, particular attention was focused on menstrual migraine. It has certain features, such as acute and long attacks and treatment difficulties. One of main issues is the use of oral contraceptives in women with migraine according to the ratio of potential benefit to cardiovascular risk. The problems of treatment headaches in pregnant and breastfeeding women are also considered. An influence of migraine on the course and outcome of pregnancy was shown. The authors analysed the results of the studies on the course of migraine during perimenopause and postmenopause and recommendations for women with migraine attacks and climacteric syndrome. The data presented in the review are useful for clinicians, because this information represents new views on pathogenetic mechanisms, clinical features and treatment of migraine in women.

Migraine is the third most common disease in the world. The overall prevalence of migraine in the Russian Federation is estimated at 20% with an estimated global prevalence of 14.7%. Migraine affects mostly people of working age and has a significant negative impact on the quality of life, the level of adaptation, ability to work, social functioning. Migraine represents a significant social and economic burden for patients and society as a whole. A team of national experts on migraine offers a program to prioritize quality of management of patients with headache.

These recommendations on the diagnosis and treatment of migraine were elaborated by Russian headache experts in accordance with the evidence-based practice. Together with the latest classification, diagnostic principles and criteria of different clinical sub-forms the consensus contains basic data on migraine epidemiology, pathophysiological mechanisms, differential diagnosis and most effective and evidence based approaches to pharmacological and non-pharmacological management of migraine patients.

A number of patients with primary headaches remain insensitive or refractory to treatment despite correctly selected drugs, adequate therapeutic dose and duration of therapy. The importance of refractory problem is determined by the fact that patients are completely maladjusted, disabled, and keeping these patients is very difficult even for seasoned professionals. Determination of the correct tactics and success of the treatment depends, in the first place, on the correct diagnosis. This article discusses the diagnostic criteria for the most important forms such as refractory chronic migraine or refractory chronic cluster headache presented by experts of the European Headache Federation in two separate Consensus.

The results of the comparative analysis of patients with migraine attacks developing in the waking period (AP) and night sleep period are presented. Patients with sleep-related migraine (SM) had higher levels of depression and anxiety, marked autonomic dysfunction and stable sleep disturbances that resulted in significant maladaptation of these patients in the between-attacks period and low quality of life. Depression plays a role in the transformation of AP to SM and formation of stable sleep disturbances in the between-attacks period in patients with SM. It is suggested that common serotoninergic mechanisms involved in migraine attack may contribute to formation of "sleep-wake" cycle and depression development. The principles of optimal therapy of such patients are formulated.

A follow-up clinical study was made of 320 patients examined in Autonomic Pathology and Headache Center, Nervous disease clinic, Sechenov Moscow Medical Academy, since 1989 to 1999. The peculiarities of migraine attack course and remission period, psychological characteristics, concomitant diseases and quality of life in men and women were described. In women, migraine attacks were more typical, prolonged and severe, being often stipulated by provoking factors, especially by emotional ones, as well as accompanied by autonomic disturbances, anxiety and depression. Despite a more favorable migraine course, men proved to score lower on quality of life, revealing more maladaptation. Patients with sleep migraine attacks were distinguished by more severe migraine course, multiple disturbances in remission period, higher depression and anxiety levels, as well as lower quality of life. Common serotoninergic mechanisms were suggested to underlie sleep migraine and depression. The leading role of depression in the origin of night migraine attacks is discussed.

The study presents a clinical analysis of a large population of migraine patients (n = 320). Computed database used in the study included over 100 clinical parameters and was based on analysis of primary medical records. As a result of statistic processing of the migraine archive, a general review of clinical picture and migraine course in patients from Moscow and Moscow region community and analysis of the peculiarities of migraine heredity, concomitant symptoms, provoking factors, co-morbid diseases, state in attack-free period, psychological characteristics and quality of life are provided. Factors determining course severity and quality of life in migraine are discussed.

The paper is concerned with clinical, therapeutical and classification problems of migraine. A "vegetative" form of migraine is distinguished characterized by a vegetovascular crisis in the disease episodes. Clinico-psychophysiological characteristics are provided for 30 patients with common and 40 with vegetative migraine. The latter run seems more severe with frequent episodes, permanent vegetative disorders in the episodes-free period, marked emotional symptoms (hypochondriac, demonstrative and anxious). In addition to clinico-neurological, questionnaire and thermographic methods, the study employed visual analog pain scale, tests of segmentary vegetative apparatuses (6 cardiovascular tests and time of pupil cycle), psychological tests (MIL, Spilberger's). Differential approaches to migraine forms are advocated, basic principles of optimal therapy of migraine cephalalgia are formulated.