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Byline: Hans-Christoph Diener (1), P. Tfelt-Hansen (2), C. Dahlof (3), M. J. A. Lainez (4), G. Sandrini (5), Sh.-J. Wang (6), W. Neto (7), U. Vijapurkar (7), A. Doyle (7), D. Jacobs (7) Keywords: placebo--controlled; migraine; topiramate; prophylaxis; propranolol Abstract: Abstract. Topiramate (TPM) has shown efficacy in migraine prophylaxis in two large placebo--controlled, dose--ranging trials. We conducted a randomised, doubleblind, multicentre trial to evaluate the efficacy and safety of two doses of topiramate vs placebo for migraine prophylaxis, with propranolol (PROP) as an active control. Subjects with episodic migraine with and without aura were randomised to TPM 100 mg/d, TPM 200 mg/d, PROP 160 mg/d (active control), or placebo. The primary efficacy measure was the change in mean monthly migraine frequency from the baseline phase relative to the double--blind treatment phase. Five hundred and seventy--five subjects were enrolled from 61 centres in 13 countries. TPM 100 mg/d was superior to placebo as measured by reduction in monthly migraine frequency, overall 50% responder rate, reduction in monthly migraine days, and reduction in the rate of daily rescue medication use. The TPM 100 mg/d and PROP groups were similar with respect to reductions in migraine frequency, responder rate, migraine days, and daily rescue medication usage. TPM 100 mg/d was better tolerated than TPM 200 mg/d, and was generally comparable to PROP. No unusual or unexpected safety risks emerged. These findings demonstrate that TPM 100 mg/d is effective in migraine prophylaxis. TPM 100 mg/d and PROP 160 mg/d exhibited similar efficacy profiles. Author Affiliation: (1) Department of Neurology, University Essen, Hufelandstr 55, 45122, Essen, Germany (2) Department of Neurology, University of Copenhagen Glostrup Hospital, Glostrup, Denmark (3) Gothenburg Migraine Clinic, Gothenburg, Sweden (4) Department of Neurology, Hospital Clinico Universitario University of Valencia, Valencia, Spain (5) Headache Centre IRCC C. Mondino Foundation, University of Pavia, Pavia, Italy (6) Neurological Institute Taipei, Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan (7) Johnson &amp Johnson, Pharmaceutical Research and Development, LLC Raritan, NJ USA Article History: Registration Date: 01/01/2004 Received Date: 02/01/2004 Accepted Date: 08/03/2004

The article presents a guideline on the management of common headache disorders in primary care. In Europe, headache disorders are amongst the top ten causes of disability. Migraine, tension-type headache and medication-overuse headache are important in primary care because they are common and responsible for almost all headache-related burden. Management of these three belongs largely in primary care.

An abstract of the article "Consensus for tinnitus patient assessment and treatment outcome measurement: Tinnitus Research Initiative meeting, Regensburg, July 2006," by B. Langguth and R. Goodey is presented.

After the introduction of chronic migraine and medication overuse headache as diagnostic entities in The International Classification of Headache Disorders, Second Edition, ICHD-2, it has been shown that very few patients fit into the diagnostic criteria for chronic migraine (CM). The system of being able to use CM and the medication overuse headache (MOH) diagnosis only after discontinuation of overuse has proven highly unpractical and new data have suggested a much more liberal use of these diagnoses. The International Headache Classification Committee has, therefore, worked out the more inclusive criteria for CM and MOH presented in this paper. These criteria are included in the appendix of ICHD-2 and are meant primarily for further scientific evaluation but may be used already now for inclusion into drug trials, etc. It is now recommended that the MOH diagnosis should no longer request improvement after discontinuation of medication overuse but should be given to patients if they have a primary headache plus ongoing medication overuse. The latter is defined as previously, i.e. 10 days or more of intake of triptans, ergot alkaloids mixed analgesics or opioids and 15 days or more of analgesics/NSAIDs or the combined use of more than one substance. If these new criteria for CM and MOH prove useful in future testing, the plan is to include them in a future revised version of ICHD-2. [ABSTRACT FROM AUTHOR]

Silberstein SD, Olesen J, Bousser M-G, Diener H-C, Dodick D, First M, Goadsby PJ, Göbel H, Lainez MJA, Lance JW, Lipton RB, Nappi G, Sakai F, Schoenen J&Steiner TJ on behalf of the International Headache Society. The International Classification of Headache Disorders, 2nd Edition (ICHD-II)—revision of criteria for 8.2Medication-overuse headache. Cephalalgia 2005; 25:460–465. London. ISSN 0333-1024 [ABSTRACT FROM AUTHOR]

Headache classification is a dynamic process through clinical testing and re-testing of current and proposed criteria. After publication of the second edition of the International Classification of Headache Disorders (ICHD-II), need arose for revisions in the classification of medication overuse headache and chronic migraine. These changes made apparent a further need for broader revisions to the standard formulation of diagnostic criteria for the secondary headaches. Currently, the fourth criterion makes impossible the definitive diagnosis of a secondary headache until the underlying cause has resolved or been cured or greatly ameliorated by therapy, at which time the headache may no longer be present. Given that the main purpose of diagnostic criteria is to enable a diagnosis at the onset of a disease in order to guide treatment, this is unhelpful in clinical practice. In the present paper we propose maintaining a standard approach to the secondary headaches using a set of four criteria A, B, C and D, but we construct these so that the requirement for resolution or successful treatment is removed. The proposal for general diagnostic criteria for the secondary headaches will be entered into the internet-based version of the appendix of ICHD-II. During 2009 the Classification Committee will apply the general criteria to all the specific types of secondary headaches. These, and other changes, will be included in a revision of the entire classification entitled ICHD-IIR, expected to be published in 2010. ICHD-IIR will be printed and posted on the website and will be the official classification of the International Headache Society. Unfortunately, it will be necessary to translate ICHD-IIR into the many languages of the world, but the good news is that no major changes to the headache classification are then foreseen for the next 10 years. Until the printing of ICHD-IIR, the printed ICHD-II criteria remain in place for all other purposes. We issue a plea to the headache community to use and study these proposed general criteria for the secondary headaches in order to provide more evidence for their utility-before their incorporation in the main body of the classification.