Headache in the development of neurosciences

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EDITORIAL

Headache in the development of neurosciences Elio Agostoni 1 Published online: 12 November 2020 # Fondazione Società Italiana di Neurologia 2020

Headache is the most frequent symptom observed in neurological disorders. Headache is both a symptom and a disease in its primary forms, a warning sign of most secondary forms, and sometimes the only sign of disease for extended periods of time in some acute neurological disorders, such as subarachnoid haemorrhage, in sub-acute ones, such as venous brain thrombosis and CSF hypotension, as well as in chronic neurological disorders. Among primary headaches, migraine is enjoying great clinical-scientific momentum, enhanced by the discovery of a true and effective prophylactic therapy. Monoclonal antiCGRP antibodies were studied in several trials that provided clinicians with a new therapeutic option to treat patients with migraine and restore a satisfactory quality of life for them. These considerations were translated into practice after the efficacy and safety of monoclonal antibodies in the real world, outside the clinical trial context, were demonstrated. International regulating bodies addressed the issue of the clinical relevance, economic impact and sustainability of this therapeutic option, and defined a few admission and treatment monitoring indicators. Clinicians, scientific societies and the institutions still have to work hard to ensure the best possible treatment for all the entitled parties. The broad domain of secondary headaches, which pose significant differential diagnosis problems and organizational and management challenges, sees the onset of new nosographic entities capable to challenge neurological knowledge and clinical practice. One form of headache now in the limelight is related to a variety of intra-arterial neurovascular procedures. Neurovascular brain procedures are implemented in a growing number of clinical centres, particularly in the light of the evidence of the efficacy * Elio Agostoni [email protected] 1

Neuroscience Department and Niguarda Neuro-Center and Neurology C.S. and Stroke Unit, Grande Ospedale Metropolitano Niguarda, Milan, Italy

of revascularization therapies, such as mechanical thrombectomy combined with systemic pharmacological thrombolysis in acute stroke. Ongoing technological development promotes advances in diagnostics and therapy in this field. During or following a procedure, patients may report a headache of variable degrees of severity, which can be either benign or a sign of a severe complication. The International Classification of Headache Disorders (ICHD-3) recognizes different subtypes of headache attributed to endovascular brain procedures, which are included in Chapter 6 (headache attributed to cranial and/or cervical vascular disorders). The fundamental feature of post-procedure headache is the time relation between the onset of a new headache or the worsening of a pre-existing one and the timing of the procedure. The pathogenic mechanisms considered include the mechanical sti