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0:00
My name is Rob Cowan.
I am a Professor of
Neurology and Neurosciences
at Stanford University.
I'll be talking today
about phenotyping the
migraine patient.
0:14
I have no relevant disclosures
relating to this topic,
but here are my other
activities for reference.
The overview of
phenotyping is actually
0:22
a fairly straightforward issue.
We had no diagnostic criteria
for migraine and
other headache types
until the late 1980s,
when the International
Classification of Headache Disorders
was first defined.
Since then we've had
about three and a half
iterations of that
classification system.
But we still have
an issue in terms
of where to go once we
have identified someone
as having the
phenotype of migraine
and that remains the
elephant in the room.
How do we decide,
given someone has migraine,
what the most appropriate
treatment strategy should be?
How do we monitor for efficacy,
most bothersome symptom
and other measures that seem
to be important to patients
and to our research
in the field.
1:17
Let's start with what I consider
the four basic questions.
First, who are the most
challenging migraine patients?
Who are the patients who have
a diagnosis of migraine,
but are most challenging to us
in figuring out what the
best treatment strategy is?
What is the most important
measure of success?
By that I mean do our
measures of success,
things like decrease in
frequency, severity,
and duration of episodes,
correlate with the single
most important measure
for individual patients.
Multiple studies have
shown that there's
not always a one
to one correlation
between what the doctor
thinks is most important
and what the patient
thinks is most important.
Certainly when do we decide
that management is not working?
When do we decide
if an intervention
has not been successful
and we need to change gears
and how do we make
that determination?
Then finally, what
is chronification?
Chronification is
a term that we're
hearing increasingly,
and that's the patient
who goes from having
a few headaches a
month or a year,
to having headaches that are
increasingly frequent, severe,
with more prominent symptoms
like cutaneous allodynia
and central sensitization.
Why is it that some patients go
from a few headaches a year
to having almost
daily headaches,
while others just stay
low frequency episodic
throughout most of their lives.
