This podcast describes how to differentiate true multiple sclerosis (MS) relapses from pseudorelapses, how to treat relapses, and the role of the primary care physician in the management of the many symptoms and comorbities that are associated with MS. To discuss these issues, Dr. Michael Yeung has once again kindly agreed to participate. Dr. Yeung is a clinical associate professor of neurology at the University of Calgary. He has been the director of the MS Clinical Trials Research Program since 2007, and the Program Director of the adult neurology residency program since 2012. Dr. Yeung's disclosures are to be published here shortly.The main references for this podcast are the following:1. Brust, Tyson B, and Yeung, Michael MC. Update on the management of multiple sclerosis: treatment of symptoms and relapses. The Canadian Journal of Diagnosis; July/August 2014; 31(7).2. Towards Optimized Practice Guideline: Multiple Sclerosis and Urinary Tract Infection (November, 2013).

In this podcast we discuss the role of the primary care physician in the initial diagnosis and work-up of patients suspected of having multiple sclerosis (MS). Specifically, we outline the approach to the diagnosis of MS and outline features that are common at the onset of MS as well as identify features that are atypical and would lead to a search for an alternate diagnosis. Our guest for this podcast is Dr. Michael Yeung, a clinical associate professor of Neurology at the University of Calgary and also an expert in MS. Dr. Yeung has been the director of the MS Clinical Trials Research program since 2007, and the Program Director of the adult neurology residency program at the University of Calgary since 2012. His disclosures will be published here shortly.The main reference used for this podcast is an article that Dr. Yeung and I recently co-authored:Brust, Tyson B and Yeung, Michael MC. When to suspect multiple sclerosis: common presentations and differential diagnosis. The Canadian Journal of Diagnosis; June 2014; 31(6).

In the last podcast we discussed tension-type headache. In the current podcast, we discuss cluster headache, which is a rare variety of primary headache, having a population frequency of about 0.1%. Because the pain of cluster headache is one of the most severe that humans experience, the treatment of cluster headache often becomes almost an emergency as patients seek relief. To discuss cluster headache diagnosis and treatment, we have Dr. Werner Becker back with us once more. Dr. Becker is a Professor of Neurology at the University of Calgary and a fellow of the American Headache Society. He has also recently written a clinical review entitled “Cluster Headache: Conventional Pharmacological Management” in the journal Headache (2013; 53(7); 1191-1196). The content of the current podcast is largely based on this article.

In the last podcast we discussed chronic migraine. In this podcast we discuss tension-type headache, which is the most common primary or secondary headache with a lifetime prevalence in adults of 46%. Because of its higher population prevalence, TTH actually has a greater societal impact than migraine even though it is less disabling. The learning objectives for this podcast include diagnosis, the general approach to the patient presenting with tension type headache, and specific pharmacological treatment.The guest expert for this podcast is once again Dr. Werner Becker, Professor of Neurology at the University of Calgary and a fellow of the American Headache Society. Dr. Becker has no disclosures. The main resource for the content of this podcast was the Towards Optimized Practice Primary Care Management of Headache in Adults guideline.

In the last podcast we discussed migraine prophylaxis. In this podcast we focus on chronic migraine, a disabling neurologic condition that affects 2% of the population. Back with us is Dr. Werner Becker, Professor of Neurology at the University of Calgary and a fellow of the American Headache Society. Dr. Becker is also the senior author of the Canadian Headache Society guidelines for acute migraine treatment and for prophylactic migraine treatment. Dr. Becker has no disclosures. In addition to the above guidelines, the content for this podcast was also based on a recent review article in the BMJ entitled "Chronic migraine" by Todd J Schwedt (BMJ 2014;348:g1416).

In the last podcast we discussed the general principles of the management of acute migraine headache. In this podcast, we discuss the principles of migraine prophylaxis, including indications for prophylaxis and specific prophylactic therapies.Dr. Werner Becker, Professor of Neurology at the University of Calgary has kindly agreed to once again be the guest expert for this podcast. Dr. Becker is also the senior author of the Canadian Headache Society guidelines for acute migraine treatment and for prophylactic migraine treatment, which is the main source of content for this podcast. Dr. Becker has no disclosures.

In the previous podcast, we discussed the general approach to headache, red flags, and clues to help distinguish primary from secondary headaches. Because migraine is such a common neurological disorder affecting over 4,000,000 Canadians and resulting in significant social and economic impact, we will discuss acute and chronic migraine in some detail over the course of the next three podcasts. In this podcast we discuss the diagnostic criteria for migraine, the general principles of acute migraine management, and specific therapies for acute migraine. In the next two podcasts we will discuss migraine prophylaxis and the challenging condition of chronic migraine.With us again is Dr. Werner Becker, professor of Neurology at the University of Calgary. Dr. Becker is also the senior author of the Canadian Headache Society guidelines for acute migraine treatment and for prophylactic migraine treatment. Dr. Becker has no disclosures.

This is the first podcast in a series of podcasts on headache. This podcast discusses the general approach to headache patients with a focus on diagnosis, investigations, and red flags. We identify features that can help distinguish primary and secondary headaches. Future podcasts will focus on the primary headache disorders, with a special emphasis on migraine headache due to its high prevalence in the Canadian population.The expert guest for this series of headache podcasts is Dr. Werner Becker, a Professor of Neurology at the University of Calgary and a fellow of the American Headache Society. Dr. Becker was also the founding director of The Calgary Headache Assessment and Management Program (CHAMP) here at the University of Calgary, a multi-disciplinary program which brings a broad range of treatment options to patients with headaches. Dr. Becker is also the senior author of the Canadian Headache Society guidelines for acute migraine treatment and for prophylactic migraine treatment. Dr. Becker has no disclosures.The main references referred to in this podcast are the following:The Canadian Headache Society guidelinesToward Optimized Practice Primary Care Management of Headache in Adults

The University of Calgary's department of clinical neurosciences podcasts are designed to bring topics in neurology, neurosurgery, and rehabilitation medicine to primary care physicians and trainees. Note that the opinions expressed in these podcasts do not necessarily reflect the views of the University of Calgary or the department of clinical neurosciences. The University of Calgary is not responsible for the accuracy of the information contained within these podcasts.