The study explores the awareness of technical terms used in evidence-based medicine (EBM) and manner of treating patients with migraine among a random sample of 500 general practitioners (GPs). A mailed questionnaire included questions on GPs' demographics and practice characteristics; awareness of EBM; sources of information about migraine and EBM; and patient's treatment behaviour. Only 27.2% of GPs agreed that clinical trials are needed to evaluate the efficacy of treatments and this awareness was higher in those who learned about migraine from scientific journals or continuing education courses and who attended courses on EBM. For two-thirds of GPs, disability is equivalent to illness diagnosis, and this behaviour was more prevalent in those who agreed that clinical trials are needed to evaluate the efficacy of preventive or curative treatments of migraine and that the clinical approach to migraine required an evaluation of clinical effectiveness, in those who treated a lower number of headache patients, who were older, and in those who did not use guidelines. The majority (93.1%) of GPs indicated that it is important to integrate clinical practice and the best available evidence, and this behaviour was significantly more frequent in those who agreed that the clinical approach to migraine required a clinical effectiveness evaluation, that clinical trials are needed to evaluate the efficacy of preventive or curative treatments of migraine, and in those who attended courses on EBM. Training and continuing educational programmes on EBM and guidelines on treatments of headache for GPs are strongly needed.

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IntroductionEvidence-based medicine (EBM) promotes the use of current best evidence in making decisions about the health care of individual patients. Its practice means integrating individual clinical expertise with clinical evidence from systematic research and its main principle is that clinical decisions should be based on the best available scientific evidence of previous experience and the conclusions based on such evidence should stimulate quality improvements in patient care [1,2]. However, it should be noted that in several areas of the medical sciences the lack of good evidence for clinical decision-making remains an issue and the availability of good evidence does not necessarily get applied to patient care [3]. Moreover, as clinicians deal with patients, there is a continuing increase in the need for clinical information, but for many reasons clinicians often do not obtain that vital evidence.Previous studies have assessed general practitioners' (GPs) perceptions of EBM and its influence on health care decisions [8][9][10], but to the best of our knowledge no information is available about its evaluation on migraine and information on this topic is needed because patients with migraine headaches often present family physicians with diagnostic and therapeutic challenges. Therefore, the purpose of the present study is to identify if GPs in Italy are aware of technical terms used in EBM and what their behaviour is in terms of treating patients with migraine. Abstract The impact of migraine headaches is one of the major public health problems in several industrialised countries, with many patients reporting frequent and significant disability. Previous studies have assessed general practitioners' (GPs) perceptions towards evidence-based medicine (EBM) and its influence on health care decisions. Of 500 questionnaires distributed, responses were received from 455 for a response rate of 91%. Respondents' awareness of technical terms used in EBM indicated that only 27.2% of GPs agreed that clinical trials are needed to evaluate the efficacy of treatments and this awareness was higher in those who learned about migraine from scientific journals or continuing education courses and who attended courses on epidemiology or EBM. Training and continuing educational programmes on EBM and guidelines in terms of treatments of headache for GPs are strongly needed.J Headache Pain (2005) 6:312-314 DOI 10.1007/s10194-005-0218-6 Study on management of headache by general practitioners in South Italy H E A D A C H E A N D C O N T I N U I T Y I N H E A L T H C A R E R. Iannacchero (౧)

Cerebral venous sinus thrombosis (CVST) is a rare condition whose most common and sometimes only symptom is headache. Alas, diagnosis and treatment of CVST is often delayed or overlooked because of its high clinical variability. Using guidelines advices in detecting warning signs or symptoms of secondary headaches might ease the diagnosis of CVST.The article presents the case of a woman who is in treatment for chronic migraine and assessed for secondary headache in a multidisciplinary outpatient headache program. Alert symptoms like sudden worsening headache presentation, along with anamnestic cues, prompted neuroimaging that detected left transverse sinus thrombosis whose onset was difficult to date.