Despite affecting opposite extremities of the body, two conditions examined in clinical reviews in The BMJ this week share a number of characteristics.
Chronic migraine and fungal nail infections are both relatively common conditions, and both have a considerable impact on patients’ quality of life. Chronic migraine affects around one in 50 people, and places a huge burden on patients, including frequent headaches, nausea, and hypersensitivity to sights, sounds, and smells. Fungal nail infections affect more than twice as many people and can have psychosocial as well as physically detrimental effects.
In their clinical review of fungal nail infections, Samantha Eisman and Rodney Sinclair summarise the diagnosis and management of the condition. Since many other disorders of the nail can mimic fungal nail infections, and there is no ideal systemic treatment, this overview will provide a useful overview for many readers.
Todd Schwedt’s examination of current knowledge on chronic migraine is the third in The BMJ’s new “State of the Art” series of clinical reviews. The series, which began last month with a review of neuropathic pain, will cover a wide range of topics and delve in sufficient depth to appeal to specialists, academic clinicians, and researchers.
In his overview, Schwedt considers the epidemiology and pathophysiology of chronic migraine, risk factors for its development, and its diagnosis and management. He also discusses new classes of drug treatments under investigation, new ways existing drugs might be delivered, and potential future non-drug treatments.
The publication of these two papers serves as an illustration of the breadth of material covered in a general medical journal such as The BMJ. Despite the similarities I have drawn, chronic migraine and fungal nail infections are wildly different conditions, with different pathophysiologies, diagnosed in different specialties using different tests.
As medicine becomes more focused on narrow specialties, calls for the value of generalism to receive more recognition will continue, and more needs to be done to ensure that happens. In that environment, the need to ensure that there are places where doctors from across the profession can learn about developments in one another’s fields is increasingly important.
Tom Moberly is careers editor, BMJ.