Primary Headache Disorders

Info

🌱 來自: Huppert’s Notes

Primary Headache Disorders🚧 施工中

Primary Headache Disorders

Migraine headache

•   Symptoms:

-   POUND: Pulsatile quality, One day duration, Unilateral, Nausea/vomiting, Debilitating

-   Increased stroke risk if migraines are associated with aura, so avoid oral contraceptive pills in these patients

•   Treatment:

-   Acute migraine treatment:

•   Mild to moderate attacks: NSAIDs (i.e., ibuprofen 400 mg, naproxen 500/550 mg, level A), acetaminophen (1000 mg, level A), combination analgesics (i.e., acetaminophen-aspirin-caffeine, level A); if severe nausea/vomiting, also prescribe an oral or rectal antiemetic

•   Moderate to severe attacks: Triptans (especially combination of sumatriptan and naproxen, level A; can be given subcutaneously or intranasally if severe vomiting), nonoral antiemetics

•   Emergency settings: Sumatriptan 6 mg subcutaneously, antiemetics/dopamine receptor blockers (metoclopramide 10 mg IV, prochlorperazine 10 mg IV/IM, chlorpromazine 0.1 mg/kg IV [total 25 mg IV], level B), dihydroergotamine 1 mg IV, with metoclopramide, ketorolac 30 mg IV or 60 mg IM (level C)

-   Prophylactic migraine treatment:

•   Indication: Frequent, prolonged, or debilitating migraines with contraindication to or failure of acute therapies above

•   Medications: Propranolol, valproic acid, topiramate

•   Efficacy: Effectiveness only apparent after taking medication for 1–3 months

•   Refer to a neurologist: Pregnancy, known structural brain anomalies, chronic daily headaches >15× per month, failure of multiple medications, consideration of calcitonin gene-related peptide (CGRP) receptor antagonists, or hospitalizations

Tension headache

•   Symptoms: Described as “boring,” “tightening,” or “vice-like”; non-pulsatile, bilateral, featureless headache

•   Treatment: Acetaminophen, NSAIDs, aspirin. Amitriptyline can be helpful for prevention

Trigeminal autonomic cephalgias (TACs)

•   Definitions:

-   Trigeminal autonomic cephalgias (TACs): Headache disorders characterized by trigeminal and cranial autonomic activation with unilateral pain and autonomic features.

-   Cluster headaches: Most common subtype of TAC (90%); onset typically 20–40 yr; M:F = 3:1. Clinically, patient reports a knife-like pain (often behind the eye) that is maximal at onset or achieves maximal intensity within minutes. Associated with autonomic features and restlessness. Headaches often cluster in periods of 2–12 weeks, followed by long periods of remission.

•   Treatment:

-   Acute: Sumatriptan 4–6 mg subcutaneously or 22 mg inhaled (max 2 doses/24 hr), high-flow oxygen >7 liters per minute face mask

-   Prophylaxis: Verapamil 80 mg TID (starting dose)