Headache: Difference between revisions
imported>Robert Badgett |
imported>Robert Badgett |
||
| Line 48: | Line 48: | ||
Secondary headaches are defined as "conditions with headache symptom that can be attributed to a variety of causes including brain vascular disorders; wounds and injuries; infection; drug use or its withdrawal."<ref name="title">{{cite web |url=http://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?mode=&index=23488&field=all&HM=&II=&PA=&form=&input= |title=Headache Disorders, Secondary |accessdate=2007-12-11 |author=National Library of Medicine |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote=}}</ref> | Secondary headaches are defined as "conditions with headache symptom that can be attributed to a variety of causes including brain vascular disorders; wounds and injuries; infection; drug use or its withdrawal."<ref name="title">{{cite web |url=http://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?mode=&index=23488&field=all&HM=&II=&PA=&form=&input= |title=Headache Disorders, Secondary |accessdate=2007-12-11 |author=National Library of Medicine |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote=}}</ref> | ||
The role of overuse of medications for treating migraine (triptans, analgesics, ergots) and their withdrawal as a cause of headache | ====Medication-overuse headache==== | ||
The role of overuse of medications for treating migraine (triptans, analgesics, ergots) and their withdrawal as a cause of headache has been successfully<ref name="pmid25112307">{{cite journal| author=Kristoffersen ES, Straand J, Vetvik KG, Benth JS, Russell MB, Lundqvist C| title=Brief intervention for medication-overuse headache in primary care. The BIMOH study: a double-blind pragmatic cluster randomised parallel controlled trial. | journal=J Neurol Neurosurg Psychiatry | year= 2014 | volume= | issue= | pages= | pmid=25112307 | doi=10.1136/jnnp-2014-308548 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25112307 }} </ref> and unsuccessfully<ref name="pmid17475943">{{cite journal |author=Bøe MG, Mygland A, Salvesen R |title=Prednisolone does not reduce withdrawal headache: a randomized, double-blind study |journal=Neurology |volume=69 |issue=1 |pages=26–31 |year=2007 |pmid=17475943 |doi=10.1212/01.wnl.0000263652.46222.e8 |issn=}}</ref> demonstrated in trials. | |||
==Diagnosis== | ==Diagnosis== | ||
Revision as of 03:51, 27 August 2014
Headache is defined as the symptom of pain in the cranial region. It may be an isolated benign occurrence or manifestation of a wide variety of headache disorders.[1]
Classification
Headache type is not stable over time.[2]
Primary headaches
Primary headaches are defined as "conditions in which the primary symptom is headache and the headache cannot be attributed to any known causes."[3]
Migraine headache
- Criteria
Diagnostic criteria developed by the International Headache Society are:[4]
Migraine without aura:
A. At least 5 attacks fulfilling criteria B-D
B. Headache attacks lasting 4-72 hours (untreated or unsuccessfully treated)
C. Headache has at least two of the following characteristics:
- unilateral location
- pulsating quality
- moderate or severe pain intensity
- aggravation by or causing avoidance of routine physical activity (eg, walking or climbing stairs)
D. During headache at least one of the following:
- nausea and/or vomiting
- photophobia and phonophobia
E. Not attributed to another disorder
Tension headache
Cluster headache
- Criteria
Diagnostic criteria developed by the International Headache Society are:[5]
A. At least 5 attacks fulfilling criteria B-D
B. Severe or very severe unilateral orbital, supraorbital and/or temporal pain lasting 15-180 minutes if untreated1
C. Headache is accompanied by at least one of the following:
- ipsilateral conjunctival injection and/or lacrimation
- ipsilateral nasal congestion and/or rhinorrhoea
- ipsilateral eyelid oedema
- ipsilateral forehead and facial sweating
- ipsilateral miosis and/or ptosis
- a sense of restlessness or agitation
D. Attacks have a frequency from one every other day to 8 per day
E. Not attributed to another disorder
Secondary headache
Secondary headaches are defined as "conditions with headache symptom that can be attributed to a variety of causes including brain vascular disorders; wounds and injuries; infection; drug use or its withdrawal."[3]
Medication-overuse headache
The role of overuse of medications for treating migraine (triptans, analgesics, ergots) and their withdrawal as a cause of headache has been successfully[6] and unsuccessfully[7] demonstrated in trials.
Diagnosis
X-ray computed tomography (CT Scan) should be considered if one of the following is present:[8]
- cluster-type headache
- abnormal findings on neurologic examination
- undefined headache (ie, not cluster, migraine, or tension-type)
- headache with aura
- headache aggravated by exertion or a valsalva-like maneuver
- headache with vomiting
Possible subarchnoid hemorrhage: nontraumatic headache that peaked within 1 hour and:
- age ≥40, neck pain or stiffness
- limited neck flexion
- witnessed loss of consciousness
- onset during exertion
- thunderclap headache (instantly peaking pain)
CT scan should also be considered in the following settings:
- Acute thunderclap headache. Prevalence of significant pathology is 40%[8]
- New-onset or change in chronic headaches. Prevalence of significant pathology is 32%.[8] This compares to a prevalence of significant pathology of 1% for patients with chronic headaches referred to a neurologist.[10] Presumably the prevalence would be lower in primary care.
- Patients with human immunodeficiency virus. This is based on a clinical practice guideline.[11]
Treatment
Prochlorperazine is better than promethazine in relieving nonspecific, benign headaches according to a randomized controlled trial.[12]
After relief has been achieved, recurrence may be similarly affected by oral sumatriptan and oral naproxen.[13]
Migraine headache
Tension headache
Prognosis
Most chronic headaches are tension-type headache, although migraine may coexist.[14] Almost half have medication overuse.[14]
References
- ↑ Anonymous (2024), Headache (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Merikangas KR, Cui L, Richardson AK, Isler H, Khoromi S, Nakamura E et al. (2011). "Magnitude, impact, and stability of primary headache subtypes: 30 year prospective Swiss cohort study.". BMJ 343: d5076. DOI:10.1136/bmj.d5076. PMID 21868455. PMC PMC3161722. Research Blogging.
- ↑ 3.0 3.1 National Library of Medicine. Headache Disorders, Primary. Retrieved on 2007-12-11. Cite error: Invalid
<ref>tag; name "title" defined multiple times with different content - ↑ International Headache Society. Migraine headache
- ↑ International Headache Society. Cluster headache
- ↑ Kristoffersen ES, Straand J, Vetvik KG, Benth JS, Russell MB, Lundqvist C (2014). "Brief intervention for medication-overuse headache in primary care. The BIMOH study: a double-blind pragmatic cluster randomised parallel controlled trial.". J Neurol Neurosurg Psychiatry. DOI:10.1136/jnnp-2014-308548. PMID 25112307. Research Blogging.
- ↑ Bøe MG, Mygland A, Salvesen R (2007). "Prednisolone does not reduce withdrawal headache: a randomized, double-blind study". Neurology 69 (1): 26–31. DOI:10.1212/01.wnl.0000263652.46222.e8. PMID 17475943. Research Blogging.
- ↑ 8.0 8.1 8.2 Detsky ME, McDonald DR, Baerlocher MO, Tomlinson GA, McCrory DC, Booth CM (2006). "Does this patient with headache have a migraine or need neuroimaging?". JAMA 296 (10): 1274–83. DOI:10.1001/jama.296.10.1274. PMID 16968852. Research Blogging.
- ↑ Perry JJ, Stiell IG, Sivilotti MA, et al. [ CLinical decision rules to rule out subarachnoid hemorrhage for acute headache]. JAMA. 2013 Sep 25;310(12):1248–55.
- ↑ Sempere AP, Porta-Etessam J, Medrano V, et al (2005). "Neuroimaging in the evaluation of patients with non-acute headache". Cephalalgia 25 (1): 30–5. DOI:10.1111/j.1468-2982.2004.00798.x. PMID 15606567. Research Blogging.
- ↑ (2002) "Clinical policy: critical issues in the evaluation and management of patients presenting to the emergency department with acute headache". Ann Emerg Med 39 (1): 108–22. PMID 11782746. [e]
- ↑ Callan JE, Kostic MA, Bachrach EA, Rieg TS (October 2008). "Prochlorperazine vs. promethazine for headache treatment in the emergency department: a randomized controlled trial". J Emerg Med 35 (3): 247–53. DOI:10.1016/j.jemermed.2007.09.047. PMID 18534808. Research Blogging.
- ↑ Friedman BW, Solorzano C, Esses D, Xia S, Hochberg M, Dua N et al. (2010). "Treating headache recurrence after emergency department discharge: a randomized controlled trial of naproxen versus sumatriptan.". Ann Emerg Med 56 (1): 7-17. DOI:10.1016/j.annemergmed.2010.02.005. PMID 20303198. PMC PMC2902611. Research Blogging.
- ↑ 14.0 14.1 Grande RB, Aaseth K, Saltyte Benth J, Gulbrandsen P, Russell MB, Lundqvist C (July 2009). "The Severity of Dependence Scale detects people with medication overuse: the Akershus study of chronic headache". J. Neurol. Neurosurg. Psychiatr. 80 (7): 784–9. DOI:10.1136/jnnp.2008.168864. PMID 19279030. Research Blogging.