Headache: Difference between revisions
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* New-onset or change in chronic headaches. Prevalence of significant pathology is 32%.<ref name="pmid16968852"/> This compares to a prevalence of significant pathology of 1% for patients with chronic headaches referred to a neurologist.<ref name="pmid15606567">{{cite journal |author=Sempere AP, Porta-Etessam J, Medrano V, ''et al'' |title=Neuroimaging in the evaluation of patients with non-acute headache |journal=Cephalalgia |volume=25 |issue=1 |pages=30–5 |year=2005 |pmid=15606567 |doi=10.1111/j.1468-2982.2004.00798.x |issn=}}</ref> Presumably the prevalence would be lower in primary care. | * New-onset or change in chronic headaches. Prevalence of significant pathology is 32%.<ref name="pmid16968852"/> This compares to a prevalence of significant pathology of 1% for patients with chronic headaches referred to a neurologist.<ref name="pmid15606567">{{cite journal |author=Sempere AP, Porta-Etessam J, Medrano V, ''et al'' |title=Neuroimaging in the evaluation of patients with non-acute headache |journal=Cephalalgia |volume=25 |issue=1 |pages=30–5 |year=2005 |pmid=15606567 |doi=10.1111/j.1468-2982.2004.00798.x |issn=}}</ref> Presumably the prevalence would be lower in primary care. | ||
* Patients with [[human immunodeficiency virus]]. This is based on a [[clinical practice guideline]].<ref name="pmid11782746">{{cite journal |author= |title=Clinical policy: critical issues in the evaluation and management of patients presenting to the emergency department with acute headache |journal=Ann Emerg Med |volume=39 |issue=1 |pages=108–22 |year=2002 |pmid=11782746 |doi= |issn=|url=http://www.acep.org/WorkArea/showcontent.aspx?id=8802}}</ref> | * Patients with [[human immunodeficiency virus]]. This is based on a [[clinical practice guideline]].<ref name="pmid11782746">{{cite journal |author= |title=Clinical policy: critical issues in the evaluation and management of patients presenting to the emergency department with acute headache |journal=Ann Emerg Med |volume=39 |issue=1 |pages=108–22 |year=2002 |pmid=11782746 |doi= |issn=|url=http://www.acep.org/WorkArea/showcontent.aspx?id=8802}}</ref> | ||
==Treatment== | |||
[[phenothiazine|Prochlorperazine]] is better than [[phenothiazine|promethazine]] in relieving nonspecific, benign headaches according to a [[randomized controlled trial]].<ref name="pmid18534808">{{cite journal |author=Callan JE, Kostic MA, Bachrach EA, Rieg TS |title=Prochlorperazine vs. promethazine for headache treatment in the emergency department: a randomized controlled trial |journal=J Emerg Med |volume=35 |issue=3 |pages=247–53 |year=2008 |month=October |pmid=18534808 |doi=10.1016/j.jemermed.2007.09.047 |url=http://linkinghub.elsevier.com/retrieve/pii/S0736-4679(08)00104-2 |issn=}}</ref> | |||
==References== | ==References== | ||
<references/> | <references/> | ||
Revision as of 21:27, 2 December 2008
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
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."[1]
Migraine headache
Tension headache
Cluster headache
- Criteria
Diagnostic criteria developed by the International Headache Society are:[2]
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."[1]
The role of overuse of medications for treating migraine (triptans, analgesics, ergots) and their withdrawal as a cause of headache is controversial.[3]
Diagnosis
X-ray computed tomography (CT Scan) should be considered if one of the following is present:[4]
- 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
CT scan should also be considered in the following settings:
- Acute thunderclap headache. Prevalence of significant pathology is 40%[4]
- New-onset or change in chronic headaches. Prevalence of significant pathology is 32%.[4] This compares to a prevalence of significant pathology of 1% for patients with chronic headaches referred to a neurologist.[5] Presumably the prevalence would be lower in primary care.
- Patients with human immunodeficiency virus. This is based on a clinical practice guideline.[6]
Treatment
Prochlorperazine is better than promethazine in relieving nonspecific, benign headaches according to a randomized controlled trial.[7]
References
- ↑ 1.0 1.1 1.2 National Library of Medicine. Headache. Retrieved on 2007-12-11. Cite error: Invalid
<ref>tag; name "title" defined multiple times with different content Cite error: Invalid<ref>tag; name "title" defined multiple times with different content - ↑ Cluster headache
- ↑ 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.
- ↑ 4.0 4.1 4.2 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.
- ↑ 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.