Chronic daily headache is a debilitating condition affecting millions in the US. It involves headaches occurring more than 15 days per month for over 3 months. The document discusses the diagnosis and management of chronic daily headache. Key points include distinguishing between primary headache disorders like migraine from secondary disorders caused by other conditions. Treatment involves identifying medication overuse, treating any comorbid conditions, using preventive medications, and limiting the use of rescue medications to no more than 2 times per week to prevent rebound headaches.
This document discusses chronic daily headache (CDH), defined as a headache occurring on 15 or more days per month for more than 3 months. It describes the classification of primary and secondary CDH according to the International Headache Society. Primary CDH includes chronic migraine, chronic tension-type headache, new daily persistent headache, and hemicrania continua. Secondary CDH is caused by underlying head/neck issues, vascular disorders, infections, or psychiatric disorders. Risk factors, pathophysiology, treatment approaches including medication overuse management, and lifestyle modifications are summarized.
Approach to headache family medicine case discussion 2010AR Muhamad Na'im
The document discusses a case of a 22-year-old female university student presenting with a week-long continuous headache. Her physical exam was unremarkable and she reported stress from her studies. Differential diagnoses for her headache include tension headache given her age, stressors, and normal exam. The document then reviews classification of headaches, pathophysiology, relevant history to obtain, red flags, management options including analgesics and stress counseling, and evidence on headache evaluation and treatment.
This document discusses various types of headaches including migraines, tension headaches, cluster headaches, and chronic daily headaches. It provides information on the prevalence, characteristics, and potential causes of different headache types. Diagnostic tests and classifications of headaches are outlined. Treatment options are also discussed, differentiating between abortive therapies used for acute headaches and prophylactic drugs prescribed for frequent or chronic headaches.
This document provides an overview of headaches other than migraines. It begins by defining headaches and outlining pain-sensitive and pain-insensitive cranial structures. It describes the mechanisms of referred pain and important aspects to cover in a headache history and examination. The document then discusses the diagnostic steps for headaches, including excluding secondary headaches and determining the primary headache type. Several primary headache types are defined in detail, including tension-type headache, cluster headache, and trigeminal autonomic cephalalgias such as cluster headache, paroxysmal hemicrania and SUNCT. Treatment approaches for various headache types are also summarized.
The document discusses the management of migraines. Key points include:
- Migraines are a common cause of recurrent headaches affecting 10-20% of the population. They are often underdiagnosed and undertreated.
- Treatment involves both abortive and preventive therapies. Common abortive medications include NSAIDs, triptans, and ergot alkaloids. Preventive options include beta-blockers like propranolol, antidepressants, anti-seizure medications, and calcium channel blockers.
- Propranolol, especially the extended release formulation, is an effective and well-tolerated option for migraine prevention and reduces attack frequency, severity, and analgesic use
This document discusses approaches to evaluating and diagnosing different types of headaches. It provides guidance on taking a thorough headache history, including questions about timing, characteristics, potential triggers and aggravating/relieving factors. Common headache types like migraine and tension headache are described. The document also outlines acute and preventive treatment strategies for migraine and tension headache, emphasizing the importance of empathy, shared decision making and monitoring response to treatment.
This course classifies the various types of headaches, many of which are mistakenly called migraine. Various types of treatments, specific to a properly diagnosed headache, are listed.
This document provides a summary of headache types including definitions, epidemiology, causes, evaluation, diagnosis, and management. It discusses common primary headache disorders like migraine and tension-type headache as well as secondary headaches that can be caused by conditions like sinusitis, pseudotumor cerebri, trigeminal neuralgia, and temporal arteritis. Key details are provided on symptoms, risk factors, diagnostic criteria and tests, and treatment approaches for each headache type. The document aims to educate medical students on conducting thorough evaluations and making accurate diagnoses to appropriately manage patients presenting with headaches.
This document discusses chronic daily headache (CDH), defined as a headache occurring on 15 or more days per month for more than 3 months. It describes the classification of primary and secondary CDH according to the International Headache Society. Primary CDH includes chronic migraine, chronic tension-type headache, new daily persistent headache, and hemicrania continua. Secondary CDH is caused by underlying head/neck issues, vascular disorders, infections, or psychiatric disorders. Risk factors, pathophysiology, treatment approaches including medication overuse management, and lifestyle modifications are summarized.
Approach to headache family medicine case discussion 2010AR Muhamad Na'im
The document discusses a case of a 22-year-old female university student presenting with a week-long continuous headache. Her physical exam was unremarkable and she reported stress from her studies. Differential diagnoses for her headache include tension headache given her age, stressors, and normal exam. The document then reviews classification of headaches, pathophysiology, relevant history to obtain, red flags, management options including analgesics and stress counseling, and evidence on headache evaluation and treatment.
This document discusses various types of headaches including migraines, tension headaches, cluster headaches, and chronic daily headaches. It provides information on the prevalence, characteristics, and potential causes of different headache types. Diagnostic tests and classifications of headaches are outlined. Treatment options are also discussed, differentiating between abortive therapies used for acute headaches and prophylactic drugs prescribed for frequent or chronic headaches.
This document provides an overview of headaches other than migraines. It begins by defining headaches and outlining pain-sensitive and pain-insensitive cranial structures. It describes the mechanisms of referred pain and important aspects to cover in a headache history and examination. The document then discusses the diagnostic steps for headaches, including excluding secondary headaches and determining the primary headache type. Several primary headache types are defined in detail, including tension-type headache, cluster headache, and trigeminal autonomic cephalalgias such as cluster headache, paroxysmal hemicrania and SUNCT. Treatment approaches for various headache types are also summarized.
The document discusses the management of migraines. Key points include:
- Migraines are a common cause of recurrent headaches affecting 10-20% of the population. They are often underdiagnosed and undertreated.
- Treatment involves both abortive and preventive therapies. Common abortive medications include NSAIDs, triptans, and ergot alkaloids. Preventive options include beta-blockers like propranolol, antidepressants, anti-seizure medications, and calcium channel blockers.
- Propranolol, especially the extended release formulation, is an effective and well-tolerated option for migraine prevention and reduces attack frequency, severity, and analgesic use
This document discusses approaches to evaluating and diagnosing different types of headaches. It provides guidance on taking a thorough headache history, including questions about timing, characteristics, potential triggers and aggravating/relieving factors. Common headache types like migraine and tension headache are described. The document also outlines acute and preventive treatment strategies for migraine and tension headache, emphasizing the importance of empathy, shared decision making and monitoring response to treatment.
This course classifies the various types of headaches, many of which are mistakenly called migraine. Various types of treatments, specific to a properly diagnosed headache, are listed.
This document provides a summary of headache types including definitions, epidemiology, causes, evaluation, diagnosis, and management. It discusses common primary headache disorders like migraine and tension-type headache as well as secondary headaches that can be caused by conditions like sinusitis, pseudotumor cerebri, trigeminal neuralgia, and temporal arteritis. Key details are provided on symptoms, risk factors, diagnostic criteria and tests, and treatment approaches for each headache type. The document aims to educate medical students on conducting thorough evaluations and making accurate diagnoses to appropriately manage patients presenting with headaches.
This PPT focuses on the diagnosis and treatment of the primary headache disorders, with special emphasis on migraine, the headache most likely to bring patients to physicians and pharmacists. warning signs of the ominous headache, which, although rare, can herald a life-threatening condition. Clinical characteristics of the primary headache types, migraine, tension-type headache, and cluster headache, are described
This document discusses headaches in children. It classifies headaches as either primary or secondary. The most common primary headaches in children are migraine, tension headache, and cluster headache. Migraines affect 3-23% of children and symptoms include throbbing pain, sensitivity to light/sound, and nausea. Tension headaches are caused by emotional or physical stress and eye strain. The document provides guidelines for evaluating and managing common childhood headaches.
Headache is a common reason patients seek medical attention and can be primary or secondary. Primary headaches include tension-type headaches, which cause bilateral tight band-like pain, and migraines, which often cause severe one-sided throbbing pain accompanied by sensitivity to light, sound, and nausea. Migraines are thought to involve neurovascular and serotonergic mechanisms. Cluster headaches are rare but cause excruciating unilateral orbital or temporal pain and may be associated with autonomic symptoms. Treatment involves acute abortive medications as well as preventive medications depending on headache type and frequency. Secondary headaches require evaluation for underlying causes such as infection, trauma, or vascular abnormalities.
The document discusses headaches and migraines. It provides classifications for different types of headaches, including primary and secondary headaches. Migraines are classified as with or without aura. The diagnostic criteria for migraine without aura is outlined. The pathophysiology of migraines involves vascular, neurovascular and brainstem activation theories. Triggers and symptom phases of migraines are described. Treatment involves preventive medications and acute medications for migraine attacks.
This document discusses several key points about managing headaches and migraines:
- It describes a case of a 24-year-old woman experiencing episodic vertigo and asks what additional information would be useful to obtain.
- It then reviews treatment options for migraine-related vertigo and indicates that cinnarizine would be an appropriate initial treatment.
- Finally, it discusses the use of flunarizine for migraine prophylaxis, including its indications, contraindications, adverse effects, interactions, and evidence from clinical studies supporting its effectiveness in reducing migraine frequency and severity.
The document discusses migraine headaches, including:
- Migraines affect 15% of women and 6% of men and cause episodic throbbing headaches along with sensitivity to light, sound, and movement.
- Migraines can be divided into those with aura, preceded by neurological symptoms like visual disturbances, and those without aura.
- Familial hemiplegic migraine is a rare form of migraine with aura that runs in families and can include additional symptoms like weakness, fever, or seizures. It is caused by mutations in genes involved in ion transport in neurons.
This document discusses migraine headaches including prevalence, definition, subtypes, mechanisms, clinical manifestations, treatment and conclusions. Some key points:
- Migraines are common, affecting 10-12% of the population, with higher rates in young women. They are often unrecognized or misdiagnosed.
- Migraines are defined by the International Headache Society criteria as recurrent headaches lasting 4-72 hours with characteristics like pulsating pain, nausea, sensitivity to light/sound.
- Common subtypes include menstrual, basilar, retinal and hemiplegic migraines. Migrainous vertigo is also described.
- The mechanism involves neurovascular and trigeminal pathways leading to vas
This document summarizes the pharmacotherapy of migraine. It outlines the pathophysiology including vascular, neurogenic, and neurovascular theories. It discusses acute treatment with non-specific medications like NSAIDs and specific treatments like triptans. Preventive treatment options are also covered including antidepressants, beta-blockers, anti-epileptics, calcium channel blockers, and newer targets such as CGRP antagonists and nitric oxide synthase inhibitors.
- Approximately half of adults worldwide suffer from headache disorders. The International Headache Society classification helps doctors differentiate primary headaches from secondary headaches caused by underlying conditions.
- A thorough history and physical exam, focusing on features of primary headaches, can often determine the headache type and reduce unnecessary tests.
- The document provides diagnostic criteria and recommendations for evaluating and testing various headache types like migraines, tension headaches, and cluster headaches. Danger signs require further investigation through tests like neuroimaging, lumbar puncture, or blood tests to rule out secondary causes.
Migraine pathophysiology, diagnosis and treatmentsYung-Tsai Chu
Introduction of migraine, including symptoms, epidemiology, pathophysiology(neurotransmitter, neural network, channel, CGRP), diagnostic criteria and treatment (oral, intravenous therapy at ED and long-term prevention)
This document provides an overview of evaluating and treating migraines through a case study of a patient named Peter. It begins by introducing Peter and categorizing his headaches as migraines without aura based on the diagnostic criteria. It then discusses differentiating between primary and secondary headaches, classifying primary headaches, and diagnosing the specific disorder. The document outlines considerations for developing a treatment plan, including non-pharmacological and pharmacological acute and preventive options. It emphasizes the importance of individualizing treatment based on a patient's needs and goals of therapy.
The document provides an overview of various headache types, including their causes, characteristics, treatments and related conditions. It discusses primary headache disorders like migraines and tension headaches, as well as secondary headaches that can indicate underlying issues. Evaluation of patient history is important for diagnosis. Treatment involves managing acute episodes and preventing recurrent headaches through lifestyle changes and medications.
Dr.avs practice pearls in diagnosis and prophylaxis of migrainewebzforu
This document provides guidelines and recommendations for the diagnosis and prophylactic treatment of migraines. It begins with an overview of the International Headache Society criteria for diagnosing migraines based on the presence of head and non-headache symptoms. It then discusses taking a thorough patient history and performing a focused neurological examination to diagnose migraines and rule out secondary causes. Various migraine triggers and types are described. The document recommends candidates for migraine prevention based on monthly headache frequency and impairment. It reviews guidelines for successful prevention and duration of treatment. Potential mechanisms of preventive medications and common side effects of treatments like flunarizine, beta-blockers, and anti-epileptics are summarized. The progression of mig
Migraine is a recurrent headache disorder characterized by attacks of moderate to severe pain that is typically pulsating and unilateral. It arises from abnormal brain activity that causes changes in blood vessels. Migraine affects 10-15% of people worldwide and is more common in women. Non-pharmacological and pharmacological treatments aim to relieve symptoms and reduce the frequency and severity of attacks. Naproxen and triptans are commonly used acute treatments, while preventive medications may include beta blockers or anti-seizure drugs. Migraine was historically treated with herbal remedies and bloodletting, and ergot alkaloids derived from fungi were among the earliest effective pharmaceutical treatments.
The document provides information on different types of primary headaches including migraine, tension-type headache, and cluster headache. It defines migraine as a recurrent throbbing headache affecting one side of the head that is often accompanied by nausea and visual disturbances. Tension-type headache is described as a chronic pain syndrome characterized by bilateral tight band-like discomfort. Cluster headache is defined as a rare but excruciating headache associated with autonomic symptoms like tearing and nasal congestion. The document discusses causes, symptoms, pathophysiology, diagnostic criteria and management of these primary headache types.
Tension type headache is characterized by bilateral tight, bandlike discomfort that builds slowly and may persist continuously for many days. It can be episodic or chronic. The headache lacks features of migraine such as nausea, vomiting, or sensitivity to light or sound. While tension type headache and migraine can be difficult to distinguish, tension type headache involves a primary disorder of central nervous system pain modulation alone, unlike migraine which involves a more general disturbance of sensory modulation. Chronic tension type headache can be effectively managed with amitriptyline, while simple analgesics and behavioral relaxation are also used to treat pain.
A talk covering epidemiology, diagnosis and management of primary headache disorders, common cases of secondary headache disorders and when to order brain imaging, lumbar puncture in headaches.
This document provides an overview of headache management in family practice. It discusses evaluating and treating common headache types like migraine, tension headache, and cluster headache. It covers diagnostic testing, acute and preventive treatment options, and considerations for headache in special populations like pregnancy, menopause, and the elderly.
Migraine is a highly prevalent and disabling neurological disease affecting over 30 million Americans. It is characterized by moderate to severe throbbing head pain that is often worsened by physical activity. Migraines are caused by transient changes in brain excitability that lead to the release of inflammatory neuropeptides from trigeminal nerves, causing dilation of blood vessels in the brain. Left untreated, migraines can progress to a chronic state associated with cutaneous allodynia (pain from non-painful stimuli) due to central sensitization in the brain. Early treatment with triptan medications is important to prevent this progression by blocking neuropeptide release. Preventive medications and lifestyle modifications targeting triggers are also important strategies for migraine
This talk summarizes the definition, diagnosis and management strategies of migraine. It will be useful for general public as well as healthcare professionals.
This is more of a summary of recent evidence available on migraine management. It is easy to read and understand. Please post your queries and comments.
This PPT focuses on the diagnosis and treatment of the primary headache disorders, with special emphasis on migraine, the headache most likely to bring patients to physicians and pharmacists. warning signs of the ominous headache, which, although rare, can herald a life-threatening condition. Clinical characteristics of the primary headache types, migraine, tension-type headache, and cluster headache, are described
This document discusses headaches in children. It classifies headaches as either primary or secondary. The most common primary headaches in children are migraine, tension headache, and cluster headache. Migraines affect 3-23% of children and symptoms include throbbing pain, sensitivity to light/sound, and nausea. Tension headaches are caused by emotional or physical stress and eye strain. The document provides guidelines for evaluating and managing common childhood headaches.
Headache is a common reason patients seek medical attention and can be primary or secondary. Primary headaches include tension-type headaches, which cause bilateral tight band-like pain, and migraines, which often cause severe one-sided throbbing pain accompanied by sensitivity to light, sound, and nausea. Migraines are thought to involve neurovascular and serotonergic mechanisms. Cluster headaches are rare but cause excruciating unilateral orbital or temporal pain and may be associated with autonomic symptoms. Treatment involves acute abortive medications as well as preventive medications depending on headache type and frequency. Secondary headaches require evaluation for underlying causes such as infection, trauma, or vascular abnormalities.
The document discusses headaches and migraines. It provides classifications for different types of headaches, including primary and secondary headaches. Migraines are classified as with or without aura. The diagnostic criteria for migraine without aura is outlined. The pathophysiology of migraines involves vascular, neurovascular and brainstem activation theories. Triggers and symptom phases of migraines are described. Treatment involves preventive medications and acute medications for migraine attacks.
This document discusses several key points about managing headaches and migraines:
- It describes a case of a 24-year-old woman experiencing episodic vertigo and asks what additional information would be useful to obtain.
- It then reviews treatment options for migraine-related vertigo and indicates that cinnarizine would be an appropriate initial treatment.
- Finally, it discusses the use of flunarizine for migraine prophylaxis, including its indications, contraindications, adverse effects, interactions, and evidence from clinical studies supporting its effectiveness in reducing migraine frequency and severity.
The document discusses migraine headaches, including:
- Migraines affect 15% of women and 6% of men and cause episodic throbbing headaches along with sensitivity to light, sound, and movement.
- Migraines can be divided into those with aura, preceded by neurological symptoms like visual disturbances, and those without aura.
- Familial hemiplegic migraine is a rare form of migraine with aura that runs in families and can include additional symptoms like weakness, fever, or seizures. It is caused by mutations in genes involved in ion transport in neurons.
This document discusses migraine headaches including prevalence, definition, subtypes, mechanisms, clinical manifestations, treatment and conclusions. Some key points:
- Migraines are common, affecting 10-12% of the population, with higher rates in young women. They are often unrecognized or misdiagnosed.
- Migraines are defined by the International Headache Society criteria as recurrent headaches lasting 4-72 hours with characteristics like pulsating pain, nausea, sensitivity to light/sound.
- Common subtypes include menstrual, basilar, retinal and hemiplegic migraines. Migrainous vertigo is also described.
- The mechanism involves neurovascular and trigeminal pathways leading to vas
This document summarizes the pharmacotherapy of migraine. It outlines the pathophysiology including vascular, neurogenic, and neurovascular theories. It discusses acute treatment with non-specific medications like NSAIDs and specific treatments like triptans. Preventive treatment options are also covered including antidepressants, beta-blockers, anti-epileptics, calcium channel blockers, and newer targets such as CGRP antagonists and nitric oxide synthase inhibitors.
- Approximately half of adults worldwide suffer from headache disorders. The International Headache Society classification helps doctors differentiate primary headaches from secondary headaches caused by underlying conditions.
- A thorough history and physical exam, focusing on features of primary headaches, can often determine the headache type and reduce unnecessary tests.
- The document provides diagnostic criteria and recommendations for evaluating and testing various headache types like migraines, tension headaches, and cluster headaches. Danger signs require further investigation through tests like neuroimaging, lumbar puncture, or blood tests to rule out secondary causes.
Migraine pathophysiology, diagnosis and treatmentsYung-Tsai Chu
Introduction of migraine, including symptoms, epidemiology, pathophysiology(neurotransmitter, neural network, channel, CGRP), diagnostic criteria and treatment (oral, intravenous therapy at ED and long-term prevention)
This document provides an overview of evaluating and treating migraines through a case study of a patient named Peter. It begins by introducing Peter and categorizing his headaches as migraines without aura based on the diagnostic criteria. It then discusses differentiating between primary and secondary headaches, classifying primary headaches, and diagnosing the specific disorder. The document outlines considerations for developing a treatment plan, including non-pharmacological and pharmacological acute and preventive options. It emphasizes the importance of individualizing treatment based on a patient's needs and goals of therapy.
The document provides an overview of various headache types, including their causes, characteristics, treatments and related conditions. It discusses primary headache disorders like migraines and tension headaches, as well as secondary headaches that can indicate underlying issues. Evaluation of patient history is important for diagnosis. Treatment involves managing acute episodes and preventing recurrent headaches through lifestyle changes and medications.
Dr.avs practice pearls in diagnosis and prophylaxis of migrainewebzforu
This document provides guidelines and recommendations for the diagnosis and prophylactic treatment of migraines. It begins with an overview of the International Headache Society criteria for diagnosing migraines based on the presence of head and non-headache symptoms. It then discusses taking a thorough patient history and performing a focused neurological examination to diagnose migraines and rule out secondary causes. Various migraine triggers and types are described. The document recommends candidates for migraine prevention based on monthly headache frequency and impairment. It reviews guidelines for successful prevention and duration of treatment. Potential mechanisms of preventive medications and common side effects of treatments like flunarizine, beta-blockers, and anti-epileptics are summarized. The progression of mig
Migraine is a recurrent headache disorder characterized by attacks of moderate to severe pain that is typically pulsating and unilateral. It arises from abnormal brain activity that causes changes in blood vessels. Migraine affects 10-15% of people worldwide and is more common in women. Non-pharmacological and pharmacological treatments aim to relieve symptoms and reduce the frequency and severity of attacks. Naproxen and triptans are commonly used acute treatments, while preventive medications may include beta blockers or anti-seizure drugs. Migraine was historically treated with herbal remedies and bloodletting, and ergot alkaloids derived from fungi were among the earliest effective pharmaceutical treatments.
The document provides information on different types of primary headaches including migraine, tension-type headache, and cluster headache. It defines migraine as a recurrent throbbing headache affecting one side of the head that is often accompanied by nausea and visual disturbances. Tension-type headache is described as a chronic pain syndrome characterized by bilateral tight band-like discomfort. Cluster headache is defined as a rare but excruciating headache associated with autonomic symptoms like tearing and nasal congestion. The document discusses causes, symptoms, pathophysiology, diagnostic criteria and management of these primary headache types.
Tension type headache is characterized by bilateral tight, bandlike discomfort that builds slowly and may persist continuously for many days. It can be episodic or chronic. The headache lacks features of migraine such as nausea, vomiting, or sensitivity to light or sound. While tension type headache and migraine can be difficult to distinguish, tension type headache involves a primary disorder of central nervous system pain modulation alone, unlike migraine which involves a more general disturbance of sensory modulation. Chronic tension type headache can be effectively managed with amitriptyline, while simple analgesics and behavioral relaxation are also used to treat pain.
A talk covering epidemiology, diagnosis and management of primary headache disorders, common cases of secondary headache disorders and when to order brain imaging, lumbar puncture in headaches.
This document provides an overview of headache management in family practice. It discusses evaluating and treating common headache types like migraine, tension headache, and cluster headache. It covers diagnostic testing, acute and preventive treatment options, and considerations for headache in special populations like pregnancy, menopause, and the elderly.
Migraine is a highly prevalent and disabling neurological disease affecting over 30 million Americans. It is characterized by moderate to severe throbbing head pain that is often worsened by physical activity. Migraines are caused by transient changes in brain excitability that lead to the release of inflammatory neuropeptides from trigeminal nerves, causing dilation of blood vessels in the brain. Left untreated, migraines can progress to a chronic state associated with cutaneous allodynia (pain from non-painful stimuli) due to central sensitization in the brain. Early treatment with triptan medications is important to prevent this progression by blocking neuropeptide release. Preventive medications and lifestyle modifications targeting triggers are also important strategies for migraine
This talk summarizes the definition, diagnosis and management strategies of migraine. It will be useful for general public as well as healthcare professionals.
This is more of a summary of recent evidence available on migraine management. It is easy to read and understand. Please post your queries and comments.
This document provides an overview of common medications used to treat migraines, including both preventative and rescue medications. It discusses lifestyle modifications that should be implemented alongside medications. For rescue medications, it emphasizes treating early in the migraine attack to improve effectiveness. Common over-the-counter options like NSAIDs, acetaminophen, and combination products are reviewed, alongside prescription medications including triptans, anti-nausea drugs, and opioids. The document cautions against medication overuse headache and stresses individualizing treatment based on a patient's needs and triggers.
- Headaches are a common neurological problem and migraine is the most frequent diagnosis in patients presenting with headache.
- Migraines affect 12-15% of the population and are characterized by distinct phases including prodrome, aura, headache, and postdrome. Common triggers include stress, hormones, sleep disturbances, and foods.
- Tension-type headaches are also very common and present as mild to moderate bilateral headaches without other symptoms. Treatment involves analgesics and behavioral therapies.
- Other primary headaches like cluster headaches and trigeminal autonomic cephalalgias present with short attacks of severe pain and autonomic symptoms. Emergency evaluation is needed for headaches with red flag symptoms.
Headache School provides education to help patients better manage migraine. Migraine is a very common neurological disorder that affects over 30 million Americans. Formal educational programs have been shown to produce better outcomes for patients with headache. The classes cover topics like different medication options, how diet can impact headaches, and headaches in women. Understanding the science behind migraine can help patients identify triggers to prevent attacks and choose effective treatment options.
This document provides information on migraine including classification, pathophysiology, treatment of acute attacks, and preventive therapy. It notes that migraine is a recurrent headache disorder characterized by attacks lasting 4-72 hours with symptoms like throbbing pain and sensitivity to light/sound. Treatment involves analgesics, triptans, or ergot derivatives for acute attacks and medications like propranolol, amitriptyline or topiramate for prevention. The pathophysiology involves dilatation and constriction of cranial blood vessels triggered by the trigeminal nerve.
This document provides an overview of common types of headaches, including migraine, tension-type headache, cluster headache, and medication overuse headache. It discusses the signs, symptoms, diagnostic approach, and management strategies for each type. The diagnostic approach involves taking a thorough history, performing a physical examination, and ordering imaging tests only if indicated. Management involves both acute and preventative treatment depending on the headache type. The document emphasizes the importance of making an accurate diagnosis and reassuring patients that other pathology has been excluded.
Headache for post basic neuroscience course 2015Ahmad Shahir
This document provides information on different types of headaches, including migraine, tension-type headache, cluster headache, and medication overuse headache. It discusses the classification, symptoms, diagnosis, and management of various headaches. For diagnosis, it emphasizes taking a thorough history and physical exam. It outlines red flags that warrant further investigation. Treatment involves acute and preventative medications. The focus is on a personalized approach and lifestyle modifications like keeping a headache diary.
Headache is one of the most common human complaints worldwide. There are two main types of headaches - primary and secondary. Primary headaches include migraines, tension headaches, and cluster headaches, which are caused by the condition itself rather than another cause. Migraines are severe headaches that can cause throbbing pain on one or both sides of the head along with nausea and sensitivity to light and sound. Tension headaches cause mild to moderate dull pain across both sides of the head that is often exacerbated by stress. Cluster headaches involve excruciating pain around one eye and are more common in men. Secondary headaches are caused by underlying conditions like infections, head injuries, or tumors. Diagnosis involves history and exams, while treatment
Clinical Approach to Migraine ward case.pptxDrMSajidNoor
Migraine is a type of headache characterized by recurrent moderate to severe throbbing pain on one side of the head lasting 4-72 hours. It is caused by activation of nerve fibers in brain blood vessels, and common symptoms include light/sound sensitivity, nausea, and vomiting. Risk factors include female sex, family history, depression/anxiety, and certain triggers like hormonal changes, stress, foods, and sleep changes. There are several types of migraine including those with and without aura, as well as menstrual, silent, vestibular, and abdominal migraines. Diagnosis involves history and tests to rule out other causes, while treatment depends on frequency and includes lifestyle changes, medications, and in rare cases surgery.
Depression: What Is It and What Are My Treatment Options? (Community Lecture)Summit Health
This document discusses depression, including its definition, statistics, types, causes, consequences, role of neurotransmitters, treatment options like medication and cognitive behavioral therapy. It defines depression and differentiates it from normal sadness. It covers diagnostic criteria, risk factors, and treatments including antidepressant medications, electroconvulsive therapy, light therapy, and cognitive behavioral therapy. Relapse prevention and the importance of continued treatment are also discussed.
This document provides information on neurology for GPs, focusing on different types of headaches. It discusses the GP liaison role, common headache types like migraine, tension headache, and cluster headache. Guidelines are provided on evaluation, diagnosis, acute and preventive treatment. Referral criteria include atypical features, treatment failure, or uncertain diagnoses. The goal is to appropriately manage most headache cases in primary care while recognizing red flags that warrant specialty referral.
Migraines are severe headaches often preceded by sensory warning signs like flashes of light and nausea. They have been documented for over 7,000 years and theories about their cause have evolved from humors rising in the body to increased blood flow in the brain. Migraines involve four phases - prodrome, aura, headache, and postdrome. Current theories suggest they are caused by cortical spreading depression leading to neurogenic inflammation and vascular changes in the brain. Treatment involves avoiding triggers, medications like triptans to abort attacks, and preventative medications like beta blockers, antidepressants, or anti-seizure drugs to reduce frequency.
Migraine is a common neurological disorder characterized by severe headaches. Common triggers include diet, hormones, environment, and stress. Migraine attacks involve a headache phase with throbbing pain that worsens with activity along with symptoms like nausea and sensitivity to light/sound. Some people experience an aura phase before the headache with visual or sensory disturbances.
Treatment involves managing triggers, acute treatments like triptans to stop headaches, and preventive medications for those with frequent attacks. Preventive options include beta blockers, anti-seizure medications, and antidepressants, with the goal of reducing attack frequency and severity. Proper acute and preventive treatment along with lifestyle modifications can help manage migraine.
This document discusses anxiety disorders and their symptoms, classification, epidemiology, and treatment. It defines anxiety as a feeling of tension, worry and physical changes. It describes several types of anxiety disorders including generalized anxiety disorder, panic disorder, phobic disorders, post-traumatic stress disorder, and obsessive-compulsive disorder. It provides information on the symptoms, diagnosis, risk factors, and treatment including pharmacological therapies such as SSRIs, TCAs, benzodiazepines, and non-pharmacological therapies such as cognitive behavioral therapy.
- Headaches are usually caused by primary tension-type headaches, migraines, or something else like infection or injury (99% of cases).
- Doctors diagnose headaches based primarily on the patient's history regarding symptoms, triggers, frequency and severity rather than tests.
- Treatment involves lifestyle changes, over-the-counter or prescription medications to treat acute attacks, and preventative medications to reduce attack frequency which are chosen through trial and error.
This document discusses different types of headaches. It defines headache and classifies headaches as primary or secondary. The main primary headaches are tension-type headaches, migraines, and cluster headaches. Tension-type headaches are the most common and feel like constant squeezing tightness. Migraines typically affect one side of the head and cause throbbing pain. Cluster headaches cause severe, stabbing pain around the eye and last 15-180 minutes. The document outlines symptoms, causes, diagnostic tests, and treatment for each type of primary headache. Nursing management includes comprehensive assessment, non-pharmacological therapies, avoiding triggers, and educating patients.
This document summarizes headache diagnosis and treatment. It begins by explaining that in most cases, headaches are not caused by brain damage but by issues with brain membranes and blood vessels. It then discusses the most common types of primary headaches like tension, migraine, and cluster headaches. The document outlines diagnosis methods and treatments for different headaches, including general pain relievers, triptans, ergots, and preventative medications. It concludes by discussing non-drug therapies and new research into non-drug electrical therapy, new drug approaches, and potential "vaccinations" for migraine prevention.
This document provides information on Dr. Ganta Rajasekhar's academic qualifications and areas of interest in neurology. It then discusses approaches to evaluating headache, classifications of primary and secondary headache disorders, migraine pathogenesis and management, tension-type headache, and trigeminal autonomic cephalalgias. Evaluation and treatment strategies for acute migraine, preventive migraine therapy, medication overuse headache, and special headache conditions are covered. Common questions in headache management are also addressed.
Migraine is a common neurological disorder affecting around 20% of women and 10% of men. It causes moderate to severe headaches that are often one-sided, throbbing, and worsened by activity. Migraine peaks during ages 30-60 and can be disabling by causing missed work or activities. Both acute and preventive treatments are available to reduce frequency and severity of attacks. Lifestyle factors like sleep, diet, caffeine, and stress can trigger migraines, so maintaining a healthy lifestyle also helps management.
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Chili's is launching a new kids menu called Chili's Clip for Kids Kick-off. The new kids menu will feature kid-friendly meals and snacks at an affordable price point. Chili's hopes the new kids menu will attract families with children and increase sales during family-friendly hours on weekday evenings and weekend lunches.
Patients at Norton Children’s Hospital were feeling the love this past Valentine’s Day. Local radio station 102.3 The Max gathered valentines from the community as part of the Cupid’s Kids program.
Dieting is not easy no matter how simple the diet gurus make it sound. But do certain foods help you lose weight faster? Recent studies have identified a handful of foods that seem to work.
This document summarizes the toxicity of several common Christmas plants. Christmas cactus, Christmas trees, and poinsettias are considered nontoxic, though eating large amounts may cause minor issues like rashes or upset stomachs. Holly berries, Jerusalem cherry, and mistletoe berries are poisonous if consumed, and can cause effects ranging from nausea to death depending on the amount ingested.
Today is National Women’s Health & Fitness Day. To celebrate, Norton Women’s Sports Health asked local women why fitness is an important part of their lives. We got some great answers!
Being average doesn’t seem like much to strive for, yet it can mean everything for children who yearn to do things that other kids do. Camp Brave Hearts gives these children that chance during a week at the Center for Courageous Kids in Scottsville, Kentucky. Children ages 6 to 16 who have congenital heart disease, require medical treatment for heart disease or have undergone heart surgery get to experience summer camp as it was meant to be — the adventure of a lifetime!
The document provides tips for choosing clothing for a Splash 'n' Dash 5k run/walk event where participants will get wet. It recommends choosing lightweight, breathable fabrics and styles that allow freedom of movement when wet. Accessories like sunglasses, wide-brim hats, and water bottles are also suggested to help participants stay comfortable and hydrated during the event, which benefits Kosair Children's Hospital.
The document provides tips for choosing clothing for a Splash 'n' Dash 5k run/walk event where participants will get wet. It recommends choosing lightweight, breathable fabrics and styles that allow freedom of movement and won't cause chafing when wet. Sunglasses and hats are also suggested to protect from the sun during the outdoor water-themed event. Proceeds will benefit Kosair Children's Hospital.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
The document discusses the benefits of meditation for reducing stress and anxiety. Regular meditation practice can help calm the mind and body by lowering heart rate and blood pressure. Making meditation a part of a daily routine, even if just 10-15 minutes per day, can offer improvements to mood, focus, and overall feelings of well-being over time.
April is Child Abuse Prevention Month. All of us play a role in stopping this preventable tragedy that kills and injures thousands of our children every year. Join our caregivers to #StopChildAbuse. Learn more at DontHurtChildren.com.
Pictured are Kosair Children's Hospital employees and residents.
This document provides a sample menu for a holistic approach to eating. The breakfast includes salmon sausage or egg whites, mixed berries, grapefruit, nuts, whole grain toast with avocado, oatmeal prepared with soy milk and water and topped with berries and nuts. Lunch includes a mixed green salad, tuna or salmon in a tortilla wrap with hummus and vegetables, and a quinoa salad. Dinner options consist of wild salmon, grilled chicken, brown rice, sautéed vegetables, baked sweet potato, steamed kale and a mixed green salad. Snacks between meals include an apple with nut butter, hummus and vegetables, trail mix, and Greek yogurt with nuts and berries.
Topic 3 holistic approach to eating presentation handoutNorton Healthcare
This document discusses the importance of nutrition and a holistic approach to eating. It makes the following key points:
1. Nutrition plays a role in 8 of the top 10 causes of death in the US, yet receives little attention in health sciences education. There is a disconnect between what we eat and our health.
2. Major industries like healthcare, food, and agriculture contribute to poor health outcomes. Healthcare lacks focus on prevention and nutrition education. The food industry promotes processed foods over whole foods.
3. Adopting a whole foods, plant-based diet can help address obesity, chronic disease, and overall sickness in the US population. Eating slowly and mindfully also supports digestion and health.
This document provides an exchange list for healthy food choices organized into categories of carbohydrates from grains/starches, vegetables, fruit, proteins from plants, proteins from eggs/fish/poultry/dairy, and fats. It lists various foods and their serving sizes that are equivalent in carbohydrates, proteins, fats, and other nutrients. The exchange lists are intended to help people make balanced food selections as part of a healthy diet.
APOE Gene Diet is a registered trademark that provides information on different APOE gene variants and their associated risks for cardiovascular disease. It recommends gene-specific diets and lifestyles to support a healthy Gene Supportive Environment for each variant. The document outlines the different variants, their prevalence in the population, toxic clearance levels, and optimal diets, exercise, supplements and alcohol consumption based on the scientific literature to maintain cardiovascular health for each gene type. It cautions that statistics may not apply to individuals, who should work with their practitioner to determine their unique needs.
This document summarizes evidence from research on various complementary and integrative therapies including massage, aromatherapy, touch therapies like Reiki, and music therapy. It discusses challenges in researching individualized and natural treatments, and presents results from studies showing benefits like reduced pain, anxiety and nausea from therapies like massage, aromatherapy, and music. It also outlines programs that have successfully implemented complementary approaches in hospital settings, improving patient outcomes and reducing costs.
This document provides an overview of herbs and supplements presented by Dr. Rachel Busse. It discusses the high rate of patient supplement use, potential risks including interactions and lack of regulation. Specific supplements are reviewed for their uses, dosages, and precautions when treating conditions like mood disorders, sleep, menopause, liver health, inflammation, arthritis, and more. Herbal teas and "kitchen medicines" made from common herbs are also outlined. Sources for additional information on supplements are recommended.
This document contains slides from a presentation on stress reduction. It discusses how stress affects healthcare professionals and patients. It defines stress and identifies its causes such as overwork, role ambiguity, and understaffing. Long-term stress can increase risks of health issues like heart disease, diabetes and mental health problems. The presentation recommends organizational changes, stress management training, and coping strategies like mindfulness, social support and seeking help to reduce workplace stress.
This presentation discusses and compares Reiki and Healing Touch, which are energy-based therapies that promote self-healing. Both therapies help restore harmony and balance in the body's energy system. While they are similar, Healing Touch provides standardized training and certification. The presentation explores the history and meanings of Reiki and Healing Touch, demonstrates techniques for self-care, and reviews limited research that has shown benefits such as reduced anxiety and pain.
2. Why is it important?
• Chronic headache disorders are among the top 20
causes of disability in the US according to the
World Health Organization (WHO)
• 4% of Americans experience 4 hours of headaches
per day, at least 15 days per month
• Headache disorders are responsible for more than
$31B in economic costs in the US annually
3. What is it?
• Headache occurring more than 15 days per
month for more than three months
– Often times is daily
• Further divided into two subgroups
– Headaches lasting more than four hours
– Headaches lasting less than four hours
4. Where do we start?
• Realization
– It is NOT normal to have a headache every day
5. How many people in this room have a bottle
of Excedrin, Advil, Aleve, etc. in their purse
right now?
6. Meeting your doctor
• History
• Examination
• Testing
– Neuroimaging (CT, MRI, etc)
– Blood work
– Ophthalmologic evaluation
– Lumbar puncture
• Diagnosis
• Management
7. Diagnosis
• Primary vs. secondary headache disorders
• Primary headache disorders
– “The headache is the thing”
• Examples: migraine, tension-type, cluster
• Secondary headache disorders
– The headache is caused by something else
• Examples: medication overuse, cervical spine disease,
vascular disorders, trauma
8. Diagnosis
• Primary headache disorders
– Lasting >4 hours
• Chronic migraine
• Chronic tension-type headache
• New daily persistent headache
• Hemicrania continua
– Lasting <4 hours
• Cluster
• Other less common disorders
• Secondary headache disorders
9. Chronic Migraine
• Headache on ≥15 days per month for at least 3 months
– Has at least two of:
• Unilateral location
• Pulsating quality
• Moderate or severe pain intensity
• Aggravation by or causing avoidance of routine physical activity (e.g.
walking or climbing stairs)
– And at least one of:
• Nausea and/or vomiting
• Light and sound sensitivity
– No medication overuse and not attributed to another
causative disorder
10. Chronic Migraine
• Usually a prior history of episodic migraine
• Eventually over time gradually develops in to a
daily pattern
• May or may not be associated with medication
overuse
11.
12. Why is this important for women’s
health?
• Frequently stated that 18% of women have
migraine
• But at mid-life is closer to 30%
• By age 50, up to 40% of women have been
affected by migraine
13. What is migraine really?
• Rather complex and not fully understood
• Neurons of individuals with migraine are
hyperexcitable
• Migraneurs are more sensitive to external
stimulation
– Some interesting evolutionary theories regarding
migraine
14. Migraine Aura
• A reversible focal neurological deficit
– Most commonly visual
• Cortical spreading depression
– Think a wave of activity moving across the brain
followed by decreased activity
– The part of the brain inactivated causes the
neurological deficit
• Occipital lobes = vision
15.
16. The Headache
• Trigeminal nerve and its blood supply
(neurovascular)
– Release of neuropeptides
• CGRP
• Substance P
• 5-HT (serotonin) --> “triptans”
• Nitric oxide
– Vasodilatation (CGRP) leads to further activation, and
the process spreads
– Brainstem, thalamus, cortex become activated leading
to “central sensitization”
• Amplified pain signaling in the central nervous system
– Allodynia: pain due to a non-noxious stimulant
18. Medication Overuse Headache
• Headache present on ≥15 days/month
• Regular overuse for ≥3 months of one or more
drugs that can be taken for acute and/or
symptomatic treatment of headache
• Headache has developed or markedly
worsened during medication overuse
• Headache resolves or reverts to its previous
pattern within 2 months after discontinuation
of overused medication
19. Medication Overuse Headache
• Generally believed to occur when medication
usage exceeds 2-3 times per week
• Most patients have a history of episodic migraine
that has transformed into a daily headache
• 80% of patients in a headache specialty clinic
• Prior to diagnosis
– Duration of primary headache: 20 years
– Time of frequent medication intake: 10 years
– Time of daily headache: 6 years
23. Medication Overuse Headache
• Serious consequences
– May reduce effectiveness of other medications
– Can cause kidney / liver problems
– Tolerance – same dose becomes less effective
– Dependence – physical need for medication
• Withdrawal
26. Medication Overuse Headache
• Treatment
– Must discontinue overused medication
– Detoxification
• Inpatient vs. outpatient
– Begin / adjust prophylactic medications
– More appropriate rescue medications
27. Cervicogenic Headache
• Pain referred from a source in the neck and
perceived in one or more regions of the head
and/or face
• Evidence of a disorder or lesion within the
cervical spine or soft tissues of the neck as a
cause of headache
• Pain resolves within 3 months after successful
treatment of the causative disorder or lesion
28. Post-Traumatic Headache
• Most patients with mild head injury are never
hospitalized, so exact estimates hard to
determine
• Estimated in 30-80% of patients with mild
head injury
• Of patients with postconcussive syndrome up
to 90% report headache
• 97% of patients with whiplash injury seeking
medical attention also have headache
29. Post-Traumatic Headache
• At 3 months post-injury up to 78% have
ongoing headache
• Most patients have headache remission
within 6 months
• 12 months post-injury up to 35%
• At 4 years 24%
• 6 months seems to be the timeframe that if
still having symptoms will likely continue
30. Comorbidity of CDH
• Depression is 35 times more likely
• Panic attacks and anxiety are three times more
likely
• Sleep-related breathing disorders occur in up
to 30% of patients
• These problems need to be considered and
addressed
31. CDH Treatment / Management
• Depends first on correct diagnosis
• Not always as easy at is sounds
• Medications
– Prescription and non-prescription
• Lifestyle modifications
• Physical / behavioral therapies
• Injections
• Hospitalization
• Surgical evaluation
33. Preventative Medications
• There are no “migraine specific” medications
used in the prevention of migraine
• Use medications from other classes
– Blood pressure medications
– Antiseizure medications
– Antidepressants
– Serotonin antagonists
– Vitamin supplements
– Botox
34. Preventative Medications
• Important to identify patients that are using
frequent rescue medications and may be on
the way to developing medication overuse
headache
• Patients who have disabling headache that is
not easily treated with rescue medications
• Ideally treat multiple conditions with a single
medication
– ie. high blood pressure and migraine
35. Antidepressants
• Tricyclic antidepressants
– Amitriptyline (Elavil)
– Nortriptyline (Pamelor)
– Protriptyline (Vivactil)
• Side effects
– Elavil and Pamelor are sedating and taken at night
(useful for patients with sleep trouble)
– Cause dry mouth, constipation, weight gain
– At high doses can cause heart related issues that may
require an EKG to be checked
36. SSRI / SNRI
• SSRI
– Fluoxetine (Prozac)
– Paroxetine (Paxil)
– Fluvoxamine (Luvox)
• SNRI
– Venlafaxine (Effexor)
– Duloxetine (Cymbalta)
– Desvenlafaxine (Pristiq)
• SNRIs tend to be more effective for migraine than
SSRIs
– Venlafaxine (Effexor) has the best evidence for use in
prevention of migraine
37. SSRI / SNRI
• Side effects
– Weight gain
– Sexual dysfunction
– Sedation
– Nervousness
38. Antiseizure Medications
• Recently have become most frequently used
medications for prevention of migraine
– Topiramate (Topamax)
– Valproate (Depakote)
– Gabapentin (Neurontin)
– Zonisamide (Zonegran)
39. Topiramate (Topamax)
• One of the most frequently used medications in
the prevention of migraine
• Has several advantages, but also does have some
side effects to be aware of
• Effective in nearly 50% of patients that use it
• Rather than weight gain, often times causes
weight loss
• Optimal dose is 50mg twice per day
– If side effects occur, sometimes may use nighttime only
dosing
40. Topiramate (Topamax)
• Side effects
– Up to 13% of patients experience cognitive dysfunction of
trouble with processing information and trouble finding words
– Numbness / tingling of fingers, toes, face
• Actually a predictor of which patients will benefit from topiramate use
• Potassium supplementation can help
– Risk of kidney stones
– Glaucoma
– Reduced sweating (important in athletes / overheating)
• Recently identified birth defects
– Oral cleft (palate, lip) 11 times higher than general population
– Rated as Category D for pregnancy
• Reduced oral contraceptive effectiveness
– At doses greater than 200mg / day
41. Valproate (Depakote)
• Quite effective, but less commonly used due to
side effect potential
• Optimal dose is 500 – 1,500mg per day
• Side effects
– Weight gain
– Hair loss
– Pancreatitis
– Liver problems
• Significant effects with women of child-bearing
potential
– Neural tube defects (ie. spina bifida)
42. Blood Pressure Medications
• Beta blockers
• Calcium channel blockers
• Other blood pressure medications
– Not frequently used
• Useful in patients with co-existent high blood
pressure
43. Beta Blockers
• Propranolol
• Timolol
• Atenolol
• Metoprolol
• Nadolol
– Lower blood pressure and heart rate
• Can lead to light-headedness
– Can reduce aerobic capacity
– Worsen asthma
– Avoid in diabetics
– Can worsen depression
44. Calcium Channel Blockers
• Verapamil
• Diltiazem
– Generally well tolerated
– Often times more useful in patients with migraine
with aura
– Side effects include light-headedness,
constipation, and swelling of legs
45. Vitamin Supplements
• Not as well studied as prescription medications
(product of financing of studies)
• Magnesium
– 400+mg / day
– Diarrhea
– Magnesium glycinate probably best tolerated form
• Riboflavin (B2)
– 25 – 400mg / day
– Will discolor urine
• Coenzyme Q10
– 100mg 3x / day – I recommend 200mg 2x/day
– Costly (sometimes)
• Butterbur and Feverfew also felt to be effective
46. Rescue Medications
• Primary goal is to achieve relief of pain,
associated symptoms, and disability within 2
hours of use
• Goal is to use rescue medications 2 or fewer
times per week to prevent developing
medication overuse headache
47. Rescue Medications
• It is important to treat the headache as soon as
possible, as time goes on the medications become
less effective
• Allodynia is defined as pain resulting from
stimulation that would not normally be perceived
as noxious (ie. light touch of the skin)
– To the patient this is perceived as scalp tingling or pain
when lightly touched during a migraine
– To physicians this means that the deep parts of the
brain have been stimulated by the migraine attack and
it is often times more difficult to treat
48. Rescue Medications
• Another note is that in treating migraine unlike
treating other conditions (ie. high blood pressure)
we often times suggest using higher dose
medications initially and backing down the dose if
side effects are experiences, rather than over time
escalating doses
– So it is important to understand what potential side
effects can occur with medications and understand that
the goal is being pain-free with TOLERABLE side effects
rather than being with pain and no side effects
49. Nonspecific Migraine Medications
• Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
• Over 20 forms of NSAIDs available in the US, many
available over-the-counter
• Have anti-inflammatory effects as well as analgesic (pain
relief) effects
• Not processed through the liver
• Kidney metabolism
– Very important for patients with kidney disease, on
other medications that have effects on the kidneys, and
in patients with extreme vomiting (dehydration can
lead to kidney problems)
• Can lead to stomach bleeding with frequent use
50. NSAIDs
• Can be used alone or in combination with
other medications (ie. triptans)
• Are non-sedating
• Have been shown to be effective in treatment
of patients with allodynia
• Because of the availability there is significant
problems with overuse, particularly leading to
medication overuse headache
51. Acetaminophen
• Acetaminophen (Tylenol)
• Most people do not find useful for severe
migraine
• Can be used for mild headache
• Typical dose is 1000mg at onset of headache
• Often times used in combination products (ie.
Fioricet, Midrin, etc)
• Can lead to medication overuse headache
• With heavy usage can lead to liver toxicity,
otherwise no significant side effects
52. Butalbital
• Combination product
• Butalbital / acetaminophen / caffeine
– Esgic, Fioricet
• Butalbital / aspirin / caffeine
– Fiorinal
• Side effects include incoordination, disinhibition,
memory problems, drowsiness
• If used for extended periods of time and then
discontinued can cause withdrawal seizures
• Significant risk of medication overuse headache
– Studies show when used as few as 5 times per month can lead
to MOH
53. Excedrin
• Combination of aspirin, acetaminophen, and
caffeine
• Can be used for mild to moderate migraine
• Due to the multiple products combined there is
significant risk of medication overuse headache
• Available OTC (unregulated by treating physicians
patients can take unlimited amounts)
• In specialty headache clinics this is probably the
most frequently overused medication and causes
more frequent headache
54. Anti-nausea medications
• Can often times alone or in combination be effective
in treating migraine
– Metoclopramide (Reglan)
– Prochlorperazine (Compazine)
– Promethazine (Phenergan) to a lesser extent
• Most common side effects are drowsiness and
dizziness
• More significant side effects include dystonia
(sustained muscle contraction) and akathisia (sense
of restlessness) which can be treated with Benadryl
55. Opiates
• Worth mentioning, but in the hands of
headache specialists are not frequently used
• In migraine, opiates are not well absorbed,
they are associated with increased nausea,
and sedation
• Very quickly can lead to physical dependence
and are quite notorious for causing
medication overuse headache
57. Triptans
• Introduced in the 1990s
• Often times considered the drug of choice in
treating migraine
• Selective agonists (activators) of serotonin
blocking the release of other inflammatory
chemicals during a migraine attack
58. Triptans
• Available in many different brand names with
varying time of onset and duration of action
• Available in a variety of delivery methods
– Oral tablet
– Oral disintegrating
– Nasal
– Injection
– Patch (in development)
59. Triptans
• Side effects
– Narrow coronary blood vessels by 10-20% (cannot be
used in individuals with a history of coronary or
cerebro-vascular disease or uncontrolled risk factors)
– Tightening of the throat, chest, jaw, neck, and limbs
– Numbness of the limbs and around the mouth
– Hot and cold sensations
• Thought to be due to esophageal (not heart) related spasm
and muscle contractions
• If warned in advance, most patients can tolerate side effects
with the benefit that they give
60. Triptans
• “Patients vary more than triptans”
• Meaning, just because one did not help or caused
side effects does not mean that another will do
the same
– I give the example of Coke and Pepsi – it’s basically the
same stuff but some people like one and some people
like another, and you won’t know until you’ve tried
them
• Or that different routes of administration won’t
have a different effect
62. Sumatriptan
• Imitrex, Statdose, Sumavel, Alsuma
• First triptan brought to market (1991)
• Available oral, nasal, subcutaneous injection and soon patch
• Available as a generic
• Oral dose is 25, 50, 100mg – maximum per 24 hours is 200mg
– Available in combination with naproxen as Treximet
• Subcutaneous (SC) forms (Statdose, Sumavel, Alsuma) are 4 and
6mg (max 12mg / 24 hours)
– Have much quicker onset of action (10 minutes) and are great
for patients with significant nausea and vomiting
– Statdose and Alsuma use a needle, Sumavel is needle-less
63. Ergots
• Ergotamine tartrate available since 1925
• Dihydroergotamine (DHE) more refined
version available since 1945
– These were the only available migraine specific
medications until triptans introduced in 1990s
• Effect many chemicals in the nervous system
which explains why they are so effective, but
also explains the side effects
64. Ergots / DHE
• Nausea is the major side effect
– May actually increase nausea of migraine rather than improve
it
• Again contraindicated in patients with vascular disease,
coronary artery disease, etc.
• Available IV (hospital use)
• Intramuscular – can be administer at home
• Intranasal (Migranal) – very easy to use at home
– Inhaled in each nostril and then repeated in 15 minutes
– Much less effective than IV / IM
• Orally inhaled DHE (Levadex) coming to market soon
– Inhaled orally at home with blood levels as high as IV, but with
less nausea
65. Lifestyle Modifications
• Diet
– Tyramine containing foods
• Cheeses: blue, cheddar, parmesan, swiss
– MSG
– Nitrates
• Processed foods / meats
– Chocolate
– CAFFEINE
• About two per day
– Water
• More than 2.5 liters per day
66. Lifestyle Modifications
• Sleep
– Too much (>8.5 hours) and too little (<6 hours)
• Maintain regular sleep schedule
– Snoring / not rested after sleep
• Sleep apnea
– Relaxation techniques for sleep
– Avoid caffeine, alcohol, nicotine
– Avoid “activating” activities in bed
• TV, phone, video games
67. Physical / Behavioral Modifications
• Physical therapy
• Normalize the musculoskeletal system as much as possible
in order to reduce stress and tension on soft tissues and
joints
• Biofeedback
• Method of gaining control of the body processes to
increase relaxation, relieve pain, and develop healthier,
more comfortable life patterns
• Progressive muscle relaxation
• Technique that teaches you to concentrate on relaxing
every muscle in your body
68. Injections
• Occipital nerve block
– Combination of local
anesthetic (lidocaine) and
steroid
– Studies vary, but up to
50% of patients report
improvement
69. Injections
• Botox
– Patients with 15 or more
days of migraine per
month
– Up to 9 days less per
month of headache
– Patients on opiates and
butalbital did worse
– FDA approved
70. Botox
• OnabotulinumtoxinA
• Famous for being used for “wrinkles”
• Found to be effective in patients with chronic
migraine
– Greater than 15 days of headache per month for
greater than 3 months
• In clinical trials patients using opiates and
butalbital were excluded as they tend to do
worse
71. Botox
• 155 units injected into 31 sites given every 3
months
• Minimal side effects
– Injection site pain is largest
• Up to 9 days less per month of headache
• FDA approved
72. Outpatient Infusion Therapy
• Treatment with IV infusions of medications
under direction of physician
• Outpatient
• Break the daily cycle
• Transition to new therapies
73. Hospitalization
• Management of withdrawal
from overused medication
• Repeated infusions of IV
medications
• Adjustment of prophylactic
medications
74. Prognosis / Outcome
• Goal is to transition from daily headache to
episodic
• Studies report up to 80% of patients can have a
50% reduction in headache at 2 years
• Many of these patients require inpatient
management initially
75. What can you do?
• Track headaches
• Paper diary
• iHeadache
• www.iheadache.com
• Evaluate lifestyle factors
• Diet
• Caffeine
• Sleep
76. What can you do?
• Evaluate medicine use
• Work with your physician
• Set reasonable expectations
• Not a cure, management
77. What can you do?
• Get involved!
• Headache school
• Alliance for Headache Disorders Advocacy
• American Headache Society (AHS) Committee for
Headache Education (ACHE)
78. Headache School
• What is a migraine?
– March 14
• Medication maze
– April 11
• How diet affects headaches
– May 16
• Women and Headaches
– June 13
79. What can you do?
• American Headache Society Committee for Headache Education
• www.achenet.org
• American Headache Society
• http://www.americanheadachesociety.org
• The International Headache Society
• www.i-h-s.org
• OUCH - Organization For The Understanding Of Cluster Headache
• www.ouch-us.org
• Southern Headache Society
• www.southernheadache.org
• Alliance for Headache Disorders Advocacy
• www.allianceforheadacheadvocacy.org
80. What can we do for you?
• Outpatient neurologists / headache specialists
• 629-1234
• Inpatient neurologists / headache specialists
• IV infusion services
• Elective hospitalization
• Occipital nerve blocks
• Botox
• Psychological counseling
• Neurosurgical consultation