Migraine headache: Difference between revisions
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==Treatment== | ==Treatment== | ||
*1st line: [[Prochlorperazine]] (compazine) 10mg IV (+/- [[diphenhydramine]] 12.5 mg IV) | *1st line: [[Prochlorperazine]] (compazine) 10mg IV (+/- [[diphenhydramine]] 12.5 mg IV)<ref>Coppola et al, Annals of Emergency Medicine, Nov 1995. Randomized, Placebo-Controlled Evaluation of Prochlorperazine Versus Metoclopramide for Emergency Department Treatment of Migraine Headaches.</ref> | ||
**Most effective therapy | **Most effective therapy | ||
*2nd line: | *2nd line: | ||
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*International Headache Society Diagnostic Criteria | *International Headache Society Diagnostic Criteria | ||
*Detsky et. al, JAMA '06 Does this Patient with a Headache have a Migraine or need Neuroimaging? | *Detsky et. al, JAMA '06 Does this Patient with a Headache have a Migraine or need Neuroimaging? | ||
<references>Coppola et al, Annals of Emergency Medicine, Nov 1995. Randomized, Placebo-Controlled Evaluation of Prochlorperazine Versus Metoclopramide for Emergency Department Treatment of Migraine Headaches.</references> | |||
[[Category:Neuro]] | [[Category:Neuro]] | ||
Revision as of 15:12, 16 June 2015
Background
Definition: Migraine Headache without Aura
- At least 5 attacks of headache fulfilling the following criteria:
- HA attacks lasting 4–72 hr (untreated or unsuccessfully treated) (>1 h for children)
- HA has at least 2 of the following characteristics:
- Unilateral location
- Pulsating quality
- Moderate or severe pain intensity
- Aggravation by or causing avoidance of routine physical activity
- During HA at least one of the following occurs:
- Nausea and/or vomiting
- Photophobia and phonophobia (may be inferred from behavior)
- Not attributed to another disorder
Diagnosis
- If pt has at least 4 of the following 5 "POUNDing" features LR of migraine is 24
- Pulsatile quality
- duration of 4-72 hOurs
- Unilateral
- Nausea or vomiting
- Disabling in quality
Differential Diagnosis
Headache
Common
Killers
- Meningitis/encephalitis
- Myocardial ischemia
- Retropharyngeal abscess
- Intracranial Hemorrhage (ICH)
- SAH / sentinel bleed
- Acute obstructive hydrocephalus
- Space occupying lesions
- CVA
- Carbon monoxide poisoning
- Basilar artery dissection
- Preeclampsia
- Cerebral venous thrombosis
- Hypertensive emergency
- Depression
Maimers
- Giant cell arteritis of temporal artery (temporal arteritis)
- Idiopathic intracranial hypertension (Pseudotumor Cerebri)
- Acute Glaucoma
- Acute sinusitis
- Cavernous sinus thrombosis or cerebral sinus thrombosis
- Carotid artery dissection
Others
- Mild traumatic brain injury
- Trigeminal neuralgia
- TMJ pain
- Post-lumbar puncture headache
- Dehydration
- Analgesia abuse
- Various ocular and dental problems
- Herpes zoster ophthalmicus
- Herpes zoster oticus
- Cryptococcosis
- Febrile headache (e.g. pyelonephritis, nonspecific viral infection)
- Ophthalmoplegic migraine
- Superior Vena Cava Syndrome
Aseptic Meningitis
- Viral
- Tuberculosis
- Lyme disease
- Syphilis
- Leptospirosis
- Fungal (AIDS, transplant, chemotherapy, chronic steroid use)
- Noninfectious
Treatment
- 1st line: Prochlorperazine (compazine) 10mg IV (+/- diphenhydramine 12.5 mg IV)[1]
- Most effective therapy
- 2nd line:
- Metoclopramide (reglan) 10mg IV
- DHE 1mg IV over 3min
- Consider metoclopramide or prochlorperazine as pre-treatment antiemetic
- Contraindications: pregnancy, cardiovascular disease, HTN
- Triptans
- Contraindications: cardiovascular disease, use of DHE in previous 24hrs
- Ketorolac
See Also
Source
- International Headache Society Diagnostic Criteria
- Detsky et. al, JAMA '06 Does this Patient with a Headache have a Migraine or need Neuroimaging?
- ↑ Coppola et al, Annals of Emergency Medicine, Nov 1995. Randomized, Placebo-Controlled Evaluation of Prochlorperazine Versus Metoclopramide for Emergency Department Treatment of Migraine Headaches.