Difference between revisions of "Migraine headache"

(Definition: Migraine Headache without Aura)
Line 2: Line 2:
 
===Definition: Migraine Headache without Aura===
 
===Definition: Migraine Headache without Aura===
 
*At least 5 attacks of headache fulfilling the following criteria:
 
*At least 5 attacks of headache fulfilling the following criteria:
**1.HA attacks lasting 4–72 hr (untreated or unsuccessfully treated) (>1 h for children)
+
**HA attacks lasting 4–72 hr (untreated or unsuccessfully treated) (>1 h for children)
**2.HA has at least 2 of the following characteristics:
+
**HA has at least 2 of the following characteristics:
***a.Unilateral location
+
***Unilateral location
***b.Pulsating quality
+
***Pulsating quality
***c.Moderate or severe pain intensity
+
***Moderate or severe pain intensity
***d.Aggravation by or causing avoidance of routine physical activity
+
***Aggravation by or causing avoidance of routine physical activity
**3.During HA at least one of the following occurs:
+
**During HA at least one of the following occurs:
***a.Nausea and/or vomiting
+
***Nausea and/or vomiting
***b.Photophobia and phonophobia (may be inferred from behavior)
+
***Photophobia and phonophobia (may be inferred from behavior)
**4.Not attributed to another disorder
+
**Not attributed to another disorder
  
 
==Diagnosis==
 
==Diagnosis==

Revision as of 07:04, 27 February 2014

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
  1. Pulsatile quality
  2. duration of 4-72 hOurs
  3. Unilateral
  4. Nausea or vomiting
  5. Disabling in quality

DDX

Headache

Common

Killers

Maimers

Others

Aseptic Meningitis

Treatment

  1. Migraine
    1. 1st line: Prochlorperazine (compazine) 10mg IV (+/- benadryl)
      1. Most effective therapy
    2. 2nd line:
      1. Metoclopramide (reglan) 10mg IV
      2. DHE 1mg IV over 3min
        1. Consider metoclopramide or prochlorperazine as pre-treatment antiemetic
        2. Contraindications: pregnancy, cardiovascular disease, HTN
      3. Triptans
        1. Contraindications: cardiovascular disease, use of DHE in previous 24hrs
    3. 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?