Difference between revisions of "Migraine headache"

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===Migraine Headache without Aura===
 
===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)
+
**1.HA attacks lasting 4–72 hr (untreated or unsuccessfully treated) (>1 h for children)
**2. HA has at least 2 of the following characteristics:
+
**2.HA has at least 2 of the following characteristics:
***a. Unilateral location
+
***a.Unilateral location
***b. Pulsating quality
+
***b.Pulsating quality
***c. Moderate or severe pain intensity
+
***c.Moderate or severe pain intensity
***d. Aggravation by or causing avoidance of routine physical activity
+
***d.Aggravation by or causing avoidance of routine physical activity
**3. During HA at least one of the following occurs:
+
**3.During HA at least one of the following occurs:
***a. Nausea and/or vomiting
+
***a.Nausea and/or vomiting
***b. Photophobia and phonophobia (may be inferred from behavior)
+
***b.Photophobia and phonophobia (may be inferred from behavior)
**4. Not attributed to another disorder
+
**4.Not attributed to another disorder
  
 
==Migraine Likelihood==
 
==Migraine Likelihood==
POUNDing
+
*If pt has at least 4 of the following 5 "POUNDing" features LR of migraine is 24
#Pulsatile
+
#Pulsatile quality
#Duration of 4-72 hours
+
#duration of 4-72 hOurs
 
#Unilateral
 
#Unilateral
 
#Nausea or vomiting
 
#Nausea or vomiting
 
#Disabling in quality
 
#Disabling in quality
  
Yes to 4 or more: LR 24
+
==Treatment==
Yes to 3 or more: LR 3.5
+
# Migraine
Yes to 1-2: LR 0.41
+
## 1st line: Prochlorperazine (compazine) 10mg IV (+/- benadryl)
 +
### Most effective therapy
 +
## 2nd line:
 +
### Metoclopramide (reglan) 10mg IV
 +
###DHE 1mg IV (often used with an antiemetic)
 +
#### Contraindications: pregnancy, cardiovascular disease, HTN
 +
###Triptans
 +
####Contraindications: cardiovascular disease, use of DHE in previous 24hrs
 +
## Ketorolac
  
 
==See Also==
 
==See Also==
[[Headache]]
+
*[[Headache]]
 
+
*[[Headache DDX]]
[[Headache DDX]]
+
*[[Headache Red Flags]]
 
 
[[Headache Red Flags]]
 
  
 
==Source==
 
==Source==

Revision as of 05:56, 1 October 2011

Definition

Migraine Headache without Aura

  • 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)
    • 2.HA has at least 2 of the following characteristics:
      • a.Unilateral location
      • b.Pulsating quality
      • c.Moderate or severe pain intensity
      • d.Aggravation by or causing avoidance of routine physical activity
    • 3.During HA at least one of the following occurs:
      • a.Nausea and/or vomiting
      • b.Photophobia and phonophobia (may be inferred from behavior)
    • 4.Not attributed to another disorder

Migraine Likelihood

  • 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

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 (often used with an antiemetic)
        1. 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?