Migraine headache: Difference between revisions
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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 | ||
#Unilateral | #Unilateral | ||
#Nausea or vomiting | #Nausea or vomiting | ||
#Disabling in quality | #Disabling in quality | ||
==Treatment== | |||
# Migraine | |||
## 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
- Pulsatile quality
- duration of 4-72 hOurs
- Unilateral
- Nausea or vomiting
- Disabling in quality
Treatment
- Migraine
- 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
- 1st line: Prochlorperazine (compazine) 10mg IV (+/- benadryl)
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?