Migraine headache

Revision as of 15:59, 24 January 2015 by Rossdonaldson1 (talk | contribs) (Rossdonaldson1 moved page Migraine Headache to Migraine headache)

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

Differential Diagnosis

Headache

Common

Killers

Maimers

Others

Aseptic Meningitis

Treatment

  1. Migraine
    1. 1st line: Prochlorperazine (compazine) 10mg IV (+/- diphenhydramine 12.5 mg IV)
      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?