Migraine headache

Revision as of 06:00, 1 October 2011 by Jswartz (talk | contribs)

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 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?