Có 19+ tài liệu thuộc chủ đề "Headache"
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Diagnosis and management is based on a careful clinical approach that is augmented by an understanding of the anatomy, physiology, and pharmacology of the nervous system pathways that mediate the various headache syndromes.. Pain can also result when pain-producing pathways of the peripheral or central nervous system (CNS) are damaged or activated inappropriately. these include the scalp, middle meningeal artery,...
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Clinical Evaluation of Acute, New-Onset Headache. The patient who presents with a new, severe headache has a differential diagnosis that is quite different from the patient with recurrent headaches over many years. In new-onset and severe headache, the probability of finding a potentially serious cause is considerably greater than in recurrent headache.. Patients with recent onset of pain require prompt...
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Intracranial Hemorrhage. Acute, severe headache with stiff neck but without fever suggests subarachnoid hemorrhage. A ruptured aneurysm, arteriovenous malformation, or intraparenchymal hemorrhage may also present with headache alone. Rarely, if the hemorrhage is small or below the foramen magnum, the head CT scan can be normal. Therefore, LP may be required to definitively diagnose subarachnoid hemorrhage. Intracranial hemorrhage is discussed...
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It is usually an episodic headache that is associated with certain features such as sensitivity to light, sound, or movement. A useful description of migraine is a benign and recurring syndrome of headache associated with other symptoms of neurologic dysfunction in varying admixtures (Table 15-3). The brain of the migraineur is particularly sensitive to environmental and sensory stimuli. migraine-prone patients...
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The key pathway for pain in migraine is the trigeminovascular input from the meningeal vessels, which passes through the trigeminal ganglion and synapses on second-order neurons in the trigeminocervical complex. These neurons in turn project in the quintothalamic tract and, after decussating in the brainstem, synapse on neurons in the thalamus. Activation of cells in the trigeminal nucleus results in...
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Positron emission tomography (PET) activation in migraine.. In spontaneous attacks of episodic migraine (A) there is activation of the region of the dorsolateral pons (intersection of dark blue lines). an identical pattern is found in chronic migraine (not shown). This area, which includes the noradrenergic locus coeruleus, is fundamental to the expression of migraine.. Moreover, lateralization of changes in this...
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Once a diagnosis of migraine has been established, it is important to assess the extent of a patient's disease and disability. Patient education is an important aspect of migraine management.. Information for patients is available at www.achenet.org, the website of the American Council for Headache Education (ACHE).. It is helpful for patients to understand that migraine is an inherited tendency...
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May repeat x 1 after 1–2 h. sublingual tablet at onset and q 1 / 2 h (max 3 per day, 5 per week). Naratriptan Amerge 2.5 mg tablet at. may repeat once after 4 h. 5–10 mg tablet at onset. may repeat after 2 h (max 30 mg/d). may repeat after 2 h (max 200 mg/d). Frovatriptan Frova 2.5...
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In general, an adequate dose of whichever agent is chosen should be used as soon as possible after the onset of an attack. If additional medication is required within 60 min because symptoms return or have not abated, the initial dose should be increased for subsequent attacks. Sumatriptan 50 mg or 100 mg PO. Almotriptan 12.5 mg PO. Rizatriptan 10...
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Nonsteroidal Anti-Inflammatory Drugs (NSAIDs). Both the severity and duration of a migraine attack can be reduced significantly by anti-inflammatory agents (Table 15-5). A general consensus is that NSAIDs are most effective when taken early in the migraine attack. However, the effectiveness of anti-inflammatory agents in migraine is usually less than optimal in moderate or severe migraine attacks. The combination of...
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Parenteral dopamine antagonists (e.g., chlorpromazine, prochlorperazine, metoclopramide) can also provide significant acute relief of migraine. they can be used in combination with parenteral 5-HT 1B/1D agonists. A common intravenous protocol used for the treatment of severe migraine is the administration over 2 min of a mixture of 5 mg of prochlorperazine and 0.5 mg of dihydroergotamine.. The combination of acetaminophen,...
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Pizotifen b 0.5–2 mg qd. Propranolol 40–120 mg bid. Amitriptyline 10–75 mg at night. Dothiepin 25–75. mg at night. Nortriptyline 25–75 mg at night. Note: Some patients may only need a total dose of 10 mg, although generally 1–1.5 mg/kg body weight is required. Topiramate 25–200 mg/d. 600 mg bid. 3600 mg qd. Methysergide 1–4 mg qd. Flunarizine b 5–15...
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a Commonly used preventives are listed with reasonable doses and common. The probability of success with any one of the antimigraine drugs is 50–. Many patients are managed adequately with low-dose amitriptyline, propranolol, topiramate, gabapentin, or valproate. If these agents fail or lead to unacceptable side effects, second-line agents such as methysergide or phenelzine can be used. Many patients are...
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Table 15-8 Clinical Features of the Trigeminal Autonomic Cephalalgias. Site Orbit, temple Orbit, temple Periorbital. 15–180 min 2–30 min 5–240 s. Yes Yes Yes. injection and lacrimation) a. Yes No No. No No Yes. a If conjunctival injection and tearing not present, consider SUNA.. photophobia and phonophobia are typically unilateral on the side of the pain.. SUNCT, short-lasting unilateral neuralgiform...
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Cluster Headache. Cluster headache is a rare form of primary headache with a population frequency of 0.1%. A core feature of cluster headache is periodicity. The typical cluster headache patient has daily bouts of one to two attacks of relatively short-duration unilateral pain for 8–10 weeks a year. Cluster headache is characterized as chronic when there is no period of...
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Many experts favor verapamil as the first-line preventive treatment for patients with chronic cluster headache or prolonged bouts. While verapamil compares favorably with lithium in practice, some patients require verapamil doses far in excess of those administered for cardiac disorders. The initial dose range is 40–80 mg twice daily. effective doses may be as high as 960 mg/d. Side effects...
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SUNCT can be seen with posterior fossa or pituitary lesions. All patients with SUNCT/SUNA should be evaluated with pituitary function tests and a brain MRI with pituitary views.. SUNCT/SUNA: Treatment. Therapy of acute attacks is not a useful concept in SUNCT/SUNA since the attacks are of such short duration. However, intravenous lidocaine, which arrests the symptoms, can be used in...
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The patient with NDPH presents with headache on most if not all days. the onset is recent and clearly recalled by the patient. The headache usually begins abruptly, but onset may be more gradual. evolution over 3 days has been proposed as the upper limit for this syndrome. Patients typically recall the exact day and circumstances of the onset of...
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Raised CSF Pressure Headache. Raised CSF pressure is well recognized as a cause of headache. Brain imaging can often reveal the cause, such as a space-occupying lesion. NDPH due to raised CSF pressure can be the presenting symptom for patients with idiopathic intracranial hypertension (pseudotumor cerebri) without visual problems, particularly when the fundi are normal.. Persistently raised intracranial pressure can...