Headache. Headache Case. Migraine Headache. Eric Kraus, MD. Types» Without aura (common)» With aura (classic)
|
|
|
- Gyles Underwood
- 5 years ago
- Views:
Transcription
1 Headache Eric Kraus, MD Headache Case This 23 year-old female has headaches behind the right eye that cause her to lay down in a quiet room. They have a throbbing quality and she may vomit. Migraine Headache Types» Without aura (common)» With aura (classic) Epidemiology» 17% women» 6% men» Onset 5-40yrs 4-72 hrs duration Criteria» At least two Unilateral Throbbing Prohibit activities Aggravate by routine activity» At least one N and/or V Photo- and/or sonophobia
2 Migraine Treatment: Overview Non-drug Symptomatic Prophylactic Migraine Treatment: Non-drug Diary - eliminate triggers Discontinue hormonal birth control Biofeedback/stress reduction Other» Acupuncture» Massage» Chiropractic» Smoking cessation Migraine Treatment: Symptomatic OTC» Naproxen» Excedrin migraine*» Advil migraine* Ergotamines*» Cafergot» DHE (nasal, SQ, IV) Triptans* Midrin* Butalbital» ASA (Fiorinol)» Tylenol (Fioricet) Compazine/Reglan Steroids Toradol Narcotics* *FDA approved
3 Migraine Treatment: Triptans 5-HT1B/D agonists Generic (Brand) Sumatriptan (Imitrex) Zolmitriptan (Zomig) Rizatriptan (Maxalt) Naratriptan (Amerge) Almotriptan (Axert) Frovatriptan (Frova) Eletriptan (Relpax) Dose/Route 6mg/SQ, 50mg/PO, 20mg/NS 2.5, 5mg/PO and ODT 5, 10mg/PO and ODT 1, 2.5mg/PO 6.25, 12.5mg/PO 2.5mg/PO 20, 40mg/PO Migraine Treatment: Triptans Improvement in 60-80% over 1-4 hrs» Most have no pain» Recurrence 30-50% in next 24 hrs SQ > nasal > PO» Faster» More efficacious May repeat dose after 2 hours Rizatriptan may be the best Subcutaneous Sumatriptan International Study Group. NEJM. 1991;325:316 Migraine Treatment: Triptans With SSRIs» Watch for serotonin syndrome With propranolol» Smaller 5mg Rizatriptan i t MAOI contraindicated» Rizatriptan» Sumatriptan» Zolmitriptan Half life» Frovatriptan 25 hours» Eletriptan 18 hours» Others 2-3 hours Contraindicated» Coronary disease» PVD» Stroke» Uncontrolled HTN» Severe renal or hepatic dis.» Age > 65
4 Migraine Treatment: Prophylactic TCAs» Nortriptyline» Amitriptyline B-blockers» Propranolol*» Nadolol, Timolol* Divalproex sodium* Gabapentin Cyproheptadine Verapamil *FDA approved Topiramate Methysergide* Phenelzine (Nardil) Tizanidine (Zanaflex) Gabitril il Lisinopril Botox Other» Riboflavin» Fever few» Magnesium» CoQ10 150mg/d (open label study) Migraine Treatment: Prophylactic Start low Gradual increase in dose until:» Good effect» Side effects > benefits» Maximal dose Don t give up too quickly! Summary: Migraine Headache diary Prophylactic» HA freq. > 1/wk.» Nortriptyline 10mg hs x 5d, then increase by 10mg q 5d up to 50mg hs. F/U in clinic. Max dose 150mg.» Propranolol LA 60mg qd x 2wks, then increase by 60mg q 2wks up to 180mg. F/U in clinic. Max dose 360mg. Symptomatic» Use no more than 2 headaches per week.» OTC drugs or triptan.
5 Rebound Headache Daily or almost daily (5+ d/wk) Mild to moderate severity» Tension-like» Intermittent migraine features Overused drug works and provides positive feedback to take frequently No other cause HA improves when drug discontinued» 1wk - 2mo washout Headache Case This 23 year-old female has a constant (nonthrobbing) headache involving the whole head. It has a pressure quality. When the pain is bad, she is light sensitive. Tension Headache Types» Episodic» Chronic <24 hrs in majority Cause» Stress» Sleep disturbance» Bruxism Is it migraine? Criteria» At least two Bilateral Pressure, band-like Mild to moderate Not aggravated by routine activity» Possible Nausea Photo- and/or sonophobia
6 Tension Treatment Recognition of comorbid illness Physical therapy» Stress reduction» Biofeedback» Massage» Tens» Chiropractic» Heat» Acupuncture Tension Treatment Symptomatic» OTC analgesics» Fiorinol» Narcotics Prophylactic» TCAs» Gabapentin» SSRIs» Tizanidine» Trigger point injections» Botox Headache Case This 26 year-old obese female has a constant bilateral headache for two weeks. For three days she has experienced blurry vision and occasional pulsatile tinnitus.
7 Pseudotumor cerebri Increased venous resistance to CSF absorption Young obese women. F:M 8:1 HA, peripheral vision loss, diplopia (6th), blurring, distortion, pulsatile tinnitus Papilledema, visual fields, elevated CSF pressure (nl cells and protein) R/O tumor, cerebral venous thrombosis Pseudotumor cerebri Drug-induced» Tetracycline, etc.» Isotretinoin (Accutane)» Vit A» Flonase» Nitrofurantoin» Danazol» Lithium» Amiodarone» Bactrim» Cyclosporin» Cimetidine» Norplant Assoc. disease» Cushing dis.» Adrenal insuffic.» Hypoparathyroid» Hypothyroid» Pregnancy» SLE Pseudotumor cerebri Treatment» Weight loss» Acetazolamide» Repeat LPs» Lumboperitoneal shunt» Optic nerve sheath fenestration Acetazolamide (Diamox)» 250mg, 500mg SR» Start 250mg bid» Increase to 250mg qid or 500mg SR bid after 1 wk» Maintenance range mg per day» Paresthesias, GI Other: prednisone, furosemide, Digoxin
8 Headache Case This 32 year-old male has headaches behind the right eye that are severe with associated right sided ptosis and coryza. He will pace around the room. Cluster Headache Acute onset of unilateral pain. Centered around orbit. Clustering of attacks Multiple attacks at same time each day Severe pain, constant, t N/V, photophobia h Duration 15 mins. to 3 hrs. Ipsilateral autonomic symptoms required» Ptosis, miosis, red eye, facial swelling or redness, nasal drainage Cluster Treatment Abortive» Oxygen» Sumatriptan SQ*» Zolmitriptan or Rizatriptan ODT» DHE nasal» Narcotics Prophylactic» Prednisone» Verapamil» Indomethacin» Sodium valproate» Lithium» Topiramate Surgical *FDA approved
9 Headache Case This 25 year-old male was bench pressing 200 lbs when he had sudden onset of headache. He has never had a bad headache before. In the ER he is alert. Subarachnoid Hemorrhage Clinical» Worst HA of life» Sudden onset» Neck rigidity, N/V, photophobia» Severity HA only ---> coma Etiology» Aneurysm rupture at bifurcation of large intracerebral vessels Vessels» 85% anterior» 15% posterior Subarachnoid Hemorrhage Diagnosis Sensitivity CT <24 hrs 90-95% 3 days 80% 5 days 70% 1 week 50% 2 weeks 30% Lumbar puncture <2 weeks 100% 3 weeks 70% 1 month 40% Angiography Treatment» Surgical clips» Coils
10 Exertional Headache Clinical» Sudden onset» Bilateral throbbing Exercise» Mins. - days Cough, valsalva» Seconds» Think Chiari malform. Sexual (3 types)» Mins. - days Differential» Benign» Chiari malformation» Subarachnoid bleed» Brain tumor» Sinusitis» Giant cell arteritis Pascual, et.al. Neurology 1996;46:1520. Chiari Anatomy Exertional Headache: Treatment Symptomatic» 30 mins. before activity» Indomethacin» Naproxen» Cox-2 inhibitor» Ergotamine Prophylactic» Rarely needed» Indomethacin» Verapamil» Propranolol» Acetazolamide (cough)
11 Headache Case This 62 year-old male has had a left sided constant headache of moderate severity for two weeks. ROS positive for joint pain and fatigue. Giant Cell Arteritis Epidemiology» > 50 years, Caucasian» F:M 2:1 Autoimmune Clinical» Headache» Scalp tenderness» Ophthalmologic» Jaw claudication» Fever, malaise, arthralgia Diagnosis» High ESR 90+%» Mild anemia, high WBC» Temporal a. Bx Treatment» Prednisone 40-80mg» Methotrexate NEJM Headache Cases This 52 year-old male has had a left sided constant headache of moderate severity for two months. Multiple trials of medications including ibuprofen, Nortriptyline, and oxycodone were unhelpful. This 24 year-old female has sharp second-long stabs in the right parietal region. This 29 year-old male has 10 min. episodes of abrupt burning pain in the forehead associated with a red eye and tearing.
12 Hemicrania Syndromes Hemicrania Spectrum/duration Autonomic features Treatment» Indomethacin» Topiramate» Cox-2» Lamotrigine» Gabapentin» Others for cluster Ice-pick SUNCT Cluster Hemicrania continua SUNCT = Short-lasting Unilateral Neuralgiform headache with Conjuctival injection and Tearing Mild Head Trauma/Whiplash Common Often accompanied by:» Dizziness» Poor concentration» Others Constant diffuse pain Migraine Occipital neuralgia Medication overuse Treatment» NSAIDs, ice, narcotics» TCA and Gabapentin if past 1 month» Physical therapy Mild Head Trauma/Whiplash Imaging CT» If lose consciousness» If no LOC but HA lasts > 1 week» Focal findings or symptoms Prognosis» 50% better in 1 mo.» 80% better in 6 mo.» 15% don t improve
13 END
Case Presentation. Case Presentation. Case Presentation. Truths about Headaches (2017) Most headaches were muscle-tension headaches
Agenda Case presentation Migraine Morphology Primary and Premonitory Phase Secondary Headache Aura Headache Primer on Pain Medication Overuse Headache Case Presentation RT is a 25 year old woman with daily
MIGRAINE UPDATE. Objectives & Disclosures. Learn techniques used to diagnose headaches. Become familiar with medications used for headache treatment.
MIGRAINE UPDATE Karen L. Bremer, MD November 16, 2018 Objectives & Disclosures Learn techniques used to diagnose headaches. Become familiar with medications used for headache treatment. Disclosure: I am
Chronic Daily Headaches
Chronic Daily Headaches ANWARUL HAQ, MD, MRCP(UK), FAHS DIRECTOR BAYLOR HEADACHE CENTER, DALLAS, TEXAS DISCLOSURES: None OBJECTIVES AT THE CONCLUSION OF THIS ACTIVITY, PARTICIPANTS WILL BE ABLE TO: define
Index. Prim Care Clin Office Pract 31 (2004) Note: Page numbers of article titles are in boldface type.
Prim Care Clin Office Pract 31 (2004) 441 447 Index Note: Page numbers of article titles are in boldface type. A Abscess, brain, headache in, 388 Acetaminophen for migraine, 406 407 headache from, 369
Faculty Disclosure. Karen L. Bremer, MD. Dr. Bremer has listed no financial interest/arrangement that would be considered a conflict of interest.
Faculty Disclosure Karen L. Bremer, MD Dr. Bremer has listed no financial interest/arrangement that would be considered a conflict of interest. HEADACHE UPDATE Karen L. Bremer, MD November 10, 2017 karen.bremer@creighton.edu
HMFP Comprehensive Headache Center Department of Anesthesia, Critical Care and Pain Medicine Beth Israel Deaconess Medical Center Instructor in
HMFP Comprehensive Headache Center Department of Anesthesia, Critical Care and Pain Medicine Beth Israel Deaconess Medical Center Instructor in Anesthesia and Neurology Harvard Medical School Limited time
OH, MY ACHING HEAD! I HAVE NO DISCLOSURES OR CONFLICTS OF INTERESTS TO DECLARE MANAGING HEADACHE IN THE OUTPATIENT SETTING SECONDARY HEADACHES
1 JUSTIN A. OSSMAN, MD CHATTANOOGA FAMILY MEDICINE UPDATE OH, MY ACHING HEAD! MANAGING HEADACHE IN THE OUTPATIENT SETTING 2 I HAVE NO DISCLOSURES OR CONFLICTS OF INTERESTS TO DECLARE OBJECTIVES International
ADVANCES IN MIGRAINE MANAGEMENT
ADVANCES IN MIGRAINE MANAGEMENT Joanna Girard Katzman, M.D.MSPH Assistant Professor, Dept. of Neurology Project ECHO, Chronic Pain Program University of New Mexico Outline Migraine throughout the decades
COLUMBIA UNIVERSITY HEADACHE CENTER: NEW PATIENT QUESTIONNAIRE
COLUMBIA UNIVERSITY HEADACHE CENTER: NEW PATIENT QUESTIONNAIRE HEADACHE CHARACTERISTICS Frequency and Severity 1. At what AGE did you get your first headache, of ANY kind? 2. At what AGE did your headaches
A synopsis of: Diagnosis and Management of Headaches in Adults: A national clinical guideline. Scottish intercollegiate Guidelines Network SIGN
A synopsis of: Diagnosis and Management of Headaches in Adults: A national clinical guideline Scottish intercollegiate Guidelines Network SIGN November 2008. PETER FRAMPTON MSc MCOptom BAppSc (Optom)(AUS)
Goals. Primary Headache Syndromes. One-Year Prevalence of Common Headache Disorders
Goals One-Year Prevalence of Common Headache Disorders Impact of primary headache syndromes Non pharmacologic Rx of migraine individualized to patient triggers Complementary and alternative Rx of migraine
Headache and Facial Pain. Mohammed ALEssa MBBS, FRCSC Assistant Professor Consultant Otolaryngology,Head & Neck Surgical Oncology
Headache and Facial Pain Mohammed ALEssa MBBS, FRCSC Assistant Professor Consultant Otolaryngology,Head & Neck Surgical Oncology Introduction It is the most common neurologic complain The diagnosis usually
Headache Questionnaire
Date: All Headache Patients We would appreciate your cooperation in filling out this form. In our evaluation of headache, your history is typically our most valuable tool for diagnosis and subsequent treatment.
10/31/2017 PRIMARY CARE AND HEADACHE DISCLOSURES WHERE DO THOSE WITH HEADACHE SEEK MEDICAL CARE? Primary Care 67%
PRIMARY CARE AND HEADACHE Sonja Potrebic MD PhD Regional Headache Specialist Kaiser LAMC 1 WHERE DO THOSE WITH HEADACHE SEEK MEDICAL CARE? Column1 Primary Care 67% Primary Care Headache Specialty Other
Headache. Section 1. Migraine headache. Clinical presentation
Section 1 Headache Migraine headache 1 Clinical presentation It is important to recognize just how significant a problem migraine headache is. It has been estimated that migraine affects 11% of the United
Disclosures. Objectives 6/2/2017
Classification: Migraine and Trigeminal Autonomic Cephalalgias Lauren Doyle Strauss, DO, FAHS Assistant Professor, Child Neurology Assistant Director, Child Neurology Residency @StraussHeadache No disclosures
Headache Syndrome. Karen Alvarez, D.O Nemours Children s Specialty Care Jacksonville, FL
Headache Syndrome Karen Alvarez, D.O Nemours Children s Specialty Care Jacksonville, FL What is a headache? A headache or cephalgia is defined as pain anywhere in the region of head or neck Where does
Tears of Pain SUNCT and SUNA A/PROFESSOR ARUN AGGARWAL RPAH PAIN MANAGEMENT CENTRE
Tears of Pain SUNCT and SUNA A/PROFESSOR ARUN AGGARWAL RPAH PAIN MANAGEMENT CENTRE IHS Classification 1989 (updated 2004) Primary Headaches 4 categories Migraine Tension-type Cluster and other trigeminal
How do we treat migraine? New SIGN Guidelines
How do we treat migraine? New SIGN Guidelines Managing your migraine Migraine Trust, Edinburgh 2018 Callum Duncan Consultant Neurologist Aberdeen Royal Infirmary Chair SIGN Guideline 155 Premonitory Mood
Headache Master School Japan-Osaka 2016 II. Management of refractory headaches Case Presentation 2. SUNCT/SUNA: concept, management and prognosis
Headache Master School Japan-Osaka 2016 II. Management of refractory headaches Case Presentation 2. SUNCT/SUNA: concept, management and prognosis Noboru Imai(Department of Neurology, Japanese Red Cross
I have no financial relationships to disclose. I will not discuss investigational use of medication in my presentation.
I have no financial relationships to disclose. I will not discuss investigational use of medication in my presentation. In 1962, Bille published landmark epidemiologic survey of headache among 9,000 school
Headache Mary D. Hughes, MD Neuroscience Associates
Headache Mary D. Hughes, MD Neuroscience Associates Case 1 22 year old female presents with recurrent headaches. She has had headaches for the past 3 years. They start on the right side of her head and
Treatment of Primary Headache Syndromes
Presenter Disclosure Information 2:45 3:45pm Treatment of Primary Headache Syndromes SPEAKER Gerald W. Smetana, MD The following relationships exist related to this presentation: Gerald W.Smetana, MD,
Headache. Susan Hickenbottom MD, MS February 24, 2015
Headache Susan Hickenbottom MD, MS February 24, 2015 Epidemiology One of most common complaints in primary care 90% of US population 50% at least one severe 25% recurrent disabling attacks 5% chronic daily
A case of a patient with chronic headache. Focus on Migraine. None related to the presentation Grants to conduct clinical trials from: Speaker bureau:
Chronic Daily Headache Bassel F. Shneker, MD, MBA Associate Professor Vice Chair, OSU Neurology The Ohio State University Wexner Medical Center Financial Disclosures None related to the presentation Grants
General Patient Information Dr. David A. Branch, M.D.
General Patient Information Dr. David A. Branch, M.D. **Please Print** Patient Name: Date of Birth: Social Security # Email Address: Patient Address: _ City: State: Zip Code: Phone : Marital Status: S
Strategies in Migraine Care
Strategies in Migraine Care Julie L. Roth, MD Rhode Island Hospital Assistant Professor, Neurology The Warren Alpert Medical School of Brown University March 28, 2015 Financial Disclosures None. Objectives
Headache evaluation and management after concussion. Assistant Professor
Headache evaluation and management after concussion Juliette Preston, M.D. Assistant Professor OHSU Headache Center OVERVIEW Introduction Definition Acute post-traumatic headache Red flags Persistent post-traumatic
Neurological Dilemmas in Primary Care
Neurological Dilemmas in Primary Care David Clark, DO dclark@oregonneurology.com When to test? How to test? Pitfalls in testing? When to treat? How to treat? How long to treat? Neurological Dilemmas Seizure
Can I send this headache patient home? Dr Nicola Giffin Consultant Neurologist Bath, Nov 2017
Can I send this headache patient home? Dr Nicola Giffin Consultant Neurologist Bath, Nov 2017 SAH v benign thunderclap headaches Other pathologies not apparent on CT Severe primary headaches: management
Clinical Policy: Triptans Reference Number: CP.CPA.217 Effective Date: Last Review Date: Line of Business: Commercial
Clinical Policy: Reference Number: CP.CPA.217 Effective Date: 11.16.16 Last Review Date: 11.17 Line of Business: Commercial Revision Log See Important Reminder at the end of this policy for important regulatory
6/4/2018. Headache. Headaches. Headache. Migraine Headaches. Headache. Red Flag signs and symptoms. Imaging CT without contrast.
Presented by M.D. Shepherd, M.D. OH MY ACHING HEAD! Estimated that one half of the adult population is affected by a headache disorder International Society Classification Primary : Tension s 40% of the
Clinical Policy: Triptans Reference Number: CP.HNMC.217 Effective Date: Last Review Date: Line of Business: Medicaid Medi-Cal
Clinical Policy: Reference Number: CP.HNMC.217 Effective Date: 11.16.16 Last Review Date: 11.17 Line of Business: Medicaid Medi-Cal Revision Log See Important Reminder at the end of this policy for important
Short Clinical Guidelines: Headache, Key Points for Diagnosis and Treatment
Clinical Highlights 1. Headache is diagnosed by history and physical examination with limited need for imaging or laboratory tests. 2. Warning signs of possible disorder other than primary headache are:
Trigeminal Autonomic Cephalalgias. Disclosures. Objectives 6/20/2018. Rashmi Halker Singh, MD FAHS UCNS Review Course June 2018
Trigeminal Autonomic Cephalalgias Rashmi Halker Singh, MD FAHS UCNS Review Course June 2018 Disclosures Honoraria from Allergan and Amgen for advisory board, Current Neurology and Neuroscience Reports
Disclosures. Triptans for Kids 5/16/13
5/16/13 Disclosures Triptans for Kids Amy A. Gelfand, MD GelfandA@neuropeds.ucsf.edu Departments of Neurology and Pediatrics UCSF Child Neurology and Headache Center I receive grant funding from: NIH/NINDS
Adult with headache. Problem-specific video guides to diagnosing patients and helping them with management and prevention
Adult with headache Problem-specific video guides to diagnosing patients and helping them with management and prevention London Strategic Clinical Networks London Neuroscience Strategic Clinical Network
Primary Care Adult Headache Management Pathway (formerly North West Headache Management Guideline for Adults) Version 1.0
Primary Care Adult Headache Management Pathway (formerly rth West Headache Management Guideline for Adults) Version 1.0 1 VERSION CONTROL Version Date Amendments made Version 1.0 October 2018 Reformatted
Headache A Practical Approach
Headache A Practical Approach Integrated Pain Symposium December 1, 2017 Alyssa Lettich. MD Neurosciences Institute/Neurosciences Clinical Program Medical Director Headache and Pain Development Teams Disclosures:
~ ColumbiaDoctors Adult New Patient Intake Form Patient Information
~ ColumbiaDoctors Adult New Patient Intake Form Patient Information Last Name: First Name: DOB: Gender: Home Phone: Mobile Phone: ---------- Preferred Phone: Home or Mobile (circle one) Email: -----------
Anti-Migraine Agents
DRUG POLICY BENEFIT APPLICATION Anti-Migraine Agents Benefit determinations are based on the applicable contract language in effect at the time the services were rendered. Exclusions, limitations or exceptions
Update on Diagnosis and Management of Migraines
Update on Diagnosis and Management of Migraines Joel J. Heidelbaugh, MD, FAAFP, FACG Clinical Professor Departments of Family Medicine and Urology University of Michigan Learning Objectives To distinguish
Headaches in the Pediatric Emergency Dept
Headaches in Children February 23, 2011 Jinny Tavee, MD Associate Professor Neuromuscular Center Cleveland Clinic Foundation Cleveland, OH 1 Headaches in the Pediatric Emergency Dept Burton Gutierrez Kan
Headache Dr. Asghari Neurologist
In the name of God Management of the Headache Dr. Asghari Neurologist Overall Approach Chief Complaint of Headache Headache Alarms Evidence of serious headache disorder by history or physical exam no Diagnosis
Farjam Farzam, M.D. Pediatric Neurology
Headaches in Children Farjam Farzam, M.D. Pediatric Neurology University of Kentucky Headaches in Children Common complaint in pediatric population. All age groups. 2-3 years old. Teenagers/Adolescents.
Maxalt. Maxalt / Maxalt-MLT (rizatriptan) Description. Section: Prescription Drugs Effective Date: April 1, 2016
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: Maxalt Page: 1 of 5 Last Review Date: March 18, 2016 Maxalt Description Maxalt / Maxalt-MLT (rizatriptan)
Headache Assessment In Primary Eye Care
Headache Assessment In Primary Eye Care Spencer Johnson, O.D., F.A.A.O. Northeastern State University Oklahoma College of Optometry johns137@nsuok.edu Course Objectives Review headache classification Understand
Migraine in Children. Germano Falcao, MD Pediatric Neurology 03/07/2014
Migraine in Children Germano Falcao, MD Pediatric Neurology 03/07/2014 Headaches in Children One of the most common concerns reported by children 3% for children age 3-7 years 4-11% for children age 7-11
Sumatriptan Tablets, Nasal Spray (Imitrex), Nasal Powder (Onzetra Xsail), sumatriptan and naproxen sodium (Treximet tablets)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 05.70.10 Subject: Sumatriptan Page: 1 of 5 Last Review Date: December 2, 2016 Sumatriptan Description Sumatriptan
HEADACHE: Benign or Severe Dr Gobinda Chandra Roy
HEADACHE: Benign or Severe Dr Gobinda Chandra Roy Associate Professor, Department of Medicine, Shaheed Suhrawardy Medical College and Hospital Outlines 1. Introduction 2. Classification of headache 3.
Headache. Luke Bennetto Consultant Neurologist Engineers House 13 th September 2016
Headache Luke Bennetto Consultant Neurologist Engineers House 13 th September 2016 Contents General thoughts Primary headache Secondary headache I want to curl up in a cave and die I want to drill a
Managing Headache in Acute Medicine. Ben Lovell Consultant Physician in Acute Medicine University College London Hospital
Managing Headache in Acute Medicine Ben Lovell Consultant Physician in Acute Medicine University College London Hospital Some ED headache stats Arrive by ambulance 31% Median age 39 Worst ever headache
Outpatient Headache Care Guideline
1 Outpatient Care Guideline Inclusion criteria: children > 3 yrs with headaches Is urgent emergency department, neuroimaging, or Neurology consultation indicated? Referral to ED if: New severe headache
Differential Diagnosis of Headaches
Angela Nelson, MSN, RN, CCRN, ACNP-BC, FCCM, FAANP Acute Care Nurse Practitioner Department of Neurosurgery AANP 2016 National Conference San Antonio, Texas June 21-26 Differential Diagnosis of Headaches
1. On how many days in the last 3 months did you miss work or school because of your headaches?
The Migraine Disability Assessment Test The MIDAS (Migraine Disability Assessment) questionnaire was put together to help you measure the impact your headaches have on your life. The information on this
Management of headache
Management of headache TJ Steiner Imperial College London Based on European principles of management of common headache disorders TJ Steiner, K Paemeleire, R Jensen, D Valade, L Savi, MJA Lainez, H-C Diener,
Prevention and Treatment of Migraines CAITLIN BARNES, PHARM.D. CANDIDATE AMBULATORY CARE JOE CAMMILLERI, PHARM.D. NATOHYA MALLORY, PHARM.D.
Prevention and Treatment of Migraines CAITLIN BARNES, PHARM.D. CANDIDATE AMBULATORY CARE JOE CAMMILLERI, PHARM.D. NATOHYA MALLORY, PHARM.D. Objectives Present patient case Review epidemiology/pathophysiology
Understanding Migraines and Treatment Options. Simplified Diagnosis of Migraine. Migraine Prevalence American Migraine Study II
Understanding Migraines and Treatment Options Deborah C. Zajac, RN-BC Center for Headache and Pain Neurological Institute Cleveland Clinic Simplified Diagnosis of Migraine Any person with a stable pattern
Clinical Learning Days November 10, 2017
Migraine Clinical Learning Days November 10, 2017 Alyssa Lettich. MD Neurosciences Institute/Neurosciences Clinical Program Medical Director Headache Disclosures: none Learning Objectives: At the conclusion
Current Migraine Treatment Therapy. Daniel Kassicieh, DO, FAAN
Current Migraine Treatment Therapy Daniel Kassicieh, DO, FAAN Migraine a Disease Process Migraines are a chronic disease process similar to many other chronic medical conditions Migraine has a low mortality
Back Pain. John W. Engstrom, MD December 15, Disclosures. A Primary Care Approach to Headache. Headache Goals
Disclosures Nothing to declare --- or --- Significant ownership interests Consulting, speaker bureaus, honorarium, grants Link to Harrison s Chapter on Headache: http://ucsfneuroresidency.com/public_html/educati
Migraine, Tension, and Cluster Headache: Primary Care for Primary Headaches. Jonathon M. Firnhaber, MD, FAAFP
Migraine, Tension, and Cluster Headache: Primary Care for Primary Headaches Jonathon M. Firnhaber, MD, FAAFP Learning objectives 1. Utilize evidence-based strategies to diagnose patients presenting with
How to remove the headache of dealing with headaches. Dr. Stefan Schumacher Consultant Neurologist Salford Royal Hospital
How to remove the headache of dealing with headaches Dr. Stefan Schumacher Consultant Neurologist Salford Royal Hospital Case 30 y old woman Sudden headache Vomiting, dizziness, photophobia Recurrent migraines
Sumatriptan Tablets, Nasal Spray (Imitrex), Nasal Powder (Onzetra Xsail), sumatriptan and naproxen sodium (Treximet tablets)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 05.70.10 Subject: Sumatriptan Page: 1 of 6 Last Review Date: March 16, 2018 Sumatriptan Description Sumatriptan
ปวดศ รษะมา 5 ป ก นยาแก ปวดก ย งไม ข น นพ.พาว ฒ เมฆว ช ย โรงพยาบาลนครราชส มา
ปวดศ รษะมา 5 ป ก นยาแก ปวดก ย งไม ข น นพ.พาว ฒ เมฆว ช ย โรงพยาบาลนครราชส มา 1 CONTENT 1 2 3 Chronic Daily Headache Medical Overused Headache Management Headaches are one of the most common symptoms List
MIGRAINE A MYSTERY HEADACHE
MIGRAINE A MYSTERY HEADACHE The migraine is a chronic neurological disease that is characterized by moderate to severe episodes of headache that is mostly associated with other central nervous system (CNS)
Page: 1 of 6. Aimovig (erenumab-aooe) injection, Ajovy (fremanezumab-vfrm) injection, Emgality (galcanezumab-gnim)
Page: 1 of 6 Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Last Review Date: November 30, 2018 Description Aimovig (erenumab-aooe) injection, Ajovy (fremanezumab-vfrm)
Çiçek Wöber-Bingöl HEADACHE UNIT FOR CHILDREN AND ADOLESCENCE
Headache in children and adolescents Çiçek Wöber-Bingöl HEADACHE UNIT FOR CHILDREN AND ADOLESCENCE Dept. of Psychiatry of Childhood and Adolescence Medical University of Vienna, Vienna, Austria Impact
Overview INTRODUCTION 3/15/2018. Headache Emergencies. Other way to differentiate between them? Is there an easy way to differentiate between them?
Overview Headache Emergencies Primary versus Secondary headache disorder Red flags 4 cases of unusual headache emergencies Disclaimer: we will not talk about brain bleed as patients usually go the ED.
Sumatriptan Tablets, Nasal Spray (Imitrex), Nasal Powder (Onzetra Xsail), sumatriptan and naproxen sodium (Treximet tablets)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 0 Subject: Sumatriptan Page: 1 of 6 Last Review Date: November 30, 2018 Sumatriptan Description Sumatriptan
By Nathan Hall Associate Editor
By Nathan Hall Associate Editor 34 Practical Neurology March 2005 These new rules may change the definition of head pain, but some practitioners may find the new guidelines themselves to be a source of
Headaches in Children and Adolescents. Paul Shillito
Headaches in Children and Adolescents Paul Shillito Topics For Discussion What s different about childhood migraine Chronic daily headache (CDH) Tumours and other things to worry about Management of childhood
Abortive Agents. Available Strengths. Formulary Limits. Tablet: 5mg, 10mg ODT: 5mg, 10 mg 25mg, 50mg, 100mg. 5mg/act, 20mg/act
MEDICATION COVERAGE POLICY PHARMACY AND THERAPEUTICS ADVISORY COMMITTEE POLICY: Migraine Therapy P&T DATE: 9/12/2017 CLASS: Neurological Disorders REVIEW HISTORY 12/16, 9/15, 2/15, 2/10, 5/07 LOB: MCL
The Pediatric Headache Handbook
The Pediatric Headache Handbook For the Primary Care Physician Brought to you by the Division of Pediatric Neurology cardinalglennon.com Classification of headache patterns in children Acute onset of worst
July 2012 Target Population. Adult patients 18 years or older in primary care settings.
Guideline for Primary Care Management of Headache in Adults July 2012 Target Population Adult patients 18 years or older in primary care settings. Exclusions: This guideline does not provide recommendations
Migraine Management. Jane Melling Headache nurse Mater Misericordiae Hospital
Migraine Management Jane Melling Headache nurse Mater Misericordiae Hospital Migraine facts Among the most common disorders of the nervous system 3 rd most prevalent medical disorder on the planet (lancet
Medication For Migraine Chart: Table 1: Acute Treatment when the attack begins
Medication For Migraine Chart: Table 1: Acute Treatment when the attack begins Page a Analgesics (painkillers) Non-steroidal antiinflammatory drugs (NSAIDs) Prescription required Brand Name Formulation
UTILIZATION MANAGEMENT CRITERIA
SUMATRIPTAN (ALSUMA, IMITREX, SUMAVEL DOSEPRO, ZECUITY ) UTILIZATION MANAGEMENT CRITERIA DRUG CLASS: BRAND (generic) NAME: Serotonin 5-HT1 receptor agonists Imitrex (sumatriptan), Alsuma (sumatriptan),
How could I be having migraine when I don't have a headache?
Migraine Your doctor thinks you may have migraine. Classic migraine attacks start with visual symptoms (often zig-zag colored lights or flashes of light expanding to one side over 10-30 minutes) followed
WHY IS MIGRAINE IMPORTANT
WHY IS MIGRAINE IMPORTANT Migraine is a complex disorder characterized by recurrent episodes of headache, most often unilateral and in some cases associated with visual or sensory symptoms collectively
Neuro-Ocular Grand Rounds
Neuro-Ocular Grand Rounds Anthony B. Litwak,OD, FAAO VA Medical Center Baltimore, Maryland Dr. Litwak is on the speaker and advisory boards for Alcon and Zeiss Meditek COMMON OPTIC NEUROPATHIES THAT CAN
Disclosures. Objectives 6/20/2018. No disclosures. Tools & Tips for Headache Management in Special Populations: The Young & Old, Pregnant & Lactating
Tools & Tips for Headache Management in Special Populations: The Young & Old, Pregnant & Lactating Lauren Doyle Strauss, DO, FAHS Child Neurology Residency Director @StraussHeadache No disclosures Disclosures
Triptan Quantity Limit
*- Florida Healthy Kids Triptan Quantity Limit Override(s) Quantity Limit Approval Duration 1 year Oral Tablets Axert (almotriptan) tablets Relpax (eletriptan) tablets 6 tablets (6.25 mg) 12 tablets (12.5
HEADACHE. Dr Nick Pendleton. September Headache
HEADACHE Dr Nick Pendleton September 2017 Headache Tension Type Headache Cranial Nerve Examination Migraine Migraine Treatment Medication Overuse Headache Headache Red Flags Sinusitis Headache Raised ICP
Migraine Migraine Age Specific Prevalence in the United States. Headache International Headache Society Classification
28 Primary Care Medicine Principles and Practice 29 October 28 Professor Peter J. Goadsby Peter.Goadsby@headache.ucsf.edu Department of Neurology Headache International Headache Society Classification
Neuro-Ocular Grand Rounds Anthony B. Litwak,OD, FAAO VA Medical Center Baltimore, Maryland
Neuro-Ocular Grand Rounds Anthony B. Litwak,OD, FAAO VA Medical Center Baltimore, Maryland Dr. Litwak is on the speaker and advisory boards for Alcon and Zeiss Meditek COMMON OPTIC NEUROPATHIES THAT CAN
TREXIMET UTILIZATION MANAGEMENT CRITERIA
TREXIMET UTILIZATION MANAGEMENT CRITERIA DRUG CLASS: BRAND (generic) NAME: 5HT1 agonists Treximet (sumatriptan/naproxen sodium) 85 mg / 500 mg tablet FDA INDICATIONS: Sumatriptan/naproxen is indicated
Lynne Kerr, MD May 2014
Lynne Kerr, MD May 2014 Headache is one of top 5 health problems in children 2 nd most common diagnosis in the peds neurology outpatient clinic 14 year old girl severe headache Headaches 1-2 times/month
25/09/2018 HEADACHE. Dr Nick Pendleton
HEADACHE Dr Nick Pendleton September 2018 1 Small Group Work Tension Type Headache Cranial Nerve Examination Migraine Migraine Treatment Medication Overuse Headache Headache Red Flags Sinusitis Headache
Pediatric Grand Rounds UT Health San Antonio 2/10/2017
Jose Luis Aceves, M.D. has no relationships with commercial companies to disclose. Jose Luis Aceves, M.D. Clinical Associate Professor Department of Pediatrics at UTHSCSA At the end of this presentation
Migraine Clinical Guideline
Migraine Clinical Guideline Definition: Migraine refers to a chronic neurological disorder characterized by episodic attacks often in association with enhanced sensitivity of the nervous system and activation
MEASURE #4: Overuse of Barbiturate Containing Medications for Primary Headache Disorders Headache
MEASURE #4: Overuse of Barbiturate Containing Medications for Primary Headache Disorders Headache Measure Description Percentage of patients age 18 years old and older with a diagnosis of primary headache
Headaches: An Approach to Evaluation & Management
Florida Osteopathic Medical Association 17 th Annual Primary Care & Cardiovascular Symposium Headaches: An Approach to Evaluation & Management Kenneth Hentschel, DO, PhD, FAANEM St. Vincent s Spine & Brain
Adult & Pediatric Patients. Stanford Health Care, Division Pain Medicine
Acute Treatment Strategies in Adult & Pediatric Patients Theresa Mallick Searle, MS, RN BC, ANP BC Disclosures Speakers Bureau: Allergan, Depomed Acute Treatment Strategies in Adult & Pediatric Patients
HEADACHE. Tahir Majeed Consultant Neurologist
HEADACHE Tahir Majeed Consultant Neurologist Classification Clinical (Practical) Acute General Focal Recurrent Chronic Progressive Non progressive Case AD 30 yr male 17 yr Hx R-sided headache initially
ABORTIVE AGENTS. Average cost per 30 days. Form Limits SEROTONIN AGONISTS $ $ Reserved for treatment failure to either Sumatriptan PA; QL
MEDICATION COVERAGE POLICY PHARMACY AND THERAPEUTICS ADVISORY COMMITTEE POLICY: Migraine Therapy P&T DATE: 12/11/2018 CLASS: Neurological Disorders REVIEW HISTORY 9/17, 12/16, 9/15, 2/15, 2/10, LOB: MCL
Page: 1 of 5. Sumatriptan Tablets and Nasal Spray (Imitrex) / sumatriptan and naproxen sodium (Treximet tablets)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 0 Subject: Sumatriptan (Imitrex / Treximet) Page: 1 of 5 Last Review Date: September 12, 2014 Sumatriptan
Paediatric headaches. Dr Jaycen Cruickshank Director of Clinical Training Ballarat Health Services. Brevity, levity, repetition
Paediatric headaches Dr Jaycen Cruickshank Director of Clinical Training Ballarat Health Services Brevity, levity, repetition Paediatric)headache?)! Headache!in!children!is!not!that!common.!The!question!is!which!headaches!do!I!
2) Headache - Dr. Hawar
2) Headache - Dr. Hawar Headache is caused by traction, displacement, inflammation, vascular spasm, or distention of the painsensitive structures in the head or neck. Isolated involvement of the bony skull,
10/13/17. Christy M. Jackson, MD Director, Dalessio Headache Center Scripps Clinic, La Jolla Clinical Professor, Neurosciences UCSD
Christy M. Jackson, MD Director, Dalessio Headache Center Scripps Clinic, La Jolla Clinical Professor, Neurosciences UCSD } Depomed Consultant 2014 to present } Avanir Consultant 2014 to present } Amgen