Outline. Etiology. General information. Definition 4/13/2012
|
|
- Howard Roberts
- 6 years ago
- Views:
Transcription
1 Outline Dr. Susan Fralick-Ball, PsyD, MSN, RN, CH, CLNC PsychMedEd for Advance 2012 Etiology, Stages & Classifications of Migraines Differential Pathophysiology from other Headaches Current Treatment Therapies Definition A migraine headache is a throbbing or pulsating headache that is often unilateral and associated with: nausea, vomiting sensitivity to light, sound, and smells sleep disruption depression Migraines are more common in menstruating women (onset~ 30; peak~ mid-life) with estrogen release, then withdrawal in the luteal phase Estrogen affects serotonin levels and may hail the onset Attacks are often recurrent and tend to become less severe as the migraine sufferer ages into natural menopause. General information Migraines can also be found in children, adolescents, and young women. They are often hailed by environmental factors and often have 4 stages associated: prodrome, aura, attack and postdrome Migraine attacks can cause significant pain for hours to days and be so severe that all you can think about is finding a dark, quiet place to lie down. Some migraines are preceded or accompanied by sensory warning symptoms (aura), such as flashes of light, blind spots or tingling in your arm or leg. Etiology The cause of migraine is unknown, yet is associated with hormonal flux and vascular changes. The condition may result from a series of reactions in the central nervous system caused by changes in the body or in the environment. There is often a family history of the disorder, suggesting that migraine sufferers may inherit sensitivity to triggers that produce inflammation in the blood vessels and nerves around the brain and scalp, causing pain. Theory of Etiology Reacting to the reduced oxygen supply, certain arteries within the brain dilate to meet the brain's energy needs. This dilation spreads, finally affecting the neck and scalp arteries. The dilation of these arteries triggers the release of prostaglandins from various tissues and blood cells. Chemicals that cause inflammation and swelling and substances that increase sensitivity to pain are also released. The circulation of these chemicals and the dilation of the scalp arteries stimulate the pain-sensitive nociceptors. The result, according to this theory, is a throbbing pain in the head. 1
2 Theories Migraine pain starts with the release of inflammatory proteins from the dura, which envelops the brain, and from blood vessels and nerve endings in the brain. The release of these proteins over-sensitizes the trigeminal ganglion, located above the palate, which receives signals about conditions inside the skull. When over-sensitized, the ganglion interprets normal pressure inside the skull as the throbbing pain of migraine. Because the trigeminal ganglion seems to cause the primary pain of migraine, it is the target of current migraine drugs, which block serotonin receptors in sensory neurons connected to the dura. The drugs are often effective, but only if taken immediately after the headache begins. Nerve pain The over-sensitized trigeminal ganglion may, in turn, send signals to the nucleus caudalis, at the top of the spinal cord. Unlike the trigeminal ganglion, this group of nerves is connected to the skin, particularly near the eye, where the most dramatic skin sensitivity in migraine sufferers. Triggers A trigger is any stimulus that initiates a process or reaction. Commonly identified migraine triggers include the following: Alcohol (e.g., red wine) Environmental factors (e.g., weather, altitude, time zone changes) Exertion Foods that contain caffeine (e.g., coffee, chocolate), monosodium glutamate (MSG; used to enhance flavor in several processed foods and in Chinese food), nitrates (found in processed foods, hot dogs), artificial sweeteners (e.g., aspartame), and tyramine (e.g., yogurt, nuts, lima beans) Glare, contrasting patterns, flashing lights, Computer screen Hormonal changes in women Hunger Lack of sleep Medications (over-the-counter and prescription) Perfume or noxious odors Stress Classifications Migraines split into two major classifications with subtypes. They are classified according to the symptoms they produce. With aura Without aura Aura Migraine with aura is characterized by a neurological phenomenon (aura) that is experienced 10 to 30 minutes before the headache. Most auras are visual and are described as bright shimmering lights around objects or at the edges of the field of vision (called scintillating scotomas) or zigzag lines, castles (teichopsia), wavy images, or hallucinations. Others experience temporary vision loss. Nonvisual auras include motor weakness, speech or language abnormalities, dizziness, vertigo, and tingling or numbness (parasthesia) of the face, tongue, or extremities. Without Aura Migraine without aura is the most prevalent type and may occur on one (unilateral) or both sides (bilateral) of the head. Tiredness or mood changes may be experienced the day before the headache. Nausea, vomiting, and sensitivity to light (photophobia) often accompany migraine without aura. 2
3 Other types of Migraines Some women experience migraines just prior to or during menstruation. These menstrual migraines may be related to hormonal changes and often do not occur or lessen during pregnancy. Other women develop migraines for the first time during pregnancy or after menopause. Abdominal migraine is most common in children with a family history of migraine. Symptoms include abdominal pain without a GI cause (may last up to 72 hours), nausea, vomiting, and flushing or paleness (pallor). Children who have abdominal migraine often develop typical migraine as they age. Other Migraines Basilar artery migraine involves a disturbance of the basilar artery in the brainstem. Symptoms include severe headache, vertigo, double vision, slurred speech, and poor muscle coordination. This type occurs primarily in young people. Carotidynia, also called lower-half headache or facial migraine, produces deep, dull, aching, and sometimes piercing pain in the jaw or neck. There is usually tenderness and swelling over the carotid artery in the neck. Episodes can occur several times weekly and last a few minutes to hours. This type occurs more commonly in older people. Doppler ultrasound studies of the carotid arteries are normal. Other Migraines Headache-free migraine is characterized by the presence of aura without headache. This occurs in patients with a history of migraine with aura. Ophthalmoplegic migraine begins with a headache felt in the eye and is accompanied by vomiting. As the headache progresses, the eyelid droops (ptosis) and nerves responsible for eye movement become paralyzed. Ptosis may persist for days or weeks. Signs & Symptoms Migraine headache pain is often described as throbbing or pulsating pain that is intensified by routine physical activity, coughing, straining, or lowering the head. The headache is often so severe that it interferes with daily activity and may awaken the person. The attack is debilitating, and migraine sufferers are often left feeling tired and weak once the headache has passed. Signs & Symptoms A migraine headache typically begins in a specific area on one side of the head, then spreads and builds in intensity over 1 to 2 hours and then gradually subsides. It can last up to 24 hours, and in some cases, several days. There may be accompanying symptoms such as nausea, vomiting, sensitivity to light (photophobia), or sensitivity to sound (phonophobia). Hands and feet may feel cold and sweaty and unusual odors may be intolerable. Diagnosis Diagnosis of migraine is based on the history of symptoms, physical examination, and neurological tests. The tests are performed to rule out other neurological and cerebrovascular conditions, including the following: Bleeding within the skull (intracranial hemorrhage) Blood clot within the membrane that covers the brain (cerebral venous sinus thrombosis) Cerebral stroke (infarct) Dilated blood vessel in the brain (cerebral aneurysm) Excess cerebrospinal fluid in the brain (hydrocephalus) Inflammation of the membranes of the brain or spinal cord (meningitis) Low level of cerebral spinal fluid (CSF) Nasal sinus blockage Postictal headache, which occurs after a stroke or seizure Tumor 3
4 Treatment The goals of treatment are to prevent or reduce the number of migraines (called prophylactic treatment) and to alleviate symptoms and shorten the duration of the migraine (called abortive treatment). Preventative medication may be prescribed for patients who have frequent headaches (3 or more a month) that do not respond to abortive treatment. Studies have shown that as many as 40% of these patients may benefit from preventative treatment. Using one medication (monotherapy) is tried first, but a combination of medicines may be necessary. Many of these medications have adverse side effects. If migraines become controlled, the dosage is often reduced or the drug discontinued. Treatment A variety of drugs have been specifically designed to treat migraines. In addition, some drugs commonly used to treat other conditions also may help relieve or prevent migraines. Medications used to combat migraines fall into two broad categories: Pain-relieving medications. Also known as acute or abortive treatment, these types of drugs are taken during migraine attacks and are designed to stop symptoms that have already begun. Preventive medications. These types of drugs are taken regularly, often on a daily basis, to reduce the severity or frequency of migraines. NSAIDs These medications, such as ibuprofen (Advil, Motrin, others) or aspirin, may help relieve mild migraines. Drugs marketed specifically for migraine, such as the combination of acetaminophen, aspirin and caffeine (Excedrin Migraine), also may ease moderate migraines but aren't effective alone for severe migraines. If taken too often or for long periods of time, NSAIDs can lead to ulcers, gastrointestinal bleeding and rebound headaches. Triptans For many people with severe migraine attacks, triptans are the drug of choice. They are effective in relieving the pain, nausea and sensitivity to light and sound that are associated with migraines. Medications include sumatriptan (Imitrex), rizatriptan (Maxalt), naratriptan (Amerge), zolmitriptan (Zomig), almotriptan (Axert), frovatriptan (Frova) and eletriptan (Relpax). Side effects of triptans include nausea, dizziness and muscle weakness. They aren't recommended for people at risk for strokes and heart attacks. A new, single-tablet combination of sumatriptan and naproxen sodium (Treximet) became available in It's more effective in relieving migraine symptoms than either medication on its own Ergots Ergot. Ergotamine (Migergot, Cafergot) is much less expensive, but also less effective, than triptans. It seems most effective in those whose pain lasts for more than 48 hours. Dihydroergotamine (Migranal) is an ergot derivative that is more effective and has fewer side effects than ergotamine. Anti-nausea medications. Because migraine attacks are often accompanied by nausea with or without vomiting, medication for nausea is appropriate and is usually combined with other medications. Frequently prescribed medications are metoclopramide (oral) or prochlorperazine (oral or suppository). Prevention Drug therapy, biofeedback training, stress reduction, and the elimination of certain foods from the diet are the most common methods of preventing migraine headaches. Regular exercise (eg, swimming, vigorous walking) can also reduce the frequency and severity of migraines. Scientists estimate that a small percentage of these patients will benefit from a treatment program focused solely on eliminating headache-provoking foods and beverages. Finally, many specialists recommend that persons with migraines avoid oversleeping on weekends 4
5 Specific Prevention Treatment Beta blockers (e.g., propranolol [Inderal ], atenolol [Tenormin ]) are the preferred medications. These drugs produce an effect on heart rate. They should not be taken by patients with asthma and should be used with caution in patients with diabetes. Side effects include gastrointestinal upset, insomnia, low blood pressure (hypotension), slowed heart rate (bradycardia), and sexual dysfunction. Some beta blockers pass into breast milk and may cause problems in nursing infants. Antiseizure drugs such as valproic acid (Depakote ), topiramate (Topamax ), and gabapentin (Neurontin ) may be used to treat migraine. Side effects include nausea, gastrointestinal upset, sedation, liver damage, and tremors. Specific Prevention Treatment Calcium channel blockers (e.g., verapamil, amlodipine [Norvasc ]) inhibit artery dilation and block the release of serotonin. They should not be taken by patients with heart failure or heart block. Side effects include constipation, flushing, low blood pressure, rash, and nausea. Tricyclic antidepressants (TCAs; e.g., amitryptaline [Elavil ], nortryptaline [Pamelor ], desipramine [Norpramin ]) block serotonin reabsorption and take 2 3 weeks be effective. Side effects include the following: Constipation Dry mouth Low blood pressure (hypotension) Increased heart rate (tachycardia) Urinary retention Sexual dysfunction Weight gain Prevention Treatment Selective serotonin reuptake inhibitors (SSRIs; e.g., paroxetine [Paxil ], fluoxetine [Prozac ], sertraline [Zoloft ]) are usually better tolerated than TCAs, but may not be as effective. Side effects include nausea, insomnia, sexual dysfunction, and loss of appetite. Methysergide maleate (e.g., Deseril, Sansert ) may be prescribed for patients with frequent, severe migraines. Side effects include insomnia, drowsiness, lightheadedness, and hair loss. This drug should not be used by patients with coronary artery disease and must be discontinued for 3 4 weeks after 4 6 months of use because it can cause retroperitoneal fibrosis, a condition in which the blood vessels in the abdomen thicken, which reduces blood flow to organs. Botox Botulinum toxin type A (Botox). Botulinum toxin type A is sometimes used for treatment of chronic migraines. Studies have had mixed results with respect to effectiveness. Some headache specialists believe that it can be helpful for some people. Injections are made in muscles of the forehead and neck. When this is effective, the treatment typically needs to be repeated every three months. Complementary / Alternative Medicine Treatment Psychotherapy Relaxation Guided Imagry Medical Hypnosis Progressive Muscle Relaxation Diaphragmatic Breathing Biofeedback Acupuncture Physical Therapy Massage Therapy Cluster Headaches They are called cluster headaches because the attacks come in groups over prolonged periods. The pain arrives with little, if any, warning, and it has been described as the most severe and intense of any headache type. A single headache generally lasts from 30 to 45 minutes, although it might persist for several hours before it disappears. It can reoccur later in the day. Most sufferers experience one to four headaches a day during a cluster period. Cluster headaches frequently surface during the morning or late at night; the cluster cycle can last weeks or months and then can disappear for months or years. Clusters often occur during spring or autumn and, thus, are often incorrectly associated with allergies. 5
6 Cluster Headache Symptoms The cluster headache was once considered a type of migraine, because it is vascular. Unfortunately, it is possible for a person to suffer from both migraines and clusters, although it is rare. The headache is strictly unilateral and rarely switches sides from one attack to another. You might feel the pain begin around one eye, "like a nail or knife stabbing or piercing" your eye, or as if someone "were pulling out" your eye; it may be accompanied by a tearing or bloodshot eye and a runny nose on the side of the headache. It can radiate from the eye to the forehead, temple and cheek on the same side. The pain of a cluster headache has been described as piercing, burning, throbbing, pulsating, and so excruciating that most victims cannot sit still and feel compelled to rock in a chair, walk back and forth, or bang their heads against something. Cluster Headache Treatment (*acute tx) Sumatriptan injection* (side effects: N/V, fatigue, parasthesias, chest/throat tightness) Zolmitriptan intranasal* (N/V, fatigue, parasthesias, chest/throat tightness) Oxygen inhalation* via non-rebreather mask x min Ergotamine/Dihydroergotamine Lidocaine intranasal for moderate adjunctive help Somatostatine & Octreotide Maintenance Prophylaxis These medications are gnerally discontinued after the resolution of the cluster period and restarted at the onset of the next cluster period. Monotherapy is optimal. Calcium channel blockers (Verapamil) (hypotension, constipation, peripheral edema) First-line Lithium (diarrhea, tremor, polyuria, kidney/liver damage) Second-line. Topiramate (parasthesias, wight loss, cognitive dysfunction, fatigue, dizziness, taste alteration) Second-line. Valproic acid (weight gain, fatigue, tremor, hair loss, nausea) Third-line. Gabapentin (somnolence, fatigue, dizziness, weight gain, peripheral edema, ataxia) Third-line Baclofen (drowsiness, dizziness, ataxia, muscle weakness) Third-line. Non-medicinal Treatments Peripheral Nerve & Sphenopalatine Ganglion Block Block (lidocaine, betamethasone)given ipsilateral to head pain or in suboccipal area Significant, temporary relief (~4 weeks) Peripheral Nerve & Sphenopalatine Ganglion For people refractory to meds Occipital nerve stimulation Benefits in minutes StimulationDeep Brain (hypothalamic) Stimulation Watch for intracerebral hemorrhage Ablative procedures Done strictly for unilateral, side-locked headaches No longer popular Trigeminal nerve often ablated Moderately good results Tension-Type Headaches (TTH) Signs and symptoms of a tension headache include: Dull, aching head pain The sensation of tightness or pressure across your forehead or on the sides and back of your head Tenderness on your scalp, neck and shoulder muscles Occasionally, loss of appetite A tension headache can last from 30 minutes to an entire week. You may experience these headaches only occasionally, or nearly all the time. Common in males or females Tension Headaches: Differential A tension-type headache, as it's medically known is the most common type of headache, and yet its causes aren't well understood. May be caused by teeth clenching which creates a chronic contraction of the temporalis muscle. May be caused by a malfunctioning pain filter which is located in the brain stem (hyperexcitability of central nociceptive neurons) TTH is generally a diffuse, mild to moderate pain that many people describe as feeling as if there's a tight band/constant pressure around the head. The pain can radiate from the neck, back, eyes, or other muscle groups in the body. Tension-type headaches account for nearly 90% of all headaches. 6
7 TTH Precipitators Various precipitating factors may cause TTH in susceptible individuals: Stress: usually occurs in the afternoon after long stressful work hours or after an exam Sleep deprivation Uncomfortable stressful position and/or bad posture Irregular meal time causing hunger One half of patients with TTH identify stress or hunger as a precipitating factor Eye strain TTH Treatment Ibuprofen, acetaminophen, and aspirin. Analgesic/sedative combinations are widely used (e.g., analgesic/antihistamine combinations like Syndol, Mersyndol and Percogesic, analgesic/barbiturate combinations such as Fiorinal). Frequent use of analgesics may, however, lead to medication overuse headache. The first-line treatment for chronic tension type headache is amitriptyline (e.g., Elavil) Other medication options include topiramate (e.g., Topamax) and valproic acid (e.g., Depakote) Biofeedback, accupuncture, and cranio-sacral pressure techniques may also help. Dr Susan Fralick-Ball, PsyD, MSN, RN, CH, CLNC PsychMedEd 7
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)
More informationHow 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
More informationHeadache 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
More informationDo you suffer from Headaches? - November/Dec 2011
Do you suffer from Headaches? - November/Dec 2011 Inside this month's issue Headaches Acute single headaches Recurring Headaches: Migraine What causes Migraine? Treatments for migraine & prevention Headaches
More informationGeneral 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
More informationADVANCES 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
More informationHeadache 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.
More informationA 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
More informationHow 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
More informationMIGRAINE 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
More informationIndex. 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
More informationHEADACHE HISTORY & PROFILE QUESTIONNAIRE
1 HEADACHE HISTORY & PROFILE QUESTIONNAIRE Patient Name: On what part of the head do your headaches start? R Side L Side Either Side Both Sides Back On Top Temples Behind/AroundEyes Forehead Face Neck
More informationShort 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:
More informationStrategies 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
More informationMigraine. What are the symptoms of a migraine attack?
Migraine Migraine causes attacks of headaches, often with feeling sick or vomiting. Treatment options include: avoiding possible 'triggers', painkillers, antiinflammatory painkillers, anti-sickness medicines,
More informationHMFP 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
More informationHEADACHE: 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.
More informationOH, 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
More informationHEADACHES AND MIGRAINES
HEADACHES AND MIGRAINES CONTENT CREATED BY Learn more at www.health.harvard.edu TALK WITH YOUR DOCTOR Table of Contents Whether this is your first visit or a follow-up, answer these questions for your
More informationFaculty 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
More information1. 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
More informationTreatments for migraine
Treatments for migraine Information for patients and carers Department of Neurology Aberdeen Royal Infirmary Contents Page About this leaflet Abortive medication for migraine Painkillers Antisickness medication
More informationMigraine 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
More informationCase 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
More informationUnderstanding. Migraine. Amy, diagnosed in 1989, with her family.
Understanding Migraine Amy, diagnosed in 1989, with her family. What Is a Migraine? A migraine is a recurring moderate to severe headache. The pain usually occurs on one side of the head. It is typically
More informationJune National Migraine and Headache Awareness Month
June 2018- National Migraine and Headache Awareness Month A note from the author Hello NCP friends! This month, I wanted to feature a topic that has been much discussed amongst several of my friends and
More informationHEADACHE: Types, Tips & Treatment Suggestions
Headaches are one of the most common complaints patients present with in primary care settings. They are often correlated with stress, tension and a litany of existing medical conditions. Often, patients
More informationÇiçek 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
More informationPreparing for your Appointment: HEADACHE. How bad is your typical headache pain on the 0-10 pain scale with 10 being the worst pain?
Preparing for your Appointment: HEADACHE Write down your symptoms: When did the headaches begin? Where are your headaches located? How bad is your typical headache pain on the 0-10 pain scale with 10 being
More informationHeadache. 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
More informationCOLUMBIA 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
More informationTears 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
More informationUnderstanding Migraines
Understanding Migraines Migraine is a severe headache syndrome that recurs. Migraine headaches are usually throbbing, but may also be described as exploding, shooting, or squeezing. Migraine headaches
More informationI 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
More informationNeuralgias tend to be sudden, brief, intermittent severe, stabbing or lightning pains or electric shock sensations.
Neuralgia is the term used to describe pain arising from a nerve. There are many different neuralgias which have been described in the medical literature, but I will only touch upon a few more common ones.
More informationGoals. 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
More informationNational Hospital for Neurology and Neurosurgery. Migraine Associated Dizziness. Department of Neuro-otology
National Hospital for Neurology and Neurosurgery Migraine Associated Dizziness Department of Neuro-otology If you would like this document in another language or format or if you require the services of
More informationUnderstanding 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
More informationMedication 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
More informationChronic 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
More informationA 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)
More informationClinical case. Clinical case 3/15/2018 OVERVIEW. Refractory headaches and update on novel treatment. Refractory headache.
OVERVIEW Refractory headaches and update on novel treatment Definition of refractory headache Treatment approach Medications Neuromodulation In the pipeline Juliette Preston, MD OHSU Headache Center Refractory
More informationWhat You Should Know About Your HEADACHE. Learn more about headache types, triggers, and treatments, when to get help, and how to help yourself
What You Should Know About Your HEADACHE Learn more about headache types, triggers, and treatments, when to get help, and how to help yourself Introduction The purpose of this brochure is to give you a
More informationManagement 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,
More informationThey are updated regularly as new NICE guidance is published. To view the latest version of this NICE Pathway see:
bring together everything NICE says on a topic in an interactive flowchart. are interactive and designed to be used online. They are updated regularly as new NICE guidance is published. To view the latest
More informationAcademy Asthma, Allergy, & Sinus Center
This questionnaire is designed to help patients with headaches. No doctors or pharmaceutical companies will profit from this questionnaire. Our only goal is to gather data on patients with headaches to
More informationHeadache 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
More informationUpdate 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
More informationSECTION OF NEUROSURGERY PATIENT INFORMATION SHEET
SECTION OF NEUROSURGERY PATIENT INFORMATION SHEET EC#: (for office use only) Patient s Name: Today s Date: Age: Date of Birth: Height: Weight: Physician you are seeing today: Marital Status: Married Work
More informationHEADACHES: MIGRAINE SYMPTOMS OF MIGRAINE HEADACHES PREVENTION
HEADACHES: MIGRAINE Migraine headaches occur when there are changes in some of the nerves and blood vessels. Migraines are common in children. Often there is a history of headaches in the family. Your
More informationCaspian Acupuncture -- Health History Form Anita Tayyebi EAMP, LAc. 652 SW 150 th St Burien WA 98166
Frist Name Last: Date Phone (H) (C) (W) E-mail Address City State Zip Age DOB Place of Birth _ Marital/Partnership Status Preferred Gender Pronoun _ Profession Family Physician Telephone # Referred By
More informationWHY 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
More informationUnderstanding Migraine Disease
By The American Institute of Health Care Professionals, Inc. Table Of Content 2 INTRODUCTION 3 Chapter 1: The Stats & Consequences of Migraines are Staggering 5 Chapter 2: Is it a Migraine or Is it Something
More informationEmotional Relationships Social Life Sexually Recreation
Name Date Address City State Zip Married Single Partner Divorced Widowed Date of Birth SS# Email Work Phone Home Phone Cell Phone Occupation Referred by Emergency Contact Family Physician Contact May we
More informationPain Management Questionnaire
In order to make the most of your visit, we require this form to be completed to the best of your ability and sent to the Pain Management Clinic a copy should be shared with your Primary Care Provider
More informationNeurosurgery Associates Headache Intake Questionnaire
Neurosurgery Associates Headache Intake Questionnaire 393 E Town Street, Suite 110 Columbus, OH 43215 First Name: Last Name : Date of Birth: Age: Referring Doctor: Pharmacy: Primary Insurance: Place of
More informationSound View Acupuncture and Chinese Herbs 5410 California Ave SW, #202, Seattle, WA
Sound View Acupuncture and Chinese Herbs 5410 California Ave SW, #202, Seattle, WA 98136 206.200.3595 Today s date Name Legal name (if different) Phone (primary) (secondary) Address City State Zip Email
More informationEmory Clinic Department of Neurological Surgery Second Opinion Questionnaire
Emory Clinic Department of Neurological Surgery Second Opinion Questionnaire First Name: M.I. Last Name: Date of Birth: Phone: Marital Status: Married Divorced Separated Widowed Single Work Status: Employed
More informationflorida child neurology
Headaches florida child neurology You re sitting at your desk, working on a difficult task, when it suddenly feels as if a belt or vice is being tightened around the top of your head. Or you have periodic
More informationPediatric Headache Diary
Patient Name Age Pediatric Headache Diary Day of week Date Time of onset Duration (hours/minutes/days) Location (forehead, temples, back of head, generalized, etc.) Type of pain (throbbing, piercing, tight
More informationHEADACHES THE RED FLAGS
HEADACHES THE RED FLAGS FAYYAZ AHMED CONSULTANT NEUROLOGIST HON. SENIOR LECTURER HULL YORK MEDICAL SCHOOL SECONDARY VS PRIMARY HEADACHES COMMON SECONDARY HEADACHES UNCOMMON BUT SERIOUS SECONDARY HEADACHES
More informationANTI-DEPRESSANT MEDICATIONS
ANTI-DEPRESSANT MEDICATIONS This information is not intended to be a substitute for medical advice. It s purpose is solely informative. If your client or yourself are taking antidepressants, do not change
More informationAmarillo Surgical Group Doctor: Date:
Office Visit Information (General Surgery) Amarillo Surgical Group Doctor: Date: Patient s Information Name: Last First Middle Social Security #: Date of Birth: Age Gender: [ Male / Female ] Marital Status:
More informationControlling Migraine Pain
Migraine Stats Controlling Migraine Pain Alan Zacharias, M.D. Associated Neurologists, Boulder Community Health 303-622-3365 Women 15% Men 5% Usually starts in 2 nd and 3 rd Decade Major Impact on days
More informationHeadache Follow-up Visit Form
!1 Headache Follow-up Visit Form We will be unable to see you unless this form is completely filled out. We appreciate your thoroughness. Name DOB Age Today s Date Referring doctor: Primary doctor: Neurologist:
More informationHead Pain Intake Form
Head Pain Intake Form NEUROLOGY LLC Your evaluation will take one hour to complete and in order to best utilize the time, please take the time to complete this questionnaire prior to your appointment.
More informationHEADACHE: Prevalence and Impact
Mod 2 Headaches HEADACHE: Prevalence and Impact PREVALENCE 18-25 % women have headaches 6-10 % men have headaches 5% of women have headaches more than 15 days per month 112 million bedridden days per year
More informationProgesterone. What is progesterone? Important information. Before taking this medicine
Progesterone Generic Name: progesterone (proe JESS te rone) Brand Names: First Progesterone MC10, Menopause Formula Progesterone, Prometrium What is progesterone? Progesterone is a female hormone important
More informationTreatment 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,
More informationHeadache Why headaches hurt When to see a doctor Diagnosing your headache
Headache Why headaches hurt Information about touch, pain, temperature, and vibration in the head and neck is sent to the brain by the trigeminal nerve, one of 12 pairs of cranial nerves that start at
More informationMIGRAINE CLASSIFICATION
MIGRAINE CLASSIFICATION Nada Šternić At most, only 30% of migraineurs have classic aura The same patient may have migraine headache without aura, migraine headache with aura as well as migraine aura without
More informationDisclosures. 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
More informationDisclosures. 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
More informationSumatriptan 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
More informationNISA Headache Questionnaire
NISA Headache Questionnaire Patient: Date: What prompted this headache appointment? Headache (HA) Duration: How many days a (circle one) week / month do you have headaches? How many (circle one) weeks
More informationImitrex for ocular migraines
Imitrex for ocular migraines Information about ocular, optical, and ophthalmic Migraine, accurate diagnoses, and the importance of correct diagnostic and classification terminology. 14-10-2015 1 Answer
More informationA PATIENT GUIDE FOR MANAGING PAIN
A PATIENT GUIDE FOR MANAGING PAIN PAIN MANAGEMENT Knowing the Facts Pain can be controlled. Pain is common after surgery and with many types of illnesses. Most patients with acute and chronic pain can
More informationMigraine, 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
More information10/13/17. 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
More informationHeadaches in Children
How common are headaches? What is the impact? Very common! 20% of kids from preschool through teenage report frequent or severe headaches in any given year 2 Headaches are more common in children who have
More informationSymptom Review (page 1) Name Date
v2.4, 2/13 JonathanTreasure.com Botanical Medicine & Cancer Herb Drug Interactions Herbalism 3.0 Symptom Review (page 1) Name Date INSTRUCTIONS Please read each section below carefully and, after each
More informationCommon Headaches. Types and Natural Treatments
Common Headaches Types and Natural Treatments by Heidi Fritz, MA, ND Bolton Naturopathic Clinic 64 King St W, Bolton, Ontario, L7E1C7 www.boltonnaturopathic.ca Three Common Types of Headaches Headaches
More informationChronic Migraine in Primary Care. December 11 th, 2017 Werner J. Becker University of Calgary
Chronic Migraine in Primary Care December 11 th, 2017 Werner J. Becker University of Calgary Disclosures Faculty: Werner J. Becker Relationships with commercial interests: Grants/Research Support: Clinical
More informationSumatriptan 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
More informationSymptom Questionnaire
Symptom Questionnaire The following questionnaire is a general assessment of your health developed by Dr Royal Lee D.D.S. Each grouping represents a particular area of your body that may be causing you
More informationBackground. Background. Headache Examination. Headache History. Primary vs. Secondary Headaches. Headaches In Children: Why Worry?
Background Headaches In Children: Why Worry? Marcy Yonker MD FAHS Associate Professor of Pediatrics University of Arizona Director, Pediatric Headache Program Phoenix Children s Hospital Headaches are
More informationWhat is it? A severe painful headache with no cure Accompanied or preceded by sensory warning signs such as. Usually affects one side of the brain
Migraines What is it? A severe painful headache with no cure Accompanied or preceded by sensory warning signs such as flashes of light blind spots, tingling in the arms and legs nausea vomiting increased
More informationPage: 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)
More informationPatient Information. Marital Status (Single, Married, Life Partner, Divorced, Widowed) CHIEF COMPLAINT
Patient Information Name Date Home Address City State Zip Phone E-mail Address Cell Phone: Business Address City State Zip Phone Occupation Place of Birth Date of Birth Age Height Weight Soc. Sec. # Sex
More informationHome. About RELPAX. About Migraines. Migraine Tools & Resources. RELPAX Success Stories. The C.A.L.M. Program. Is Your Headache A Migraine?
About Types of What is a migraine? A migraine is not just a bad headache. It is an intense, throbbing pain. can also cause nausea and sensitivity to light and sound. Most experts agree that migraine pain
More information~ 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: -----------
More informationปวดศ 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
More informationOther physician #1. #(p) List any allergies to medications. Please list below all other current medical conditions or previous surgeries
Dept. of Obstetrics and Gynecology Division of Gynecological Pain and Minimally Invasive Surgery Frank Tu, MD, MPH Sangeeta Senapati, MD, MS Howard Topel, MD Name: New Patient Intake Questionnaire Names
More informationTranscutaneous stimulation of the cervical branch of the vagus nerve for cluster headache and migraine
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Interventional procedure consultation document Transcutaneous stimulation of the cervical branch of the vagus nerve for cluster headache and migraine Cluster
More informationBridges Family Wellness PC. New Patient Intake. Bridges Family Wellness Intake Form SE Lake Rd, Suite 102 Milwaukie, OR
New Patient Intake Bridges Family Wellness Intake Form Full Name: * What is your birthdate? MM/DD/YYYY * What is your gender identity? * Home address: * Cell Phone * Other Phone number(s): Emergency Contact
More informationMaternity. Migraine in pregnancy Information for women
Maternity Migraine in pregnancy Information for women You have been given this leaflet as you have a diagnosis of migraines. It contains advice to help you manage your migraines safely during your pregnancy.
More informationPlease fill out the following form in as much detail as possible. Please Print. Name. Address. City State Zip. Home Phone Office Phone.
CASE NO. Please fill out the following form in as much detail as possible. Please Print Date Name Address City State Zip Home Phone Office Phone E-mail Address Age Date of Birth Occupation Sex (M) (F)
More informationCare for patients with Neurological disorders
King Saud University College of Nursing Medical Surgical Department Application of Adult Health Nursing Skills ( NUR 317 ) Care for patients with Neurological disorders Outline; EEG Overview. Nursing Interventions;
More informationHeadaches. Mini Medical School. November 10, A. Laine Green MSc, MD FRCP(C) Assistant Professor Department of Medicine (Neurology)
Headaches. Mini Medical School. November 10, 2016 A. Laine Green MSc, MD FRCP(C) Assistant Professor Department of Medicine (Neurology) Artist Agnes Cecile Disclosures I have received an honorarium from
More informationNew Patient Specialty Intake Form Department of Surgery
This form contains questions specific to the Department of Surgery. If you are new to Baylor College of Medicine and have not been seen in any of our offices, please be sure to complete our New Patient
More information