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Headache Examination

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1. Screening for Insomnia: An Observational Study Examining Sleep Disturbances, Headache Characteristics, and Psychiatric Symptoms in Patients Visiting a Headache Center. Full Text available with Trip Pro

Screening for Insomnia: An Observational Study Examining Sleep Disturbances, Headache Characteristics, and Psychiatric Symptoms in Patients Visiting a Headache Center. Effective treatments for insomnia exist, but few physicians treating headaches have routine methods for screening for insomnia. We sought to 1) describe the migraine characteristics and comorbid conditions that can affect sleep and 2) assess their relationships with positive screens on the Insomnia Severity Index (ISI (...) patients were suspected to have migraines. The mean number of headache days per month was 11.6. Only 41% of patients reported sleeping seven or more hours; 49.2% had an ISI of 15 or higher (positive screen). Regarding the insomnia scores, there were no differences between moderate and severe headache pain, between episodic and chronic headaches, and between the associated symptoms (nausea/vomiting, photophobia, phonophobia; P > 0.05). Musculoskeletal pain (18.7 vs 13.8, P = 0.027), depression (rho

2017 Pain Medicine

2. gammaCore for cluster headache

the clinical evidence as well as its strengths and limitations. Overall assessment of the evidence The studies included in table 2 examine the use of gammaCore as a prophylactic treatment for preventing cluster headache and for treating acute pain after the onset of a cluster headache. Several of the studies also separate cohorts into those that have been diagnosed with chronic cluster headache and people diagnosed with episodic cluster headache. The studies recruited relatively large populations given (...) gammaCore for cluster headache gammaCore for cluster headache gammaCore for cluster headache Medtech innovation briefing Published: 22 October 2018 nice.org.uk/guidance/mib162 pathways Summary Summary The technology technology described in this briefing is gammaCore. It is used as a daily preventative measure for cluster headache and can be used to treat pain during a headache. The inno innovativ vative aspects e aspects compared with other vagus nerve stimulators is that gammaCore is applied

2018 National Institute for Health and Clinical Excellence - Advice

3. Randomized Controlled Trial Examining the Effects of Balloon Catheter Dilation on "Sinus Pressure" / Barometric Headaches. Full Text available with Trip Pro

Randomized Controlled Trial Examining the Effects of Balloon Catheter Dilation on "Sinus Pressure" / Barometric Headaches. Objective To determine if balloon catheter dilation of sinus ostia affects the severity or frequency of headache among patients who have barometric pressure-related "sinus" headache. Study Design Prospective single-blinded randomized controlled trial. Setting Tertiary care medical center. Subjects and Methods Subjects with a diagnosis of sinus pressure headache without (...) evidence of mucosal thickening on computed tomography were recruited. Subjects were blinded and randomized to undergo balloon dilation of affected sinus ostia (active treatment) or balloon dilation in the nasal cavity (placebo). Two balloon devices were utilized (Acclarent and Entellus) and outcomes compared. Subjects were followed with pre- and postprocedure SNOT-22 scores (Sinonasal Outcome Test-22), HIT-6 scores (Headache Impact Test-6), and medication utilization logs for 6 months. Results

2018 Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Controlled trial quality: uncertain

4. Barriers to Behavioral Treatment Adherence for Headache: An Examination of Attitudes, Beliefs, and Psychiatric Factors. Full Text available with Trip Pro

Barriers to Behavioral Treatment Adherence for Headache: An Examination of Attitudes, Beliefs, and Psychiatric Factors. Nonpharmacological interventions, such as biofeedback, cognitive behavioral therapy, and relaxation techniques are Level-A evidence-based treatments for headache. The impact of these interventions is often equivalent to or greater than pharmacological interventions, with fewer side effects. Despite such evidence, the rate of participation in nonpharmacological interventions (...) for headache remains low. Once obstacles to optimizing use of behavioral interventions, such as local access to nonpharmacological treatment and primary headache providers are traversed, identification of barriers contributing to low adherence is imperative given the high levels of disability and cost associated with treating headache disorders. In this review of factors in adults associated with underuse of nonpharmacological interventions, we discuss psychological factors relevant to participation

2018 Headache

5. Assessment of acute headache in children

Society (IHS). The international classification of headache disorders, 3rd edition. Cephalalgia. 2018 Jan;38(1):1-211. https://www.ichd-3.org/ http://www.ncbi.nlm.nih.gov/pubmed/29368949?tool=bestpractice.com Primary headaches include migraine, tension-type, cluster, as well as the new daily persistent headache. Secondary headaches are symptomatic of an underlying intracranial or medical condition that requires treatment. The initial assessment of acute headache aims to determine whether (...) there is a secondary cause for headache that requires urgent intervention. Clinical classification Headache may be classified in terms of time course. Acute headache A single episode of headache pain without prior headaches. May represent the first or an unusually severe form of primary headache. May suggest a new acute secondary cause for headache that, therefore, requires evaluation. Acute recurrent headache Stereotyped headaches separated by headache-free periods. Most suggestive of a primary headache disorder

2018 BMJ Best Practice

6. Migraine headache in children

excluded. Diagnosis is difficult in young children because the condition is defined by subjective symptoms. History and exam presence of risk factors age >2 years gradual onset of headache normal physical examination aura nausea and/or vomiting visual disturbance phonophobia occipital headache, ataxia, diplopia, blurred vision, vertigo, and tinnitus unilateral motor or sensory signs and headache ptosis generalised seizure positive family history of migraine chocolate, cheese, and citrus fruits stress (...) in quality, of moderate or severe intensity, and is aggravated by routine physical activity. Nausea, vomiting, photophobia, and phonophobia are common accompanying symptoms. Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition (beta version). Cephalalgia. 2013 Jul;33(9):629-808. https://www.ichd-3.org/ http://www.ncbi.nlm.nih.gov/pubmed/23771276?tool=bestpractice.com Diagnostic criteria for children are broader

2018 BMJ Best Practice

7. Tension-type headache

care and usually successfully self-treat. The attacks are generalised throughout the head with a predilection for involving the frontal and occipital regions. The pain is typically expressed as being a 'tight band' around the head. It does not worsen with routine physical activity. History and exam presence of risk factors generalised head pain frontal or occipital head pain non-pulsatile head pain constricting pain normal neurological examination pericranial tenderness sternocleidomastoid muscle (...) Tension-type headache Tension-type headache - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Tension-type headache Last reviewed: February 2019 Last updated: July 2018 Summary Tension-type headaches can be either episodic or chronic. Stress and mental tension are common triggers. Symptoms include dull, non-pulsatile, bilateral, constricting pain (not severe); pericranial tenderness is common. Unlike migraine

2018 BMJ Best Practice

8. Cluster headache

from the episodic form. History and exam presence of risk factors repeated attacks of unilateral pain excruciating pain lacrimation, rhinorrhoea, and partial Horner's syndrome agitation nausea, vomiting photophobia, phonophobia migrainous aura male sex family history head injury cigarette smoking heavy drinking Diagnostic investigations brain CT scan or MRI erythrocyte sedimentation rate pituitary function tests polysomnogram ECG Treatment algorithm ACUTE ONGOING Contributors Authors Clinical (...) declare that they have no competing interests. Peer reviewers Director of Headache and Pain Medicine Professor of Neurology, Anesthesiology, and Rehabilitation Medicine Icahn School of Medicine at Mount Sinai New York NY Disclosures MWG declares that he has no competing interests. Professor Family and Community Medicine University of Kansas School of Medicine Wichita KS Disclosures AW declares that she has no competing interests. Department Head Department of Neurology and Pain Medicine

2018 BMJ Best Practice

9. Migraine headache in adults

/articles/PMC31895/ http://www.ncbi.nlm.nih.gov/pubmed/11287655?tool=bestpractice.com Bashir A, Lipton RB, Ashina S, et al. Migraine and structural changes in the brain: a systematic review and meta-analysis. Neurology. 2013 Oct 1;81(14):1260-8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3795609/ http://www.ncbi.nlm.nih.gov/pubmed/23986301?tool=bestpractice.com History and exam presence of risk factors prolonged headache nausea decreased ability to function headache worse with activity sensitivity (...) to light sensitivity to noise aura vomiting unilateral throbbing sensation family history of migraine high caffeine intake exposure to change in barometric pressure female sex obesity habitual snoring stressful life events overuse of headache medications lack of sleep low socio-economic status allergies or asthma hypertension hypothyroidism diet Diagnostic investigations clinical diagnosis erythrocyte sedimentation rate (ESR) lumbar puncture (LP) cerebrospinal fluid (CSF) culture CT head MRI brain

2018 BMJ Best Practice

10. Migraine headache in adults

/articles/PMC31895/ http://www.ncbi.nlm.nih.gov/pubmed/11287655?tool=bestpractice.com Bashir A, Lipton RB, Ashina S, et al. Migraine and structural changes in the brain: a systematic review and meta-analysis. Neurology. 2013 Oct 1;81(14):1260-8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3795609/ http://www.ncbi.nlm.nih.gov/pubmed/23986301?tool=bestpractice.com History and exam presence of risk factors prolonged headache nausea decreased ability to function headache worse with activity sensitivity (...) to light sensitivity to noise aura vomiting unilateral throbbing sensation family history of migraine high caffeine intake exposure to change in barometric pressure female sex obesity habitual snoring stressful life events overuse of headache medications lack of sleep low socio-economic status allergies or asthma hypertension hypothyroidism diet Diagnostic investigations clinical diagnosis erythrocyte sedimentation rate (ESR) lumbar puncture (LP) cerebrospinal fluid (CSF) culture CT head MRI brain

2018 BMJ Best Practice

11. Migraine and Tension Headache

with sumatriptan 85/naproxen sodium 500 in (truly) episodic migraine: what's neck pain got to do with it? Postgrad Med. 2014 Mar;126(2):86-90. Créac'h C, Frappe P, Cancade M, et al. In-patient versus out-patient withdrawal programmes for medication overuse headache: a 2- year randomized trial. Cephalalgia. 2011 Aug;31(11):1189-1198. Cull RE. Investigation of late-onset migraine. Scott Med J. 1995 Apr;40(2):50-52. Deitch K, Kuhfahl K, Kinzler D, et al. A Randomized, Double-blind Comparison of Single Dose (...) , Freitag FG. Ibuprofen plus caffeine in the treatment of tension-type headache. Cephalalgia. 2000 Jul;20(6):597-602. Facco E, Liguori A, Petti F, Fauci AJ, Cavallin F, Zanette G. Acupuncture versus valproic acid in the prophylaxis of migraine without aura: a prospective controlled study. Minerva Anestesiol. 2013 Jun;79(6):634-642. Fan W, Lv Y, Ying G, Li W, Zhou J. Pilot study of amitriptyline in the prophylactic treatment of medication-overuse headache: a 1-year follow-up. Pain Med. 2014 Oct;15(10

2018 Kaiser Permanente Clinical Guidelines

12. Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Headache

205 flexion on examination) as a decision rule that has high sensitivity to rule out SAH, but low specificity to rule in 206 SAH, for patients presenting to the ED with a normal neurologic examination result and peak headache severity 207 within 1 hour of onset of pain symptoms. 208 Although the presence of neck pain and stiffness on physical examination in ED patients with an acute 209 headache is strongly associated with SAH, do not use a single physical sign and/or symptom to rule out SAH. 210 (...) the following clinical questions: (1) In the adult emergency department patient presenting with acute headache, are 60 there risk-stratification strategies that reliably identify the need for emergent neuroimaging? (2) In the adult 61 emergency department patient treated for acute primary headache, are nonopioids preferred to opioid medications? 62 (3) In the adult emergency department patient presenting with acute headache, does a normal noncontrast head 63 computed tomography scan performed within 6 hours

2019 American College of Emergency Physicians

13. gammaCore for cluster headache

is provided with each new RFID card. Additional gel can be provided at no extra cost. Inno Innovativ vative e aspects aspects gammaCore is currently the only technology that uses non-invasive stimulation of the vagus nerve to treat cluster headache. Intended Intended use use The instructions for using gammaCore state that gammaCore should be used regularly throughout the day to prevent cluster headache attacks and acutely to reduce pain during an attack. gammaCore is intended to be self-administered (...) . In all other studies gammaCore was used in addition to standard of care treatments. The studies show that gammaCore can reduce the frequency of The studies show that gammaCore can reduce the frequency of cluster headache attacks and the intensity of pain during an cluster headache attacks and the intensity of pain during an attack attack 3.3 The evidence for gammaCore comprises a small number of studies which include comparative, non-comparative and observational studies. The external gammaCore

2019 National Institute for Health and Clinical Excellence - Medical technologies

14. 34m with fever, headache and myalgias

pain in his bilateral lower extremities, particularly in his calves, without any weakness or parasthesias. He also experiences a bi-frontal, throbbing headache over this time period, without any photophobia, nausea, or vomiting. He feels generally fatigued with a poor appetite and decreased PO intake. He takes ibuprofen 600mg every six hours and gabapentin 300mg nightly, but these don’t bring him any relief. Three days after his symptoms begin, he presents to an outside ER where he is diagnosed (...) 34m with fever, headache and myalgias Core IM Hoofbeats: 34M with Fever, Headache and Myalgias – Clinical Correlations Search Core IM Hoofbeats: 34M with Fever, Headache and Myalgias January 16, 2019 15 min read Podcast: | Subscribe: | By Shira Sachs MD, Stephanie Sherman MD, Cindy Fang MD and John Hwang MD || Audio Editing by Richard Chen || Graphic by Amy Ou MD Time Stamps Player three has entered the game! [0:15] Case presentation, part 1 [1:20] First impressions [3:24] Rethinking another

2019 Clinical Correlations

15. Headache

are relatively similar with 83%–99% sensitivity and specificity [62]. MRA of the neck is most commonly performed with gadolinium contrast, whereas MRA of the head is most commonly performed without contrast. MRA of the brain with contrast is generally indicated if embolization coils or intracranial stents have been placed [63]. Headache of Trigeminal Autonomic Origin Trigeminal autonomic cephalgia is a group of primary headache disorders characterized by pain in unilateral trigeminal distribution (...) Headache Date of origin: 1996 Last review date: 2013 ACR Appropriateness Criteria ® 1 Headache American College of Radiology ACR Appropriateness Criteria ® Clinical Condition: Headache Variant 1: Chronic headache. No new features. Normal neurologic examination. Radiologic Procedure Rating Comments RRL* MRI head without and with IV contrast 4 O MRI head without IV contrast 4 O CT head without IV contrast 3 ??? CT head without and with IV contrast 3 ??? CT head with IV contrast 3 ??? MRA head

2019 American College of Radiology

16. Guideline for concussion/mild traumatic brain injury & persistent symptoms - Post-Traumatic Headache

clinic. 6.4 B Primary care providers and healthcare professionals treating patient’s headaches should perform a neurologic and musculoskeletal exam including cervical spine and vestibular examination (see Appendix ). Non-Pharmacological Treatment of Post-Traumatic Headache New Key Section Level of evidence A B C Updated Evidence 6.5 C Education should be provided on lifestyle strategies and simple, self-regulated intervention strategies that may minimize headache occurrence and/or decrease the impact (...) of the environment. Pharmacologic interventions as appropriate both for acute pain and prevention of headache attacks. Taken from the VA/DoD Management of Concussion/Mild Traumatic Brain Injury Clinical Practice Guideline (VA/DoD, 2016). Pharmacological Treatment of Post-Traumatic Headache New Key Section Level of evidence A B C Updated Evidence 6.7 C All patients with frequent headaches should be strongly encouraged to maintain an accurate headache diary (see Appendix ), medication calendar and activity log

2018 Ontario Neurotrauma Foundation

17. A pilot study examining the effects of priming headache illness schema on attentional engagement towards pain relief medication, in those with high and low medication treatment beliefs. Full Text available with Trip Pro

A pilot study examining the effects of priming headache illness schema on attentional engagement towards pain relief medication, in those with high and low medication treatment beliefs. Few studies have assessed the underlying theoretical components of the Common Sense Model. Past studies have found, through implicit priming, that coping strategies are embedded within illness schema. Our aim was to evaluate the effect priming 'headache' illness schema upon attentional engagement to pain relief (...) medication and to examine the interaction with illness treatment beliefs. Attentional engagement to the pain relief medication ('Paracetamol') was assessed using a 2 (primed vs. control) × 2 (strong belief in medication efficacy vs. weak belief in medication efficacy) design. During a grammatical decision task (identifying verbs/non-verbs), participants were randomised to receive a headache prime or a control. Response latency to the target word, 'Paracetamol' was the dependent variable. 'Paracetamol

2017 Psychology, health & medicine

18. Psychosocial and Demographic Characteristics of Children and Adolescents With Headache Presenting for Treatment in a Headache Infusion Center. (Abstract)

Psychosocial and Demographic Characteristics of Children and Adolescents With Headache Presenting for Treatment in a Headache Infusion Center. Approximately 10% of pediatric patients have recurrent headaches, with migraine being the most common headache type. If untreated, migraine may progress to status migrainosus, a debilitating condition of prolonged duration, high pain severity, and significant disability. There is high variability in the treatment of status migrainosus including (...) medications used and treatment setting, which may occur in the emergency room, as an inpatient admission, or, less often, in an outpatient infusion center. The paucity of research on the treatment of status migrainosus is a limitation to treatment effectiveness.The objective of the study was twofold. First, we sought to examine the demographic characteristics of children and adolescents accessing our outpatient infusion center for prolonged headache. Second, we sought to determine whether any demographic

2019 Headache

19. Combined use of cervical headache snag and cervical snag half rotation techniques in the treatment of cervicogenic headache. Full Text available with Trip Pro

patients with cervicogenic headache, who were randomly assigned to three equal groups: Group A (Headache SNAG), group B (C1-C2 SNAG rotation), and group C (combined). Neck Disability Index was used to examine neck pain intensity and cervicogenic headache symptoms. The 6-item Headache Impact Test scale was used to examine headache severity and its adverse effects on social life and functions. Flexion-Rotation Test was used to assess rotation range of motion at the level of C1-C2 and confirmed (...) Combined use of cervical headache snag and cervical snag half rotation techniques in the treatment of cervicogenic headache. [Purpose] Cervicogenic headache is a major problem in patients with upper cervical dysfunction. However, its physical therapy management is a topic of debate. This study aims to determine the effect of C1-C2 Mulligan sustained natural apophyseal glide mobilizations on cervicogenic headache and associated dizziness. [Participants and Methods] This study included 48

2019 Journal of physical therapy science Controlled trial quality: uncertain

20. Effectiveness of Oxygen and Other Acute Treatments for Cluster Headache: Results From the Cluster Headache Questionnaire, an International Survey. Full Text available with Trip Pro

: The Journal of Head and Face Pain published by Wiley Periodicals, Inc. on behalf of American Headache Society. (...) or older.Large international surveys of cluster headache are rare, as are examinations of treatments and side effects in older cluster headache patients. This article presents data from the Cluster Headache Questionnaire, with respondents from over 50 countries and with the vast majority from the United States, the United Kingdom, and Canada.This internet-based survey included questions on cluster headache diagnostic criteria, which were used as part of the inclusion/exclusion criteria for the study, as well

2019 Headache

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