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Assessment of acute headache in adults Assessment of acute headache in adults - Differential diagnosis of symptoms | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Assessment of acute headache in adults Last reviewed: August 2018 Last updated: June 2018 Summary Headache is pain localised to any part of the head, behind the eyes or ears, or in the upper neck. Headaches represent 2% of all emergency department visits. Ninety percent of men and 95 (...) % of women have at least one headache per year. Diagnostic clues should be derived primarily from history. Hallmark physical signs are often absent, and many physical findings are non-specific. The majority of patients presenting with acute headache have a benign diagnosis, but a high index of suspicion should be maintained for life-threatening causes of headache. Ramirez-Lassepas M, Espinosa CE, Cicero JJ, et al. Predictors of intracranial pathologic findings in patients who seek emergency care because
Assessment of acute headache in children Assessment of acute headache in children - Differential diagnosis of symptoms | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Assessment of acute headache in children Last reviewed: August 2018 Last updated: June 2018 Summary Headaches are common in children, increasing in incidence from early childhood to adolescence. They account for 0.7% to 1.3% of all paediatric emergency department visits. Kan L, Nagelberg (...) J, Maytal J. Headaches in a pediatric emergency department: etiology, imaging, and treatment. Headache. 2000;40:25-29. http://www.ncbi.nlm.nih.gov/pubmed/10759899?tool=bestpractice.com Burton LJ, Quinn B, Pratt-Cheney JL, et al. Headache etiology in a pediatric emergency department. Pediatr Emerg Care. 1997;13:1-4. http://www.ncbi.nlm.nih.gov/pubmed/9061724?tool=bestpractice.com Headaches may be classified as primary or secondary. Headache Classification Committee of the International Headache
Migraine headache in children Migraine headache in children - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Migraine headache in children Last reviewed: August 2018 Last updated: May 2018 Important updates European Medicines Agency (EMA) strengthens measures to avoid use of valproate medicines in pregnancy In March 2018, the EMA announced stronger measures aimed at avoiding the exposure of babies to valproate (...) not getting through to women, despite earlier steps aimed at ensuring this. Summary Migraine has a high prevalence in children (10%) and is a significant source of morbidity. Careful consideration of the broad differential diagnosis is important when evaluating a child with headache. The expectations for the success of treatment should take account of the level to which psychological factors are contributing to symptoms. Not all treatments (acute or prophylactic) work for every patient. Spontaneous
A Comparison of Headache Treatment in the Emergency Department: Prochlorperazine Versus Ketamine 29033296 2017 10 16 1097-6760 2017 Oct 13 Annals of emergency medicine Ann Emerg Med A Comparison of Headache Treatment in the Emergency Department: Prochlorperazine Versus Ketamine. S0196-0644(17)31568-8 10.1016/j.annemergmed.2017.08.063 Intravenous subdissociative-dose ketamine has been shown to be effective for pain management, but has not been specifically studied for headaches in the emergency (...) department (ED). For this reason, we designed a study to compare standard treatment (prochlorperazine) with ketamine in patients with benign headaches in the ED. This study was a multicenter, double-blind, randomized, controlled trial with a convenience sample of patients presenting to the ED with benign headaches. Patients were randomized to receive either prochlorperazine and diphenhydramine or ketamine and ondansetron. Patients' headache severity was measured on a 100-mm visual analog scale (VAS) at 0
Validation of the Ottawa Subarachnoid Hemorrhage Rule in patients with acute headache 29133539 2017 11 21 2017 12 19 1488-2329 189 45 2017 Nov 13 CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne CMAJ Validation of the Ottawa Subarachnoid Hemorrhage Rule in patients with acute headache. E1379-E1385 10.1503/cmaj.170072 We previously derived the Ottawa Subarachnoid Hemorrhage Rule to identify subarachnoid hemorrhage (SAH) in patients with acute headache (...) . Our objective was to validate the rule in a new cohort of consecutive patients who visited an emergency department. We conducted a multicentre prospective cohort study at 6 university-affiliated tertiary-care hospital emergency departments in Canada from January 2010 to January 2014. We included alert, neurologically intact adult patients with a headache peaking within 1 hour of onset. Treating physicians in the emergency department explicitly scored the rule before investigations were started. We
Manual Therapy for the Treatment of Cervicogenic Headaches: Clinical Effectiveness Manual Therapy for the Treatment of Cervicogenic Headaches: Clinical Effectiveness | CADTH.ca Find the information you need Manual Therapy for the Treatment of Cervicogenic Headaches: Clinical Effectiveness Manual Therapy for the Treatment of Cervicogenic Headaches: Clinical Effectiveness Published on: July 12, 2017 Project Number: RA0914-000 Product Line: Research Type: Devices and Systems Report Type: Reference (...) List Result type: Report Question What is the clinical effectiveness of using manual therapy for the treatment of adults or pediatric patients with cervicogenic headaches? Key Message Fourteen systematic reviews, 12 randomized controlled trials, and one non-randomized study were identified regarding manual therapy for the treatment of cervicogenic headaches. Tags headache disorders, acupressure, headache, manipulation, chiropractic, massage, musculoskeletal manipulations, traction, Cervicogenic
Effectiveness of Lateral Decubitus Position for Preventing Post-Dural Puncture Headache: A Meta-Analysis 28535561 2017 05 23 2017 05 23 2150-1149 20 4 2017 May Pain physician Pain Physician Effectiveness of Lateral Decubitus Position for Preventing Post-Dural Puncture Headache: A Meta-Analysis. E521-E529 Post-dural puncture headache (PDPH) is a relatively common complication of lumbar punctures for spinal anesthesia or neurologic diagnosis. For many years, a high number of drugs has been
A randomized trial of telemedicine efficacy and safety for nonacute headaches 28615434 2017 06 15 2017 07 11 1526-632X 89 2 2017 Jul 11 Neurology Neurology A randomized trial of telemedicine efficacy and safety for nonacute headaches. 153-162 10.1212/WNL.0000000000004085 To evaluate long-term treatment efficacy and safety of one-time telemedicine consultations for nonacute headaches. We randomized, allocated, and consulted nonacute headache patients via telemedicine (n = 200 (...) ) or in a traditional manner (n = 202) in a noninferiority trial. Efficacy endpoints, assessed by questionnaires at 3 and 12 months, included change from baseline in Headache Impact Test-6 (HIT-6) (primary endpoint) and pain intensity (visual analogue scale [VAS]) (secondary endpoint). The primary safety endpoint, assessed via patient records, was presence of secondary headache within 12 months after consultation. We found no differences between telemedicine and traditional consultations in HIT-6 (p = 0.84) or VAS
Ropivacaine Intramuscular Paracervical Injections for Pediatric Headache: A Randomized Placebo-Controlled Trial 28460864 2017 05 02 2017 05 02 1097-6760 2017 Apr 28 Annals of emergency medicine Ann Emerg Med Ropivacaine Intramuscular Paracervical Injections for Pediatric Headache: A Randomized Placebo-Controlled Trial. S0196-0644(17)30269-X 10.1016/j.annemergmed.2017.03.011 We seek to determine whether ropivacaine cervical paraspinal injections compared with normal saline solution injections (...) provide headache relief to pediatric patients that is sufficient for emergency department (ED) discharge. We enrolled children aged 7 to 17 years in a double-blinded, randomized, controlled trial of patients presenting to a pediatric ED with headache. Subjects were randomized into 1 of 3 groups: bilateral cervical paraspinal injections of either (1) 0.5% ropivacaine or (2) normal saline solution, or (3) a natural history group (not blinded) receiving no headache therapy for the first 30 minutes. Pain
Complementary and integrative medicine in the management of headache. Headaches, including primary headaches such as migraine and tension-type headache, are a common clinical problem. Complementary and integrative medicine (CIM), formerly known as complementary and alternative medicine (CAM), uses evidence informed modalities to assist in the health and healing of patients. CIM commonly includes the use of nutrition, movement practices, manual therapy, traditional Chinese medicine, and mind (...) -body strategies. This review summarizes the literature on the use of CIM for primary headache and is based on five meta-analyses, seven systematic reviews, and 34 randomized controlled trials (RCTs). The overall quality of the evidence for CIM in headache management is generally low and occasionally moderate. Available evidence suggests that traditional Chinese medicine including acupuncture, massage, yoga, biofeedback, and meditation have a positive effect on migraine and tension headaches. Spinal
Melatonin Is Superior to Amitriptyline for Headache Prevention Based on the Proportion of Patients Who Improved >50% in Headache Frequency UTCAT3159, Found CAT view, CRITICALLY APPRAISED TOPICs University: | | ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM View the CAT / Title Melatonin Is Superior to Amitriptyline for Headache Prevention Based on the Proportion of Patients Who Improved >50% in Headache Frequency Clinical Question In adults with migraine headaches, is melatonin superior than (...) amitriptyline in preventing the frequency and intensity of migraine headaches? Clinical Bottom Line For patients with migraine headaches, melatonin 3 mg is better than placebo for migraine prevention, more tolerable than amitriptyline, and as effective as amitriptyline 25 mg. Tolerability measures included the incidences of adverse events, including those that led to the premature withdrawal from the study as well as those that were life threatening. Best Evidence (you may view more info by clicking
Cluster headache: pathogenesis, diagnosis, and management. Cluster headache is a stereotyped primary pain syndrome characterised by strictly unilateral severe pain, localised in or around the eye and accompanied by ipsilateral autonomic features. The syndrome is characterised by the circadian rhythmicity of the short-lived attacks, and the regular recurrence of headache bouts, which are interspersed by periods of complete remission in most individuals. Headaches often start about 1-2 h after (...) falling asleep or in the early morning, and show seasonal variation, suggesting that the hypothalamus has a role in the illness. Consequently, the vascular theory has been superseded by recognition that neurovascular factors are more important. The increased familial risk suggests that cluster headache has a genetic component in some families. Neuroimaging has broadened our pathophysiological view and has led to successful treatment by deep brain stimulation of the hypothalamus. Although most patients