Monday, February 22, 2010

Neuro I

Hi! This is another neurology week.

A 35 year old woman presents with a headache that started this morning. It is on the right side of her head, dull, deep, pulsating, with a gradual onset. The headache was preceded by fatigue, difficulty concentrating, nausea, yawning, and pallor. It is worse with physical activity. During the time of the headache, she also gets head pain when brushing her hair. There were no visual disturbances, sensory symptoms, motor weakness, or speech disturbances. She's had the same headache in the past which have lasted anywhere from 24 to 48 hours. They seem to be triggered by stress, menstruation, lack of sleep, weather, hunger, and certain foods or odors. She treats herself by lying down in a dark quiet room. There is a positive family history. She is obese. Her neurologic exam is nonfocal.

Challenge: What is the acute treatment? What is the prevention?

2 comments:

Suheil said...

Migraine (without aura)- the clinically more common variant..

Craig Chen said...

correct!
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Neuro I

Migraine without aura makes up 80% of migraines. The symptom of pain from innocuous stimulation is cutaneous allodynia. Prophylactic treatment is indicated with more than four migraines a month, migraines longer than 12 hours, or significant disability; selection of medication depends on comorbidities. In patients with depression, tricyclics or other antidepressants may be used. In patients with hypertension, beta blockers and calcium channel blockers may be used, but not first-line in smokers or patients > 60 (risk of stroke). Clinical trials validate use of propranolol, metoprolol, timolol, amitriptyline, topiramate, and valproate. Acute therapy is use of a triptan, metoclopramide, or prochlorperazine.

Source: UpToDate.