1/2. Casebook: headache.headache alone rarely indicates a sinister underlying cause. However, if the red flags are flying -- that is, if the patient is over 30 years old when the first headache develops, has additional symptoms or signs or has a very acute onset, particularly involving vomiting, then suspicion should be raised (see table 4). Although migraine has a high impact on the sufferer and affects a large proportion of the population on a monthly basis, the problem of acute muscle contraction headache is far greater. Other forms of headache are actually uncommon in comparison to these two. However, chronic daily headache is the most common condition seen by the medical professional because of its impact on the patient's quality of life. The key to the management of this condition is the assessment of analgesic dependence including NSAIDs, and particularly the codeine-containing agents. These should be avoided while long-term aproached such as exercise and certain prophylactic agents are introduced. It is true to say that if a careful initial assessment is made leading to a correct diagnosis, then the chance of appropriate management is enormously increased. patients undergoing the correct management should generally see a massive improvement in their quality of life. headache can, therefore, be a very satisfying condition for the clinician to treat.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
2/2. Chronic daily headache: a rational approach to a challenging problem.Chronic daily headache (CDH) is a significant public health problem with 3 to 5% of the population worldwide experiencing daily or near-daily headaches. patients with CDH can be particularly challenging, and clinicians require a systematic approach to help guide investigations and management. The revised 2004 International headache Society classification Criteria introduces formalized criteria for several CDH disorders including chronic migraine and medication overuse headache as well as new daily persistent headache, hemicrania continua, hypnic headache, and sunct syndrome. Medication overuse is common in patients with CDH who present to physicians. Familiarity and comfort with drug-withdrawal and detoxification strategies is therefore essential. patients with chronic migraine and chronic cluster experience significant disability and diminished quality of life. The ability to manage these patients effectively is a rewarding clinical experience.- - - - - - - - - - ranking = 0.5keywords = life (Clic here for more details about this article) |