Re: ? per creamaster
Inderali eshte emri i tregut i propranololit - eshte beta-bllokues. Perdoret, vec te tjerash, per parandalimin e dhimbjeve te stresit (angl tension headache), te migrenes, dhimbjeve te njohura si 'cluster headache', etj. Kurse per trajtimin e episodeve akute te migrenes ilacet me te mira jane triptanet (nara-, almo-, sumatriptan, etj.).
Me poshte eshte nje handout qe e kam pas pergatitur para ca kohe. Eshte ne anglisht dhe tani po pertoj ta perkthej, po eshte shume komplet dhe kompakt.
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Headaches
The history of the headache
1. Hx is very important and together with PE often is enough to make the diagnosis (see below)
2. History features that are more suggestive of an organic lesion as a cause of the headache:
a. Severe headache in a previously well patient
b. Headaches that disturb sleep.
c. Patients with headaches immediately upon waking up
d. Exertional headaches
e. Headaches accompanied by neurological symptoms: drowsiness, focal deficits, seizures, projectile vomiting.
Types of headaches
1. Subarachnoid hemorrhage
a. "The worst headache of my life"
b. Caused by traumas, berry aneurisms in old people, and AVMs in young people
2. Tension headaches
a. Most common headache type, usually between ages 20-50
b. Constant daily headaches that are bilateral, dull/tight/vice-like in quality
c. May be more intense about the neck or back of the head
d. Worse with stress, fatigue, noise, glare, not aggravated by activity
e. Can be associated with depression
3. Cluster headaches
a. Usually 30 y.o. males, 6 times more common in males
b. Series of attacks followed by months of remission
c. Unilateral stabbing periorbital headache
e. Often occurs within 90 minutes of falling asleep, pt wakes up, usually lasts less than 2 hours, spontaneous remission
d. Associated with lacrimation, ptosis, nasal congestion, rhinorrhea
f. Triggered by alcohol, stress, glare
4. Migraines
a. 3 times more common in females, positive family Hx in 80% of cases
b. Onset often in adolescence
c. Unilateral in 60% of cases
d. Aura in 15%: scotoma, teichopsia, photopsia, stars, sparks, field defects
e. Other: nausea, photophobia, phonophobia, blurring of vision, aphasia, numbness, tingling clumsiness, focal weakness
f. Many migrainous headaches do not conform to this pattern: migraines may be lateralized or generalized, dull or throbbing
g. Triggered by stress, odors, foods, missed meals, alcohol, menses, sleep deprivation, sleep excess, BCP
5. Giant cell arteritis
a. Twice as common in females, almost all affected are more than 50 y.o.
b. Unilateral in temporal region
c. Associated with jaw claudication, temporal artery tenderness, high ESR
d. Associated with polymyalgia rheumatica, malaise, anorexia, weight loss
e. Biopsy for definitive diagnosis
f. Early treatment with steroids avoids blindness
6. Trigeminal neuralgia
a. About 60 y.o.
b. Episodic strong pain that radiates from side of mouth to ear, eye, nose
7. Other
a. Masses, neoplasia
b. Trauma: the headache appears about 24 hrs after trauma; does not correlate with extent of injury
c. Spondyloarthrosis
d. Dental disease
e. Ocular disease, glaucoma
f. TMJ arthritis
g. Sinusitis
h. Hypertension
i. Cough headache: intracranial lesions in 10% of cases; CT, MRI are indicated
Labs
1. Suspected subarachnoid hemorrhage
a. CT is better than MRI for the detection of intracranial bleeds
b. Xanthochromia in CSF can be detected 6 hours after onset of headache
2. Head CT if intracranial lesion is suspected (see above)
3. Head CT or MRI for trigeminal neuralgia (to rule out other causes of pain)
4. Biopsy for temporal arteritis
Treatment
1. Subarachnoid hemorrhage
a. These patients need to see a neurosurgeon right away
b. Nimodipine reduces the vasospasm & ischemia
2. Tension headaches
a. Trial of NSAIDs, antimigrainous if NSAIDs are not effective
b. Massage, hot baths, biofeedback
c. Beta-blockers or antidepressants for prophylaxis, exploration of underlying causes of malignancy
3. Cluster headaches
a. 100% O2 for acute attacks
b. Sumatriptan, dihydroergotamin, ergotamine, butorphanol
c. Prophylaxis with verapamil, Li, methysergide, ergotamine, propranolol, amitryptiline, cyproheptadine
4. Migraines
a. Sumatriptan, dihydroergotamine, NSAIDs, cafergot, antinausea
b. Prophylaxis: propranolol, amitryptiline, imipramine, sertraline, fluoxetine, ergonovine, cyproheptadine, clonidine, methysergide, Ca blockers
5. Temporal arteritis
a. Prednisone, 60 mg/d for 1-2 months, biopsy, f/u biopsy 1-2 weeks after initiation of treatment
6. Tregeminal neuralgia
a. Carbamazepine, phenytoin, baclofen, clonazepam, valproate
Nje mendim ish kjo, mund t'ja kem futur dhe kot ... :shrug: